A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence.
OBJECTIVE
To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI).


METHODS
Randomised trial.


METHODS
Urogynaecology unit in large UK district general hospital.


METHODS
Women with USI resistant to conservative management and requiring a suburethral sling.


METHODS
A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies.


METHODS
The presence of SUI at 6 weeks and 6 months after treatment.


RESULTS
The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8-32.6) and 6 months (OR 8.14, 95% CI 2.7-24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7-24.7). The rate of complication was similar in the two groups.


CONCLUSIONS
The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution.
Basu
M
M
Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Gillingham, Kent, UK. mayabasu@aol.com
Duckett
J
J
D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics