Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study

Abstract

Objectives To describe surgical complications in 597 women over a 24 month period following randomization to retropubic or transobturator midurethral slings. Study Designs During the Trial of Midurethral Sling (TOMUS) study, the DSMB regularly reviewed summary reports of all adverse events (AE) using the Dindo Surgical Complication Scale. Logistic regression models were created to explore associations between clinico-demographic factors and surgical complications. Results A total of 383 AEs were observed among 253 of the 597 women (42%). Seventy-eight AEs (20%) were classified as serious (SAE); occurring in 72 women. Intra-operative bladder perforation (15 events) occurred exclusively in the retropubic group. Neurologic adverse events were more common in the transobturator group than in retropubic (31 events versus 18 events, respectively). Twenty-three (4%) women experienced mesh complications, including delayed presentations, in both groups. Conclusions Adverse events vary by procedure, but are common after midurethral sling. Most events resolve without significant sequelae.

Surgical Pain After Transobturator and Retropubic Midurethral Sling Placement

“…T he midurethral sling is a common, safe, and effective surgery for the treatment of stress urinary incontinence. [1][2][3] Two surgical approaches exist, retropubic and transobturator. 4,5 Risks of the retropubic approach include voiding dysfunction, bladder injury, and vascular injury.…”

Long term safety, efficacy and clinical outcomes of transobturator tension free tape (inside-out technique) in women with stress urinary incontinence

“…Voiding dysfunction with transobturator approach is 2.0 % in the TOMUS trial. 18 Pre-operative urodynamic variables have been evaluated to assess their predictive value in postoperative voiding dysfunction. [19][20][21][22] The risk of bladder injury is considerably lower, less than 1% with the transobturator approach, but it does exist and hence Cystoscopy should be considered in TOT procedures as well.…”

Urinary incontinence in women

“…Kirurške sling tehnike uobičajeno se ovisno o tipu zahvata inseriraju u regionalnoj ili lokalnoj anesteziji te najče-šće zahtijevaju jednodnevnu hospitalizaciju uz profilaktičnu uporabu antibiotika. Najčešće intraoperativne te kratkoročne komplikacije sling operacija uključuju krvarenja uz nastanak hematoma, potom ozljede mokraćnog mjehura i/ili uretre, opstrukciju mokraćne cijevi te infekcije, dok dugoročne najčešće uključuju pojavu erozije polipropilenske trake te de novo urgentnu inkontinenciju 8,9 . Usprkos svemu navedenom važno je napomenuti da trenutno sling metode predstavljaju zlatni standard u liječenju stresne urinarne inkontinencije u žena.…”