Women who were in the 1-year and 2-year outcomes of the randomized equivalence trial of retropubic and transobturator MUS were invited to enroll in the observational study. In total, 404 women from the original study (out of 597, 68%) consented and enrolled in the study. Women who underwent surgical retreatment were excluded from the study. The primary outcome, or treatment success, was defined as no retreatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms, QOL, satisfaction, sexual function, and adverse events of MUS.
The results of the study showed that women assigned to the retropubic sling have higher five year surgical treatment success (7.9%) as compared to the transobturator sling (51.3% vs 43.4%, 95% CI – 1.4, 17.2). In both slings, satisfaction decreased during the 5 years, urinary symptoms and QOL worsened with time (p<0.001). Women with retropubic sling reported greater urinary urgency (p=0.01), more negative impact on QOL (p=0.02), and worse sexual function (p=0.001). However, there was no significant difference in proportion of women experiencing at least 1 adverse event. Similar to their 2-year findings5, long-term treatment success after retropubic MUS was slightly higher than transobturator MUS, while urinary urgency incontinence, sexual function, and overall impression of improvement was better after transobturator MUS. This suggests that treatment success in the retropubic group comes at the cost of QOL and other symptom improvement, which transobturator did much better.
Some limitations of the study included slightly lower retention rate (67%) from the original study. Because of this, mesh exposures may be slightly higher than reported, which may not be overrepresented in the study population. In conclusion, long-term treatment success and satisfaction decreased with time in both retropubic and transobturator MUS. Women in the study reported higher satisfaction for the transobturator study even though it had lower treatment success rate. The findings from the study may assist physicians and patients in suggesting slings be offered as first line treatment for SUI8.
Written by: Jaime Landman Professor of Urology and Radiology Chairman, Department of Urology University of California, Irvine
Authors: Kimberly Kenton, Anne M. Stoddard, Halina Zyczynski, Michael Albo, Leslie Rickey, Peggy Norton, Clifford Wai, Stephen R. Kraus, Larry T. Sirls, John W. Kusek, Heather J. Litman, Robert P. Chang, and Holly E. Richter
Affiliations: Northwestern University, Chicago, Illinois (KK), New England Research Institutes, Watertown (AMS, RPC), and Boston Children’s Hospital, Boston (HJL), Massachusetts; University of Pittsburgh, Magee-Women’s Research Institute, Pittsburgh, Pennsylvania (HZ); University of California San Diego, San Diego, California (MA); Yale University, New Haven, Connecticut (LR); University of Utah, Salt Lake City, Utah (PN);University of Texas Southwestern, Dallas (CW), and University of Texas Health Sciences Center at San Antonio, San Antonio (SRK), Texas; William Beaumont Hospital, Royal Oak, Michigan (LTS); National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (JWK); and University of Alabama at Birmingham, Birmingham, Alabama (HER)
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