Transobturator versus transabdominal mid urethral slings: a multi-institutional comparison of obstructive voiding complications.
OBJECTIVE
In the last year TO slings have become an increasingly popular alternative to TA slings for the surgical treatment of SUI. Proposed advantages of the transobturator approach include improved speed, safety and the reduction of obstructive complications. We assessed outcomes of TO and TA slings in a large series of women treated at several institutions to compare the rate of obstructive complications from these procedures.


METHODS
We reviewed the charts of 504 consecutive women who had synthetic mid urethral sling procedures (154 TO or 350 TA) performed by 24 different urologists for SUI at 8 institutions from 2002 to 2004. Obstructive complications were defined as increased PVR (greater than 100 cc), or the need for CIC, prolonged Foley catheter drainage or urethrolysis.


RESULTS
While TO and TA sling procedures appeared to be similarly efficacious in eliminating the need for incontinence pad use (TO 89%, TA 86%, p = 0.36), the transobturator approach was associated with fewer obstructive complications (TO 11.0%, TA 18.3%, p < 0.05). Urethrolysis was required in none of the 154 TO cases and 8 of 350 (2.3%) TA cases. Concomitant pelvic surgery did not significantly increase the likelihood of obstructive voiding complications in either group.


CONCLUSIONS
Although TO and TA sling procedures had similar short-term results for decreasing pad use in patients with stress urinary incontinence, the transobturator approach is associated with fewer obstructive voiding complications.
Urology Service, Brooke Army Medical Center and Urology San Antonio, San Antonio, Texas, USA. amedd.army.mil
Allen F
AF
Morey
Andrew R
AR
Medendorp
Mark W
MW
Noller
Rafael V
RV
Mora
Kevin C
KC
Shandera
John P
JP
Foley
Luis R
LR
Rivera
Juan A
JA
Reyna
Patricia J
PJ
Terry
D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016055:Urinary Retention / Q000453:epidemiology* / Q000209:etiology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods