Comparison of the Long-term Treatment Outcome Between Pubovaginal and Transobturator Suburethral Sling for Stress Urinary Incontinence in Women.

purposeStress urinary incontinence (SUI) affects women worldwide, and surgery remains important for those who do not respond to conservative management.

methodsWe retrospectively reviewed the medical records of 533 female patients with mixed urinary incontinence and predominant SUI treated at a medical center. Some patients may have had stage 3 or higher cystocele and underwent concomitant anterior colporrhaphy. Patients were divided into 4 groups: pubovaginal sling (PVS) alone, PVS with colporrhaphy, transobturator suburethral sling (TOT) alone, and TOT with colporrhaphy. The primary outcome was the long-term cumulative success rate in each group, and a successful outcome was defined as being dry or using fewer than 1 pad per day. The secondary outcomes included subjective postoperative lower urinary tract symptoms and various perioperative complications.

resultsThe long-term cumulative success rates of the PVS groups, with or without colporrhaphy, were significantly higher than those of the TOT groups, with or without colporrhaphy (P<0.001). The group receiving PVS with concurrent colporrhaphy demonstrated the highest success rate, followed by PVS alone, TOT with colporrhaphy, and TOT alone (P=0.003). In addition, the highest rate of persistent overactive bladder symptoms was observed in the TOT-alone group (P<0.001).

conclusionThis study suggests that PVS is superior to TOT in controlling incontinence symptoms and achieving long-term success. Concurrent colporrhaphy may also contribute to improved anti-incontinence outcomes.