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5-year longitudinal followup after retropubic and transobturator mid urethral slings.
J Urol. 2015 Jan; 193(1):203-10.JU

Abstract

PURPOSE

Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings.

MATERIALS AND METHODS

Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events.

RESULTS

Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI -1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4).

CONCLUSIONS

Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate.

Authors+Show Affiliations

Northwestern University, Chicago, Illinois. Electronic address: kimberly.kenton@northwestern.edu.New England Research Institutes, Watertown, Massachusetts.University of Pittsburgh, Magee-Women's Research Institute, Pittsburgh, Pennsylvania.University of California San Diego, San Diego, California.Yale University, New Haven, Connecticut.University of Utah, Salt Lake City, Utah.University of Texas Southwestern, Dallas, Texas.University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.William Beaumont Hospital, Royal Oak, Michigan.National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.Boston Children's Hospital, Boston, Massachusetts.New England Research Institutes, Watertown, Massachusetts.University of Alabama at Birmingham, Birmingham, Alabama for the Urinary Incontinence Treatment Network.

Pub Type(s)

Journal Article
Observational Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25158274

Citation

Kenton, Kimberly, et al. "5-year Longitudinal Followup After Retropubic and Transobturator Mid Urethral Slings." The Journal of Urology, vol. 193, no. 1, 2015, pp. 203-10.
Kenton K, Stoddard AM, Zyczynski H, et al. 5-year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol. 2015;193(1):203-10.
Kenton, K., Stoddard, A. M., Zyczynski, H., Albo, M., Rickey, L., Norton, P., Wai, C., Kraus, S. R., Sirls, L. T., Kusek, J. W., Litman, H. J., Chang, R. P., & Richter, H. E. (2015). 5-year longitudinal followup after retropubic and transobturator mid urethral slings. The Journal of Urology, 193(1), 203-10. https://doi.org/10.1016/j.juro.2014.08.089
Kenton K, et al. 5-year Longitudinal Followup After Retropubic and Transobturator Mid Urethral Slings. J Urol. 2015;193(1):203-10. PubMed PMID: 25158274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 5-year longitudinal followup after retropubic and transobturator mid urethral slings. AU - Kenton,Kimberly, AU - Stoddard,Anne M, AU - Zyczynski,Halina, AU - Albo,Michael, AU - Rickey,Leslie, AU - Norton,Peggy, AU - Wai,Clifford, AU - Kraus,Stephen R, AU - Sirls,Larry T, AU - Kusek,John W, AU - Litman,Heather J, AU - Chang,Robert P, AU - Richter,Holly E, Y1 - 2014/08/23/ PY - 2014/08/14/accepted PY - 2014/8/27/entrez PY - 2014/8/27/pubmed PY - 2015/4/4/medline KW - stress KW - suburethral slings KW - urinary incontinence SP - 203 EP - 10 JF - The Journal of urology JO - J Urol VL - 193 IS - 1 N2 - PURPOSE: Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings. MATERIALS AND METHODS: Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events. RESULTS: Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI -1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4). CONCLUSIONS: Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/25158274/5_year_longitudinal_followup_after_retropubic_and_transobturator_mid_urethral_slings_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2014.08.089?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -