To evaluate long-term failure rates and complications after retropubic and transobturator midurethral sling procedures for primary stress urinary incontinence (SUI).
Retrospective cohort study.
Academic medical centre.
A previously described cohort of patients (n = 1881) who underwent midurethral sling procedures (2002-2012) and a covariate-matched cohort of patients with retropubic (n = 570) or transobturator (n = 317) slings.
Health record review with follow-up extended by 9 years (through December 31, 2022).
Treatment failure (reoperation for recurrent SUI) and procedure-associated complications.
The duration of assessment was extended by 6.9 years for the retropubic group and by 6.4 years for the transobturator group. The median (IQR) follow-up was 11.1 (5.1-14.5) years (retropubic, 11.4 [5.9-14.6]; transobturator, 9.6 [2.6-13.7]). Higher risk of reoperation was observed with transobturator (8.8%) than retropubic (4.4%) slings (unadjusted hazard ratio [HR], 2.29 [95% CI, 1.49-3.54]; p < 0.001; covariate-matched analysis HR, 1.91 [95% CI, 1.15-3.17]; p = 0.01). The increased risk of reoperation with a transobturator sling was higher when the procedure was combined with prolapse repair (unadjusted HR, 6.34 [95% CI, 3.09-13.02]; p < 0.001; covariate-matched analysis HR, 3.96 [95% CI, 1.35-11.58]; p = 0.01). Higher rates of reoperation for urinary retention were observed for the retropubic group than for the transobturator group (covariate-matched analysis HR, 8.39 [95% CI, 1.11-63.22]; p = 0.04).
In this long-term follow-up study, midurethral slings had a low failure rate. Women with SUI undergoing transobturator sling placement plus prolapse repair had a greater risk of reoperation. However, women with retropubic slings had a greater risk of urinary retention requiring intervention.
BJOG : an international journal of obstetrics and gynaecology. 2026 Jul 02 [Epub ahead of print]
Ayssa Teles Abrao Trad, Sherif A El Nashar, Brian J Linder, Annetta M Madsen, John A Occhino, John B Gebhart, Michaela E McGree, Angela J Fought, Emanuel C Trabuco
Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Department of Obstetrics and Gynecology, Mayo Clinic, Jacksonville, Florida, USA., Department of Urology, Mayo Clinic, Rochester, Minnesota, USA., Division of Urogynecology, Mayo Clinic, Rochester, Minnesota, USA., Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.