CHARLESTON, S.C. – Single-incision mini-slings for the treatment of stress urinary incontinence are associated with higher failure and reoperation rates than are retropubic midurethral slings, according to findings from a survey and review of medical records of more than 200 patients.
At a mean follow-up of 21 months, 71 of 93 (76%) women who underwent a single-incision mini-sling procedure reported treatment failure, defined as overall incontinence, compared with 70 of 109 (64%) women who underwent a retropubic midurethral sling procedure, Dr. Annetta M. Madsen reported at the annual meeting of the Society of Gynecologic Surgeons.
After adjustment for body mass index and follow-up time, which differed between the groups, the odds ratio for treatment failure in the mini-sling vs. retropubic midurethral sling group was 1.84, which trended toward statistical significance, said Dr. Madsen of the Mayo Clinic, Rochester, Minn.
The secondary outcomes of postoperative stress-specific incontinence occurred in 47% and 29% of the mini-sling and retropubic midurethral sling groups, respectively. This difference did reach statistical significance (adjusted odds ratio, 2.4). There was no significant difference between the groups with respect to de novo urge.
As for other secondary endpoints, the mini-sling group had significantly reduced odds of reporting global improvement and patient satisfaction, and significantly increased odds of surgery for recurrent or persistent stress urinary incontinence (SUI), compared with the retropubic midurethral sling group, but the retropubic midurethral sling group had a higher reoperation rate for mesh erosion, Dr. Madsen said.
There was no difference in urethrolysis between the groups.
Study participants were women with a mean age of 60 years with SUI or stress-predominant mixed urinary incontinence, who underwent a sling procedure between January, 2008, and December, 2009. Treatment failure was defined by a score of greater than 0 on the International Consultation on Incontinence Questionnaire, an affirmative response to questions about stress incontinence on the questionnaire, or a need for a repeat anti-incontinence procedure.
The mini-sling and retropubic midurethral sling groups were similar with respect to most demographics – with the exception of BMI and duration of follow-up, and also were similar with respect to baseline urodynamics, Dr. Madsen noted.
Although retropubic and transobturator midurethral slings have been shown to have similar efficacy, it has remained unknown how single-incision mini-slings compare with these types of slings, she said.
These findings suggest that the retropubic midurethral sling is associated with higher risk of mesh exposure and reoperation for mesh complications, but with lower rates of stress-specific incontinence, higher global impression of improvement and patient satisfaction, and similar rates of overall urethrolysis and reoperation rates for any indication, Dr. Madsen concluded.
She reported having no disclosures. The meeting was jointly sponsored by the American College of Surgeons.