title: 5-year longitudinal followup after retropubic and transobturator mid urethral slings.
abstract: OBJECTIVE
  Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings.
  
  
  METHODS
  Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events.
  
  
  RESULTS
  Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI -1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4).
  
  
  CONCLUSIONS
  Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate.
authors.affiliation: Northwestern University, Chicago, Illinois. Electronic address: kimberly.kenton@northwestern.edu.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.affiliation: New England Research Institutes, Watertown, Massachusetts.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stoddard
authors.affiliation: University of Pittsburgh, Magee-Women's Research Institute, Pittsburgh, Pennsylvania.
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.affiliation: University of California San Diego, San Diego, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Albo
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Leslie
authors.initials: L
authors.lastname: Rickey
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.affiliation: University of Texas Southwestern, Dallas, Texas.
authors.forename: Clifford
authors.initials: C
authors.lastname: Wai
authors.affiliation: University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Litman
authors.affiliation: New England Research Institutes, Watertown, Massachusetts.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Chang
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama for the Urinary Incontinence Treatment Network.
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D005500:Follow-Up Studies; D008137:Longitudinal Studies; D053825:Suburethral Slings / Q000009:adverse effects; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery; D016032:Randomized Controlled Trials as Topic
keywords: stress; suburethral slings; urinary incontinence