BACKGROUND: Midurethral slings have become the most preferred surgical treatment for female urinary incontinence.
OBJECTIVE: To compare the efficacy and safety of two midurethral sling procedures with a different technique of sling insertion 5 yr after intervention.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial conducted in seven public hospitals in Finland including primary cases of stress urinary incontinence.
INTERVENTION: Surgical treatment with the retropubic tension-free vaginal tape (TVT) procedure or the transobturator tension-free vaginal tape (TVT-O) procedure.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Objective treatment success criteria were a negative stress test, a negative 24-h pad test, and no retreatment for stress incontinence. Patient satisfaction was assessed by condition-specific quality-of-life questionnaires.
RESULTS AND LIMITATIONS: A total of 95% of the included women could be assessed according to the protocol 5 yr after surgery. The objective cure rate was 84.7% in the TVT group and 86.2% in the TVT-O group, with no statistical difference between the groups. Subjective treatment satisfaction was 94.2% in the TVT group and 91.7% in the TVT-O group, with no difference between groups. Complication rates were low, with no difference between groups.
CONCLUSIONS: Both objective and subjective cure rates were >80% in both groups even when women lost to follow-up were included as failures. The complication rates were low, with no difference between the groups. No late-onset adverse effects of the tape material were seen.
PATIENT SUMMARY: Female urinary stress incontinence can be treated surgically with minimally invasive midurethral sling procedures. Two main approaches of sling placement have been developed: the retropubic and the transobturatory. We compared both approaches and followed the patients for 5 yr. We found no difference in cure rate between the procedures, and patient satisfaction was high.
Written by:
Laurikainen E, Valpas A, Aukee P, Kivelä A, Rinne K, Takala T, Nilsson CG. Are you the author?
Turku University Hospital, Turku, Finland; South Carelia Central Hospital, Lappeenranta, Finland; Central Finland Central Hospital, Jyväskylä, Finland; Oulu University Hospital, Oulu, Finland; Kuopio University Hospital, Kuopio, Finland; Päijät-Häme Central Hospital, Lahti, Finland; Helsinki University Central Hospital, Helsinki, Finland.
Reference: Eur Urol. 2014 Jan 31. pii: S0302-2838(14)00100-6.
doi: 10.1016/j.eururo.2014.01.031
PubMed Abstract
PMID: 24508070
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