A randomized prospective comparison of the needleless mini‐sling “hammock” and “U‐shape” configurations for management of stress urinary incontinence: 60 month follow‐up results

Abstract Objective: This study aimed to compare the efficacy of needleless mini-slings placed either retropubic (U-shape) or trans-obturator (hammock-shape) for treating stress urinary incontinence. Setting: A total of 126 women were randomized in a 2:1 ratio to receive either hammock-shaped or U-shaped Contasure-NDL. A reassessment was conducted at the end of the 5th year with lost to follow-ups. Methods: All surgical procedures were performed by an experienced senior surgeon specializing in anti-incontinence surgery with mesh. The objective outcome included a cough-stress test, while subjective outcomes involved the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I), and a three-item Likert scale to measure satisfaction. Assessments were performed at the 60th month. Results: At the end of 60 months, no significant differences were found in objective cure rate, subjective cure rate, mesh complications, or the need for reintervention due to incontinence between the U-shape and hammock-shaped groups . However, a significant decrease was observed in objective and subjective cure rates when comparing results at 18 and 60 months in both groups. In the hammock-shaped group, there was a significant difference in ICIQ-SF, Likert scale, and PGI-I scores between 18 and 60 months. In the U-shaped group, a significant difference was observed in ICIQ-SF and PGI-I scores, with no notable change in the Likert scale. Conclusion: In conclusion, without a significant difference, it is challenging to assert the superiority of needleless mini-slings placed either retropubically (U-shape) or transobturatorly (hammock-shape) for treating stress urinary incontinence (SUI).