A Retrospective Study Comparing Retropubic Versus Transobturator Sling Systems for Treatment of Urodynamic Stress Incontinence in Hong Kong Chinese Women: a One-year Outcome Review

Abstract

Objectives: To compare surgical outcomes of retropubic suburethral slings (RPS) and transobturator suburethral slings (TOS) for the treatment of urodynamic stress incontinence in local Chinese women at 1 year after operation.
Methods: In this retrospective study, 402 patients with urodynamically proven stress incontinence who underwent RPS or TOS sling procedure during the period from January 1999 to July 2007 in the urogynaecology centre of Queen Elizabeth Hospital were reviewed. Immediate surgical outcome and at 1 year later in the two groups were compared.
Results: In all, 281 patients had the RPS procedure and 121 had the TOS procedure during the study period. The TOS group resulted in significantly less bladder injury (0% vs 6%; p=0.004). Patients having the TOS experienced more pain than those having the RPS, as gauged by the visual analogue pain score on postoperative day 1 (scores being 4.8 vs 2.9, respectively; p=0.005). One year after the procedure in the TOS and RPS groups, there was no significant difference in tape excision due to voiding dysfunction (3% vs 6%, respectively; p=0.131), subjective success rate (87% vs 90%, respectively; p=0.322). In the TOS group, there was significantly less subjective urgency (10% vs 23%; p=0.002), poor stream voiding (3% vs 4%; p=0.004), and subjective incomplete emptying of the bladder (1% vs 5%; p=0.002). In the TOS and RPS groups, urodynamic study 1 year post-operation showed no significant difference in the objective success rate (94% vs 89%, respectively; p=0.165). There were significantly fewer patients with peak flow rate lower than 15 ml/s in the TOS group (30% vs 51%; p<0.001).
Conclusion: The transobturator approach to treatment of urodynamic stress incontinence is as effective as the retropubic approach and results in less bladder injury in Chinese women.