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Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures.
Obstet Gynecol. 2019 08; 134(2):333-342.OG

Abstract

OBJECTIVE

To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.

METHODS

We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure.

RESULTS

We identified 1,881 women who underwent a sling procedure for primary SUI-1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein are based on the covariate-matched cohort. Women undergoing a transobturator sling procedure had an increased risk of reoperation for recurrent SUI compared with women undergoing a retropubic sling procedure (hazard ratio 2.42, 95% CI 1.37-4.29). The cumulative incidence of reoperation for recurrent SUI by 8 years was 5.2% (95% CI 3.0-7.4%) in the retropubic group and 11.2% (95% CI 6.4-15.8%) in the transobturator group. Women in the retropubic group had a significantly higher rate of intraoperative complications compared with women in the transobturator group (13.7% [78/570] vs 4.7% [15/317]; difference=9.0%, 95% CI for difference 5.3-12.6%); the majority of this difference was due to bladder perforation (7.0% [40/570] vs 0.6% [2/317]; difference=6.4%, 95% CI for difference 4.1-8.7%). The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups.

CONCLUSION

Women with primary SUI treated with a retropubic sling procedure have significantly lower cumulative incidence of reoperation for recurrent SUI compared with women who were treated with a transobturator sling procedure. Retropubic slings were associated with a higher risk of sling revision for urinary retention.

Authors+Show Affiliations

Division of Urogynecology, the Division of Biomedical Statistics and Informatics, and the Department of Urology, Mayo Clinic, Rochester, Minnesota; the Clinical Pharmacology Division, Vanderbilt University, Vanderbilt, Tennessee; and the Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31306327

Citation

Trabuco, Emanuel C., et al. "Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures." Obstetrics and Gynecology, vol. 134, no. 2, 2019, pp. 333-342.
Trabuco EC, Carranza D, El Nashar SA, et al. Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures. Obstet Gynecol. 2019;134(2):333-342.
Trabuco, E. C., Carranza, D., El Nashar, S. A., Weaver, A. L., McGree, M. E., Elliott, D. S., Linder, B. J., Occhino, J., Gebhart, J. B., & Klingele, C. J. (2019). Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures. Obstetrics and Gynecology, 134(2), 333-342. https://doi.org/10.1097/AOG.0000000000003356
Trabuco EC, et al. Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures. Obstet Gynecol. 2019;134(2):333-342. PubMed PMID: 31306327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures. AU - Trabuco,Emanuel C, AU - Carranza,Daniel, AU - El Nashar,Sherif A, AU - Weaver,Amy L, AU - McGree,Michaela E, AU - Elliott,Daniel S, AU - Linder,Brian J, AU - Occhino,John, AU - Gebhart,John B, AU - Klingele,Christopher J, PY - 2019/7/16/pubmed PY - 2020/3/20/medline PY - 2019/7/16/entrez SP - 333 EP - 342 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 134 IS - 2 N2 - OBJECTIVE: To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures. METHODS: We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure. RESULTS: We identified 1,881 women who underwent a sling procedure for primary SUI-1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein are based on the covariate-matched cohort. Women undergoing a transobturator sling procedure had an increased risk of reoperation for recurrent SUI compared with women undergoing a retropubic sling procedure (hazard ratio 2.42, 95% CI 1.37-4.29). The cumulative incidence of reoperation for recurrent SUI by 8 years was 5.2% (95% CI 3.0-7.4%) in the retropubic group and 11.2% (95% CI 6.4-15.8%) in the transobturator group. Women in the retropubic group had a significantly higher rate of intraoperative complications compared with women in the transobturator group (13.7% [78/570] vs 4.7% [15/317]; difference=9.0%, 95% CI for difference 5.3-12.6%); the majority of this difference was due to bladder perforation (7.0% [40/570] vs 0.6% [2/317]; difference=6.4%, 95% CI for difference 4.1-8.7%). The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups. CONCLUSION: Women with primary SUI treated with a retropubic sling procedure have significantly lower cumulative incidence of reoperation for recurrent SUI compared with women who were treated with a transobturator sling procedure. Retropubic slings were associated with a higher risk of sling revision for urinary retention. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/31306327/Reoperation_for_Urinary_Incontinence_After_Retropubic_and_Transobturator_Sling_Procedures_ L2 - http://dx.doi.org/10.1097/AOG.0000000000003356 DB - PRIME DP - Unbound Medicine ER -