Mid-urethral slings demonstrate efficacy, few adverse effects

Author(s):

A recently published review expands understanding of the effectiveness and side effects of mid-urethral sling procedures for stress urinary incontinence, providing more information for women considering minimally invasive surgical treatment.

For the study, which was published online in the Cochrane Database of Systematic Reviews (July 1, 2015), researchers considered data from a total of 81 trials (12,113 women), 55 of which (8,652 women) directly compared mid-urethral sling surgery by the transobturator route and retropubic route, according to a press release from Cochrane. The quality of evidence from most of the trials was rated moderate, mainly because of bias or imprecision.

Read: Despite warnings, mesh use for prolapse on the rise

Rates of subjective cure over the short term (up to 1 year) were similar for the two procedures, ranging from 62% to 98% in the transobturator group and 71% to 97% in the retropubic group, as were objective cure rates. Subjective cure rates also were similar in the few trials that reported medium-term (1 to 5 years) and long-term (more than 5 years) results.

Overall, both transobturator and retropubic procedures cured or significantly improved symptoms in more than 80% of women at 12 months. The cure rate decreased to around 70% in the few studies that reported 5-year results.

NEXT: Adverse event rates low for both procedures

Want more Urology Times?

Weight-loss surgery may reduce incontinence

Overactive bladder: Two drugs found better than one

PTNS for overactive bladder: Patient selection and technique

Adverse event rates for both procedures were low. Transobturator surgery had a lower rate of bladder perforation than the retropubic procedure (0.6% vs. 4.5%) as well as lower major vascular or visceral injury, operative blood loss, mean operating time, and length of hospital stay. Fewer women who underwent the transobturator operation experienced postoperative voiding dysfunction than women who had retropubic surgery (around 4% vs. 7%).

Women in the transobturator group were more likely than women in the retropubic group to experience short-term groin pain (6.4% vs. 1.3%) but less likely to have suprapubic pain (0.8% vs. 2.9%). Limited data suggested that women who underwent transobturator surgery were more likely to need repeat surgery. For both procedures, the rate of tape erosion at 1 to 5 years post-op was low-around 2%-as was the rate of pain during sexual intercourse.

“Overall, the rates of complication with both [procedures] are low, and women should be reassured by this. Importantly, for women considering surgery, quality of life has been found to be greatly improved following both operations and remains significantly improved even beyond 5 years following surgery,” lead author Abigail A. Ford, MD, of the Bradford Royal Infirmary, West Yorkshire, United Kingdom, told Urology Times.

The review illustrates the need to obtain longer-term follow-up data from existing trials, its authors emphasize, “to increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.”