Randomized trial follow-up finds retropubic slings achieve higher five-year success than transobturator slings in women, indicating divergent long-term efficacy and symptom profiles.
Key Points
To assess the 5-year longitudinal outcomes, treatment success, and adverse events of retropubic versus transobturator mid urethral slings in women with stress urinary incontinence.
Follow-up study of women (N=404 of 597 eligible, 68%) who completed 2 years in a randomized equivalence trial without surgical re-treatment for stress urinary incontinence.
Evaluated primary treatment success (no surgical re-treatment and no self-reported stress incontinence symptoms) alongside secondary outcomes including quality of life, patient satisfaction, sexual function, and adverse events through 5 years.
At 5 years, treatment success was 51.3% in the retropubic group compared to 43.4% in the transobturator group (difference 7.9%, 95% CI -1.4 to 17.2), failing to meet the prespecified criteria for equivalence.
Patient satisfaction remained high without significant difference between arms (retropubic 79% vs transobturator 85%, p=0.15), though women with retropubic slings had significantly greater urinary urgency (p=0.001), worse quality-of-life impact (p=0.02), and poorer sexual function (p=0.001).
The rate of women experiencing at least one adverse event did not differ between arms (p=0.17), with seven new late mesh erosions identified across both cohorts (3 retropubic, 4 transobturator).