title: Five-year results of a randomized trial comparing retropubic and transobturator midurethral slings for stress incontinence.
abstract: BACKGROUND
  Midurethral slings have become the most preferred surgical treatment for female urinary incontinence.
  
  
  OBJECTIVE
  To compare the efficacy and safety of two midurethral sling procedures with a different technique of sling insertion 5 yr after intervention.
  
  
  METHODS
  Multicenter randomized clinical trial conducted in seven public hospitals in Finland including primary cases of stress urinary incontinence.
  
  
  METHODS
  Surgical treatment with the retropubic tension-free vaginal tape (TVT) procedure or the transobturator tension-free vaginal tape (TVT-O) procedure.
  
  
  METHODS
  Objective treatment success criteria were a negative stress test, a negative 24-h pad test, and no retreatment for stress incontinence. Patient satisfaction was assessed by condition-specific quality-of-life questionnaires.
  
  
  CONCLUSIONS
  A total of 95% of the included women could be assessed according to the protocol 5 yr after surgery. The objective cure rate was 84.7% in the TVT group and 86.2% in the TVT-O group, with no statistical difference between the groups. Subjective treatment satisfaction was 94.2% in the TVT group and 91.7% in the TVT-O group, with no difference between groups. Complication rates were low, with no difference between groups.
  
  
  CONCLUSIONS
  Both objective and subjective cure rates were >80% in both groups even when women lost to follow-up were included as failures. The complication rates were low, with no difference between the groups. No late-onset adverse effects of the tape material were seen.
  
  
  RESULTS
  Female urinary stress incontinence can be treated surgically with minimally invasive midurethral sling procedures. Two main approaches of sling placement have been developed: the retropubic and the transobturatory. We compared both approaches and followed the patients for 5 yr. We found no difference in cure rate between the procedures, and patient satisfaction was high.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT00379314.
authors: Turku University Hospital, Turku, Finland.
authors: Eija
authors: E
authors: Laurikainen
authors: South Carelia Central Hospital, Lappeenranta, Finland.
authors: Antti
authors: A
authors: Valpas
authors: Central Finland Central Hospital, Jyväskylä, Finland.
authors: Pauliina
authors: P
authors: Aukee
authors: Oulu University Hospital, Oulu, Finland.
authors: Aarre
authors: A
authors: Kivelä
authors: Kuopio University Hospital, Kuopio, Finland.
authors: Kirsi
authors: K
authors: Rinne
authors: Päijät-Häme Central Hospital, Lahti, Finland.
authors: Teuvo
authors: T
authors: Takala
authors: Helsinki University Central Hospital, Helsinki, Finland. Electronic address: carl.nilsson@hus.fi.
authors: Carl Gustav
authors: CG
authors: Nilsson
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D053825:Suburethral Slings / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Midurethral slings; Randomized multicenter trial; Retropubic and transobturator procedures