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Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures
Emanuel C Trabuco1, Daniel Carranza, Sherif A El Nashar
1Division of Urogynecology, the Division of Biomedical Statistics and Informatics, and the Department of Urology, Mayo Clinic, Rochester, Minnesota; the Clinical Pharmacology Division, Vanderbilt University, Vanderbilt, Tennessee; and the Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio.
Obstetrics and Gynecology
|July 16, 2019
Summary
Retropubic slings for stress urinary incontinence (SUI) show lower reoperation rates for recurrence than transobturator slings. However, retropubic procedures have a higher risk of intraoperative complications like bladder perforation.
Area of Science:
- Urology
- Gynecology
- Female Pelvic Medicine and Reconstructive Surgery
Background:
- Stress urinary incontinence (SUI) is a common condition affecting women's quality of life.
- Midurethral sling procedures, including retropubic and transobturator approaches, are standard surgical treatments for SUI.
- Understanding the comparative reoperation rates and complication profiles of these sling types is crucial for patient selection and surgical decision-making.
Purpose of the Study:
- To compare the reoperation rates for recurrent stress urinary incontinence (SUI) following retropubic versus transobturator sling procedures.
- To evaluate secondary outcomes, including intraoperative and mesh-related complications requiring reoperation.
Main Methods:
- Retrospective cohort study of 1,881 women undergoing midurethral sling procedures for primary SUI (2002-2012).
- Covariate matching (age, BMI, procedure type, diagnosis) created a cohort of 570 retropubic and 317 transobturator sling patients.
- Primary outcome: reoperation for recurrent SUI. Secondary outcomes: intraoperative and mesh-related complications.
Main Results:
- Women receiving transobturator slings had a significantly higher risk of reoperation for recurrent SUI (HR 2.42) compared to retropubic slings.
- Cumulative incidence of reoperation for recurrent SUI by 8 years was 11.2% for transobturator vs. 5.2% for retropubic slings.
- Retropubic slings were associated with a higher rate of intraoperative complications (13.7% vs. 4.7%), primarily due to bladder perforations (7.0% vs. 0.6%).
Conclusions:
- Retropubic sling procedures demonstrate a significantly lower cumulative incidence of reoperation for recurrent SUI compared to transobturator slings.
- Transobturator slings are associated with a lower risk of recurrent SUI requiring reoperation.
- Retropubic slings are linked to a higher risk of intraoperative complications, notably bladder perforation, and a higher rate of sling revision for urinary retention.
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