Long-term efficacy and complications of a multicentre randomised controlled trial comparing retropubic and transobturator mid-urethral slings: a prospective observational study.
Complications
long-term patient-reported outcomes
retropubic mid-urethral sling
stress urinary incontinence
transobturator mid-urethral sling
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
accepted:
02
03
2021
pubmed:
4
9
2021
medline:
17
12
2021
entrez:
3
9
2021
Statut:
ppublish
Résumé
There are concerns regarding the risks of mid-urethral slings (MUS) for stress urinary incontinence (SUI), particularly because of the lack of long-term data. We compare patient-reported outcomes of a multicentre randomised controlled trial of retropubic (TVT, GYNECARE™) versus transobturator (TOT, MONARC™) tape surgery at 12 years. A multicentre study was performed in 11 tertiary referral centres. A cohort of 180 participants from the original trial, the majority of whom had mixed urinary incontinence. Postal questionnaire survey of patient-reported outcome measures using the International Consultation on Incontinence Questionnaire, Patient Global Impression of Improvement questionnaire (PGI-I) and a numeric rating scale pain questionnaire. Comparison of the efficacy and complications between the TVT and TOT procedures in the long term. A total of 110/180 responses were received: 55 for TVT and 55 for TOT. The mean follow-up was 12.8 ± 0.29 years (SD). TVT was significantly superior to TOT: 41.8% TVT with no SUI, versus 21.8% TOT (P = 0.04). Urgency urinary incontinence (UUI) was the most bothersome urinary symptom: 14.5% of respondents reported UUI after TVT and TOT. This was an improvement from the baseline levels: 61.8% TVT and 76.4% TOT. Seventeen patients (9 TVT and 8 TOT) out of 121 reported moderate or severe pain with severe pain in 3 with TVT and 2 with TOT. Overall, 80% TVT and 77% TOT participants reported their symptoms as improved on the PGI-I. TVT is superior to TOT for SUI cure. Efficacy is reduced by 12 years. There is low incidence of severe vaginal or groin pain. Careful patient counselling on long-term outcomes is required. The Retropubic tape appears to be an effective treatment for the majority of women with SUI. Retropubic tape has superior efficacy to transobturator tape. Complications are comparable with low rates.
Identifiants
pubmed: 34478604
doi: 10.1111/1471-0528.16899
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
2191-2199Subventions
Organisme : United Kingdom Continence Society
Investigateurs
I Offiah
(I)
R Freeman
(R)
M Waterfield
(M)
K Lochhead
(K)
T Hillard
(T)
C Madhu
(C)
A Sultan
(A)
M James
(M)
S Foley
(S)
S Buckley
(S)
M Speaksman
(M)
F Reid
(F)
P Abrams
(P)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons Ltd.
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