PURPOSE: To evaluate efficacy and complications after retropubic midurethral slings (RMS) and transobturator midurethral slings (TMS) in the treatment of female stress urinary incontinence (SUI).
MATERIALS AND METHODS: A systematic literature review was performed using Medline limited to randomized controlled trials (RCT) with a minimum follow-up of one year and type 1 grafts. Statistical analyses were performed using StatsDirect Version 2.7.9 (StatsDirect Ltd, Altrincham, UK).
RESULTS: RMS procedures showed statistically significant improvements in objective (OR=1.35, 95% CI=1.10 to 1.67, p=0.005) as well as subjective cure (OR=1.24, 95% CI=1.04-1.49, p=0.02). Bladder perforations (OR=5.72, CI=2.94-11.12, p< 0.0001) and bleeding (OR=2.65, CI=1.54-4.59, p=0.0005) were significantly more common with RMS, whereas vaginal perforations (OR=0.29, CI=0.15-0.56, p=0.0002) and neurologic symptoms (OR=0.35, CI=0.25-0.5, p< 0.0001) were more common with TMS. Operation time was significantly longer in RMS than TMS (OR=1.38, p< 0.0001). No significant differences were noted in mesh erosions and exposure, urinary retention, infection, LUTS and length of hospital stay.
CONCLUSIONS: RMS showed better objective and subjective cure rates than TMS. Bladder perforation and bleeding however were more common with RMS. Operating time was longer for RMS. TMS was associated with more cases of neurologic symptoms and vaginal perforation.
Written by:
Seklehner S, Laudano MA, Xie D, Chughtai B, Lee RK. Are you the author?
Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
Reference: J Urol. 2014 Oct 1. pii: S0022-5347(14)04584-4.
doi: 10.1016/j.juro.2014.09.104
PubMed Abstract
PMID: 25281779