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Two Intraoperative Techniques for Midurethral Sling Tensioning: A Randomized Controlled Trial.

Erin A Brennand1, Guosong Wu, Sara Houlihan

  • 1Department of Obstetrics & Gynecology, the Department of Community Health Sciences, the Division of Urology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, the Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, the Department of Obstetrics & Gynecology, University of Manitoba, Winnipeg, Manitoba, the Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, the Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; and the Department of Obstetrics & Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

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Summary

The Babcock technique for mid-urethral sling surgery resulted in fewer abnormal bladder outcomes compared to the Mayo Scissor technique. Both methods offered similar stress urinary incontinence (SUI) cure rates, but differed in obstruction and mesh erosion risks.

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Area of Science:

  • Urology
  • Female Pelvic Medicine and Reconstructive Surgery
  • Clinical Trials

Background:

  • Mid-urethral sling surgery is a common treatment for stress urinary incontinence (SUI).
  • Tensioning techniques during sling placement can influence surgical outcomes.
  • The choice of instrumentation for sling tensioning may impact postoperative bladder function.

Purpose of the Study:

  • To compare the rates of abnormal bladder outcomes between Mayo Scissor and Babcock clamp techniques for mid-urethral sling surgery.
  • To evaluate secondary outcomes including urinary retention, catheterization duration, and patient-reported SUI.
  • To assess the impact of each technique on uroflowmetry parameters and mesh-related complications.

Main Methods:

  • The Mid-Urethral Sling Tensioning (MUST) trial was a block-randomized, double-blind, multicenter clinical trial.
  • 318 women were randomized to have their retropubic mid-urethral slings tensioned by either the Scissor or Babcock technique.
  • The primary outcome was a composite of abnormal bladder, including persistent SUI, overactive bladder, and urinary retention, assessed at 12 months.

Main Results:

  • Abnormal bladder outcomes occurred in 31.3% of patients with the Scissor technique versus 18.4% with the Babcock technique (P=.018).
  • The Babcock technique was associated with shorter catheterization duration and less urinary retention requiring sling lysis.
  • The Scissor technique showed lower rates of mesh erosion but suggested more restrictive uroflowmetry parameters.

Conclusions:

  • The Babcock technique resulted in significantly lower rates of abnormal bladder outcomes compared to the Mayo Scissor technique.
  • While both techniques achieved comparable patient-reported SUI cure rates, they differed in postoperative complications like obstruction and mesh erosion.
  • Findings aid surgeons in preoperative counseling and technique selection for mid-urethral sling procedures.