Comparison of the Long-term Treatment Outcome Between Pubovaginal and Transobturator Suburethral Sling for Stress Urinary Incontinence in Women

Abstract

Purpose: Stress urinary incontinence (SUI) affects women worldwide, and surgery remains important for those who do not respond to conservative management. Methods: We retrospectively reviewed the medical records of 533 female patients with mixed urinary incontinence and predominant SUI treated at a medical center. Some patients may have had stage 3 or higher cystocele and underwent concomitant anterior colporrhaphy. Patients were divided into 4 groups: pubovaginal sling (PVS) alone, PVS with colporrhaphy, transobturator suburethral sling (TOT) alone, and TOT with colporrhaphy. The primary outcome was the long-term cumulative success rate in each group, and a successful outcome was defined as being dry or using fewer than 1 pad per day. The secondary outcomes included subjective postoperative lower urinary tract symptoms and various perioperative complications. Results: The long-term cumulative success rates of the PVS groups, with or without colporrhaphy, were significantly higher than those of the TOT groups, with or without colporrhaphy (P<0.001). The group receiving PVS with concurrent colporrhaphy demonstrated the highest success rate, followed by PVS alone, TOT with colporrhaphy, and TOT alone (P=0.003). In addition, the highest rate of persistent overactive bladder symptoms was observed in the TOT-alone group (P<0.001). Conclusions: This study suggests that PVS is superior to TOT in controlling incontinence symptoms and achieving long-term success. Concurrent colporrhaphy may also contribute to improved anti-incontinence outcomes.