Single-incision sling as good as retropubic sling for repairing vagina for stress urinary incontinence symptoms: Study

The process of making surgical decisions about managing pelvic organ prolapse (POP) and stress urinary incontinence (SUI), both symptomatic and potential, is intricate and subject to debate. Recent multicenter, noninferiority, randomized trial that compared the use of a single-incision sling (Altis sling, Coloplast Minneapolis, MN) versus a retropubic sling in women with stage II or greater pelvic organ prolapse and stress urinary incontinence undergoing reconstructive or obliterative vaginal repair. The primary objective was to determine if the single-incision sling was noninferior to the retropubic sling for the management of stress urinary incontinence. Secondary objectives were to compare adverse events and surgeon ease of use between the two sling types. A total of 280 participants were enrolled across 7 clinical sites, with 255 randomized - 126 to the single-incision sling group and 129 to the retropubic sling group.

The primary outcome was abnormal lower urinary tract function within 12 months, defined as bothersome stress urinary incontinence symptoms, retreatment for stress urinary incontinence, or treatment for urinary retention. The results showed that the single-incision sling was noninferior to the retropubic sling for the primary outcome, with abnormal lower urinary tract function occurring in 25% of the single-incision group versus 20% of the retropubic group (risk difference 0.04472, 95% CI -0.03 to 0.1133, p=0.001 for noninferiority). Rates of bothersome stress urinary incontinence (20% vs 17%, p=0.27) and retreatment (4% vs 2%, p=0.44) also did not differ significantly between groups. Adverse events were reported in 16% of the single-incision group and 9% of the retropubic group (p=0.70), including de novo or worsening urgency incontinence, urinary tract infections, mesh exposures, need for prolonged catheter drainage, and de novo pain. Patient satisfaction and surgeon ease of use were high in both groups.

In conclusion, for women undergoing vaginal repair, the single-incision sling was found to be noninferior to the retropubic sling for stress urinary incontinence symptoms, and complication rates were similar between the two groups. This provides important information to guide surgical decision-making for the concomitant management of pelvic organ prolapse and stress urinary incontinence.

Key Points

Here are the 6 key points from the research paper:

1. This was a multicenter, noninferiority, randomized trial that compared the use of a single-incision sling versus a retropubic sling in women with pelvic organ prolapse and stress urinary incontinence undergoing vaginal repair.

2. The primary objective was to determine if the single-incision sling was noninferior to the retropubic sling for managing stress urinary incontinence. Secondary objectives were to compare adverse events and surgeon ease of use between the two sling types.

3. 280 participants were enrolled, with 255 randomized - 126 to the single-incision sling group and 129 to the retropubic sling group. The primary outcome was abnormal lower urinary tract function within 12 months.

4. The results showed the single-incision sling was noninferior to the retropubic sling for the primary outcome, with abnormal lower urinary tract function occurring in 25% of the single-incision group versus 20% of the retropubic group. Rates of bothersome stress urinary incontinence and retreatment did not differ significantly between groups.

5. Adverse events were reported in 16% of the single-incision group and 9% of the retropubic group, including de novo or worsening urgency incontinence, UTIs, mesh exposures, need for prolonged catheter drainage, and de novo pain. Patient satisfaction and surgeon ease of use were high in both groups.

6. This study found that for women undergoing vaginal repair, the single-incision sling was noninferior to the retropubic sling for stress urinary incontinence symptoms, with similar complication rates, providing important information to guide surgical decision-making.

Reference –

Matthews C, Rardin CR, Sokol A, et al. A randomized trial of retropubic vs single-incision sling among patients undergoing vaginal prolapsed repair. Am J Obstet Gynecol 2024;231:261.e1-10