Stress incontinence surgeries are not equivalent in all ways

Although retropubic and transobturator midurethral slings may be objectively equivalent in their treatment of stress incontinence, women do not find them subjectively so, and complication rates differ, according to the findings of a multicenter, randomized trial.

Researchers included almost 600 women in a 12-month assessment. Objectively (based on a negative stress test, negative pad test, and no re-treatment at 1-year follow-up), 80.8% of the retropubic-sling procedures and 77.7% of the transobturator-sling procedures were successful (3.0 percentage-point difference; 95% CI, –3.6 to 9.6). Subjectively (self-reported absence of stress incontinence symptoms, no leakage episodes recorded, and nore-treatment), 62.2% and 55.8%, respectively, of the women in the groups viewed the procedures as successful (6.4 percentage-point difference; 95% CI, –1.6 to 14.3), which was close but not statistically equivalent.

In terms of complications, 2.7% of the women who received retropubic slings required surgery for voiding dysfunction versus none in the transobturator group (P=.004); however, more than twice as many in the transobturator group as in the retropubic group experienced neurologic symptoms (9.4% vs 4.0%, respectively, P=.01).

Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066-2076.