Five-year results of a randomized trial comparing retropubic and transobturator midurethral slings for stress incontinence.

Abstract:

BACKGROUND:Midurethral slings have become the most preferred surgical treatment for female urinary incontinence. OBJECTIVE:To compare the efficacy and safety of two midurethral sling procedures with a different technique of sling insertion 5 yr after intervention. DESIGN, SETTING, AND PARTICIPANTS:Multicenter randomized clinical trial conducted in seven public hospitals in Finland including primary cases of stress urinary incontinence. INTERVENTION:Surgical treatment with the retropubic tension-free vaginal tape (TVT) procedure or the transobturator tension-free vaginal tape (TVT-O) procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Objective treatment success criteria were a negative stress test, a negative 24-h pad test, and no retreatment for stress incontinence. Patient satisfaction was assessed by condition-specific quality-of-life questionnaires. RESULTS AND LIMITATIONS:A total of 95% of the included women could be assessed according to the protocol 5 yr after surgery. The objective cure rate was 84.7% in the TVT group and 86.2% in the TVT-O group, with no statistical difference between the groups. Subjective treatment satisfaction was 94.2% in the TVT group and 91.7% in the TVT-O group, with no difference between groups. Complication rates were low, with no difference between groups. CONCLUSIONS:Both objective and subjective cure rates were >80% in both groups even when women lost to follow-up were included as failures. The complication rates were low, with no difference between the groups. No late-onset adverse effects of the tape material were seen. PATIENT SUMMARY:Female urinary stress incontinence can be treated surgically with minimally invasive midurethral sling procedures. Two main approaches of sling placement have been developed: the retropubic and the transobturatory. We compared both approaches and followed the patients for 5 yr. We found no difference in cure rate between the procedures, and patient satisfaction was high. TRIAL REGISTRATION:ClinicalTrials.gov identifier NCT00379314.

journal_name

Eur Urol

journal_title

European urology

authors

Laurikainen E,Valpas A,Aukee P,Kivelä A,Rinne K,Takala T,Nilsson CG

doi

10.1016/j.eururo.2014.01.031

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

1109-14

issue

6

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(14)00100-6

journal_volume

65

pub_type

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