Retropubic Sling Surgery Superior for Treating SUI

Retropubic sling procedures for stress urinary incontinence (SUI) demonstrate better long-term results than transobturator sling surgery, according to a new study.

Researchers at the Mayo Clinic (Rochester, MN, USA), Case Western Reserve University (CWRU; Cleveland, OH, USA), and other institutions conducted a retrospective cohort study of 1,881 women who underwent midurethral sling procedures for primary SUI at the Mayo Clinic between 2002 and 2012. The primary outcome was defined as reoperation for recurrent SUI, with secondary outcomes including intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure.

In all, 1,551 women underwent a retropubic sling and 330 underwent a transobturator sling procedure. The results showed that reoperations within an eight-year period were 11.2% following transobturator sling surgery, compared to 5.2% after a retropubic sling procedure. On the other hand, women in the retropubic group had a significantly higher rate of intraoperative complications, mostly due to bladder perforation. The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups, respectively. The study was published on July 9, 2019, in Obstetrics and Gynecology.

“The failure rate for the transobturator procedure was even higher among women who had the sling combined with vaginal prolapse repair. These findings would suggest that the retropubic procedure has better long-term results compared to the transobturator sling,” said lead author urogynecologist Emanuel Trabuco, MD, MSc. “We're hopeful that the findings in this study will encourage women to talk to a provider about the surgical and nonsurgical options to treat their conditions, which can greatly affect a woman's daily activities.”

SUI is a loss of bladder control or involuntary loss of urine when coughing, laughing, sneezing, or during heavy lifting, or simply getting up from a chair. It is the most common type of incontinence suffered by women, especially older women and those who have given birth. Other causes for SUI in women include weak pelvic muscles or a weak sphincter muscle, chronic coughing, smoking and obesity.

Related Links:
Mayo Clinic
Case Western Reserve University