Transobturator vs Single-Incision Suburethral Mini-slings for Treatment of Female Stress Urinary Incontinence: Early Postoperative Pain and 3-Year Follow-up

• Published in: Journal of minimally invasive gynecology Vol. 18; no. 6; pp. 769 - 773
• Main Authors: Neuman, Menahem, MD, Sosnovski, Vladimir, MD, Kais, Mohammad, MD, Ophir, Ella, MD, Bornstein, Jacob, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2011
• Subjects: Adult; Aged; Female; Follow-Up Studies; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Humans; Middle Aged; Obstetrics and Gynecology; Pain Measurement; Pain, Postoperative - etiology; Postoperative Period; Prospective Studies; Suburethral Slings - adverse effects; Surgery; Surveys and Questionnaires; Treatment Outcome; Urethra - surgery; Urinary Incontinence, Stress - surgery; Vagina - surgery
• ISSN: 1553-4650; 1553-4669
• DOI: 10.1016/j.jmig.2011.08.718

Abstract Study Objective To compare related pain and cure using the transobturator and single-incision suburethral mini-sling anti-incontinence operations. Design Open, prospective, nonrandomized 2-armed study comparing 2 surgical procedures for treatment of female stress urinary incontinence ( Canadian Task Force classification II-1). Setting A university and a private hospital. Patients One hundred sixty-two women with stress urinary incontinence underwent either a tension-free vaginal tape–obturator (TVT-O) or a single-incision (TVT-SECUR) suburethral or mid-urethral tape operation. Measurements and Main Results Pain levels were estimated using a visual analog scale, and outcome using the Urinary Distress Inventory and the Incontinence Impact Questionnaire. Postoperative vaginal and thigh pain was transient, lasting for up to 2 weeks, and occurred significantly more frequently in the TVT-O group (32% vs 1% and 32% vs 0%, respectively). Dyspareunia was not self-limited, and occurred more frequently in the TVT-SECUR group (7.9% vs 0%). Cure rates were 86.9% in the TVT-O group and 90.9% in the TVT-SECUR group. Complication rates were similar in the 2 groups. Conclusion Both procedures were effective, with few adverse effects. In sexually inactive patients, the TVT-SECUR procedure may be preferable because thigh and vaginal pain is largely averted with this procedure. Sexually active patients might be better referred for the TVT-O procedure because it was not followed by dyspareunia in our series. Patient choice of surgical method rather than randomization weakened the strength of this study.