Objective Measures Equivalent in Stress Incontinence Surgeries
But retropubic, transobturator slings not found subjectively equivalent and complications vary
TUESDAY, May 18 (HealthDay News) -- In women with stress incontinence, rates of objectively assessed treatment success with the retropubic and transobturator midurethral slings meet the prespecified criteria for equivalence, though the rates of subjectively assessed success do not, according to a study published online May 17 in the New England Journal of Medicine to coincide with a presentation at the American College of Obstetricians and Gynecologists' 58th Annual Clinical Meeting in San Francisco.
Holly E. Richter, Ph.D., M.D., of the University of Alabama at Birmingham, and colleagues randomly assigned 597 women to receive either a retropubic or transobturator midurethral sling, of whom 565 completed the 12-month assessment.
The researchers found that the rates of objectively assessed treatment success (a negative stress test, negative pad test, and no retreatment at one-year follow-up) were 80.8 percent for the retropubic-sling group and 77.7 percent for the transobturator-sling group and met the criteria for equivalence. They found that rates of subjectively assessed success (self-reported absence of stress incontinence symptoms, no leakage episodes recorded and no retreatment) were similar at 62.2 percent and 55.8 percent, respectively, but did not meet the criteria for equivalence. They also found retropubic slings were associated with a higher rate of voiding dysfunction requiring surgery (2.7 percent versus 0 percent), a lower rate of neurological symptoms (4.0 percent versus 9.4 percent), and that there were no significant group differences in postoperative urge incontinence, satisfaction with procedure results, and quality of life.
"This trial confirms that the procedures are very similar with respect to both efficacy and overall complication rates," states the author of an accompanying editorial. "What may change is how patients are counseled regarding the benefits and harms associated with the surgery, allowing surgical choices to better match a patient's goals and wishes, as well as the surgeon's abilities."