Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications

Abstract

Objective This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary incontinence (SUI) by conducting a systematic review.Materials and Methods We selected all randomized controlled trials (RCTs) that compared retropubic and transobturator sling placements for treatment of SUI. We estimated pooled odds ratios and 95% confidence intervals for intraoperative and postoperative outcomes and complications.Results Six hundred twelve studies that compared retropubic and transobturator approaches to midurethral sling placement were identified, of which 16 were included in our research. Our study was based on results from 2646 women. We performed a subgroup analysis to compare outcomes and complications between the two approaches. The evidence to support the superior approach that leads to better objective/subjective cure rate was insufficient. The transobturator approach was associated with lower risks of bladder perforation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.09-0.32), retropubic/vaginal hematoma (OR 0.32, 95% CI 0.16-0.63), and long-term voiding dysfunction (OR 0.32, 95% CI 0.17-0.61). However, the risk of thigh/groin pain seemed higher in the transobturator group (OR 2.53, 95% CI 1.72-3.72). We found no statistically significant differences in the risks of other complications between the two approaches.Conclusions This meta-analysis shows analogical objective and subjective cure rates between the retropubic and transobturator approaches to midurethral sling placement. The transobturator approach was associated with lower risks of several complications. However, good-quality studies with long-term follow-ups are warranted for further research.

Long‐term outcomes of transobturator midurethral slings: A critical evaluation of a real‐world population

“…It is the most extensively researched surgical treatment for female SUI, 2 and the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction SUI guideline cites Grade A evidence for offering the retropubic or transobturator approach in the index patient 1 . By avoiding the space of Retzius, transobturator placement may offer advantages over the retropubic approach, such as lower rates of bladder or urethral perforations, voiding dysfunction, and suprapubic pain 2,3 . Conversely, thigh and groin pain appears to be more common after the transobturator MUS 2,3 …”

Complications and their treatment after midurethral tape implantation using retropubic and transobturator approaches for treatment of female stress urinary incontinence

“…Both the TOT and TVT-O procedures proved to be associated with few peri-operative complications [ 8 ]. This operative technique allowed a reduction of the risk of bladder and bowel perforation, and major vascular injury [ 9 – 11 ], also voiding dysfunction that can occur with TVT, but has been reported to be associated with higher incidence of groin pain [ 12 , 13 ].…”

Transurethral excision and re-erosion of mesh material after transobturator tape surgery: A case report

“…In addition, Novara et al [12] found both bladder and urinary tract injuries to be lower after TOT, compared to tension-free vaginal tape (TVT) in their meta-analysis of controlled randomized trials. Recently, Sun et al [13] randomized 2.646 women to TOT, TVT-obturator (TVT-O), and TVT groups and found that bladder perforation risk was lower in the TOT (odds ratio [OR] 0.17, 95% confidence interval [CI] 0.06–0.49) and TVT-O groups (OR 0.18, 95% CI 0.08–0.38) than the TVT group. However, the authors reported that three bladder perforations were diagnosed in routine cystoscopy, and the true perforation rate could be higher than estimated.…”