Promising results of mid-urethral slings for urine incontinence treatment

A new study by Vasileios Alexandridis and team showed that in a 10-year perspective, mid-urethral slings show promising outcomes for the management of stress urine incontinence with manageable complication profiles. The findings of this study were published in International Urogynecology Journal. 

There are few studies on the long-term effectiveness of mid-urethral slings (MUS) and possible variations between the retropubic and the transobturator approach for insertion. In order to compare the two primary surgical approaches and assess the efficacy and safety of the procedure 10 years after it was performed, this study was carried out.

The Swedish National Quality Register of Gynecological Surgery was used to identify women who underwent surgery with a MUS between 2006 and 2010. Ten years after the procedure, these women were invited to respond to questionnaires about urinary incontinence and its impact on quality-of-life parameters (UDI-6, IIQ-7), as well as inquiries about potential sling-related complications and reoperation.

The key findings of this study were:

2421 participating women reported a 63.3% subjective cure rate.

Among the participants, 79.2% said they had improved. 

Women who underwent retropubic surgery experienced better cure rates, decreased rates of urgency incontinence, and lower UDI-6 scores. 

Complications, reoperation owing to complications, or IIQ-7 scores did not differ between the two techniques. 

17.7% of the participants reported continuing sling-related symptoms, the most prevalent of which was urine retention. 

The transobturator group saw considerably greater mesh exposure (2.0%), reoperations due to the tape (5.6%), and repeated operations for incontinence (6.9%), with 9.1% vs. 5.6% respectively. 

Preoperative urine retention was a highly reliable indicator of 10 year reduced efficacy and safety.

In conclusion, the participants' overall feeling of improvement suggests that MUS still provide good long-term outcomes with a tolerable complication profile, despite a little loss in effectiveness. At 10 years, the RP approach shows a much higher effectiveness than the TO technique, with no differences between the two procedures in terms of complications or the need for reoperation owing to difficulties with the sling. While postoperative urine retention is the most frequent sling-related event, preoperative retention is a significant predictor of reduced effectiveness and safety after 10 years.

Reference: 

Alexandridis, V., Lundmark Drca, A., Ek, M., Westergren Söderberg, M., Andrada Hamer, M., & Teleman, P. (2023). Retropubic slings are more efficient than transobturator at 10-year follow-up: a Swedish register-based study. In International Urogynecology Journal. Springer Science and Business Media LLC. https://doi.org/10.1007/s00192-023-05506-4