Transobturator versus retropubic synthetic slings: comparative efficacy and safety

To review the reported effectiveness and safety of transobturator (TransOburator route, TOR) versus retropubic (retropubic tape) synthetic mid-urethral slings discussing the controversy existing on which of these procedures is best.

From August 2009 to January 2011 three meta-analyses of the pertinent topic were identified. They concluded that TOR was less favourable than the retropubic tape in objective cure rates without any significant difference in subjective cure rates. Moreover TOR showed a shorter operating time and less serious perioperative complications than retropubic tape, also when using a standardized complications grading system. The most recent RCTs confirmed these results.

TOR showed similar short and mid-term subjective cure rates compared to retropubic tape; with a shorter operating time and a lower risk of perioperative complications. Subjective cure rates and patient satisfaction are crucial, thus, patient-report outcomes should be used as the primary outcome measure for all trials of incontinence treatments. The absence of standard methods for assessment of anti-incontinence procedures and the use of different methods to evaluate safety and effectiveness led to reporting of different rates of success and complications for the same procedure, making it difficult to compare data, to draw conclusions or make recommendations.