Transobturator Versus Minisling for Urinary Incontinence: A Randomized Controlled Trial

Area of Science:

• Urology
• Gynecology
• Surgical Innovation

Background:

• Stress urinary incontinence (SUI) affects a significant number of women.
• Midurethral slings are a common surgical treatment for SUI.
• Single-incision slings (SIS) offer a less invasive approach, but their efficacy compared to traditional midurethral slings varies by device.

Purpose of the Study:

• To evaluate if the Solyx SIS is noninferior to the Obtryx transobturator (TOT) sling for treating SUI.
• To compare patient-reported outcomes and surgical results between the two sling types.

Main Methods:

• A prospective, randomized controlled trial involving 114 women with SUI.
• Patients were randomized to receive either the Obtryx-halo TOT sling (n=58) or the Solyx SIS (n=56).
• Outcomes assessed included Patient Global Impression of Improvement (PGI-I), Kings Health Questionnaire (KHQ) scores, subjective improvement, and surgical complications at 6 and 12 months post-surgery.

Main Results:

• Both groups showed significant improvement in PGI-I at 6 and 12 months (P=0.001).
• The TOT sling group reported higher subjective improvement at 6 months (P=0.006) and better KHQ scores at 12 months in incontinence impact, physical limitations, and severity domains (P<0.05).
• Mesh erosion was significantly higher in the SIS group (P=0.006), with no significant difference in reoperation rates.

Conclusions:

• The Obtryx-halo TOT sling was superior to the Solyx SIS in terms of patient-reported outcomes and subjective improvement at 12 months.
• The Solyx SIS was associated with a higher rate of mesh erosion.
• These findings suggest that the TOT approach may offer better long-term results for SUI treatment compared to this specific SIS device.