title: A comparison of transobturator versus retropubic midurethral slings for mixed urinary incontinence.
abstract: OBJECTIVE
  : The primary objective of this study was to compare improvement and/or cure of mixed urinary incontinence (MUI) symptoms after retropubic (RP) versus transobturator (TO) slings. The secondary objective was to compare improvement and/or cure of the urge urinary incontinence (UUI) component of MUI.
  
  
  METHODS
  : This retrospective cohort study included all patients with MUI who underwent a midurethral sling from January 2006 to May 2007. IRB approval was obtained to perform telephone interviews to collect the Patient Global Impression of Improvement (PGI-I) questionnaire for MUI and to elicit any changes in the SUI and/or UUI components of MUI. The primary outcome was based on a 7-point Likert scale for the PGI-I questionnaire. The secondary outcome was improvement or resolution of the UUI component of MUI based on a 4-point Likert scale of patient responses to the question, "Is your urge incontinence worse, the same, or improved after surgery?" Subjects who had RP slings were compared with those with TO with respect to these outcomes. Patient satisfaction, adverse events, urinary retention, and worsening of urge incontinence symptoms were also assessed.
  
  
  RESULTS
  : For the primary outcome (MUI), no significant difference was found in the PGI-I scores between the 2 groups. Similarly, no difference was found in UUI improvement/resolution between the 2 groups. UUI improvement was noted in 46.4% of the TO group and 56.5% of the RP group, and UUI cure in 39.3% of the TO group and 26.1% of the RP group. An 84.3% overall improvement/cure rate of UUI was noted when both groups were combined. Ten (19.6%) women required anticholinergic use after slings. A total of 52.6% of subjects were "completely satisfied" and 14.3% were "not at all satisfied" with the procedure in the TO group, versus 65.2% and 7.7% in the RP group (Mann-Whitney U test, P = 0.23). There was no difference in perioperative adverse events between the 2 groups.
  
  
  CONCLUSIONS
  : RP and TO slings result in similar global improvement in MUI symptoms. A total of 84.3% of patients undergoing RP or TO sling for MUI have improvement/cure of the UUI component.
authors.affiliation: From the Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Washington Hospital Center, Washington, DC.
authors.forename: Bela I
authors.initials: BI
authors.lastname: Kudish
authors.forename: David
authors.initials: D
authors.lastname: Shveiky
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Sokol
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gutman