Why should we stop implanting transobturator sling?

Area of Science:

• Urogynecology
• Pelvic Floor Surgery
• Biomaterials in Medicine

Background:

• The use of synthetic polypropylene slings for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) has been debated since the 2008 FDA warning.
• Transvaginal tape (TVT) and transobturator tape (TOT) procedures have significantly advanced pelvic floor reconstructive surgery.

Purpose of the Study:

• To compare the safety and efficacy of TVT and TOT procedures for SUI and POP treatment.
• To evaluate the long-term complication rates, including chronic pain and revision surgery, associated with TVT and TOT.
• To provide recommendations regarding the continued use of TOT versus TVT in clinical practice.

Main Methods:

• Systematic reviews and large clinical trials were analyzed.
• Comparative efficacy and complication rates of TVT and TOT were assessed.
• Evidence regarding chronic pain, nerve entrapment, and mesh removal difficulties was examined.

Main Results:

• Both TVT and TOT are effective for SUI and POP, with slings showing comparable efficacy to older methods like Burch colposuspension but with fewer voiding issues.
• TOT has lower intraoperative risks but a significantly higher incidence of chronic groin and pelvic pain, often linked to nerve entrapment and difficult mesh removal.
• TVT demonstrates lower complication rates and is more manageable in case of adverse events compared to TOT.

Conclusions:

• The higher rates of chronic pain, re-operation, and complex management associated with TOT warrant its discontinuation.
• TVT, despite inherent risks, offers better efficacy, reversibility, and complication management.
• Future clinical efforts should focus on enhancing surgeon training, patient selection, and postoperative care to optimize outcomes for pelvic floor reconstructive surgery.