What patients think: patient-reported outcomes of retropubic versus trans-obturator mid-urethral slings for urodynamic stress incontinence—a multi-centre randomised controlled trial

Abstract

Patient-reported outcomes have shown that TOT is not inferior to TVT, but both produce lower success rates than studies using objective measures.

Vaginal Symptoms and Sexual Function After Tension-free Vaginal Tape-obturator Placement: Minimum 12-Month Follow-up

“…A comparison between MiniArc and tension-free vaginal tape (TVT) midurethral sling (MUS) placement demonstrated similar improvements in sexual function outcomes with both sling types. 10 Similarly, the possible association of sling placement and pelvic and/or vaginal pain is of concern. The Food and Drug Administration warning regarding serious complications associated with transvaginal placement of surgical mesh has served to further stimulate caution among the surgical community and highlights the need for investigation focused on vaginal symptoms and pain after MUS placement.…”

Safety considerations for synthetic sling surgery

“…9,110,143 In studies of effectiveness and safety, pain was mostly divided into perioperative pain and pain lasting more than 6 weeks. Perioperative pain has been reported in up to 33% of patients, 252 occurring more frequently after implantation of TOT slings than RP slings, 331 and chronic pain (of any definition) has been reported in 0-31% of patients (REFS 17,18,20,30,39,47,48,53,58,59,(61)(62)(63)66,69,70,73,76,79,82,(89)(90)(91)95,98,99,140,152,155,159,164,167,168,(171)(172)(173)(174)177,(180)(181)(182)185,208,…”

“…9,261 In addition, the qualifiers persistent or de novo 261 were often used. De novo OAB, indicating the occurrence of OAB after sling surgery, was reported in 0-48% of patients in various studies (REFS 17,18,20,26,39,(46)(47)(48)(50)(51)(52)(53)55,(57)(58)(59)61,62,66,67,70,(73)(74)(75)(76)(77)79,83,87,88,91,92,96,97,99,140,152,153,155,157,159,161,163,164,(166)(167)(168)(170)(171)…”

“…In patients with SMUS-related infections, removal of the complete mesh is particularly important. Of course, many more serious infectious complications are likely to arise from the 'minor' ones listed above, 113 [132][133][134]140,145,146,148,[151][152][153]156,158,162,163,167,168,171,173,[176][177][178][179][181][182][183][184], or bowel) perforation at the time of trocar passage has been reported to occur in 0-16% of sling surgery procedures (0-14% for RP sling implantation and 0-16% for TOT sling implantation). In most reports, the authors usually downplay any substantial implications of pelvic organ perforations.…”

“…9 Pain Pain is the most poorly studied complication of SMUS surgery; we found only a few studies that included prospective data collection and/or validated questionnaires assessing pain. 30,79,90,95,152,168,174,229,254 Some investigators used postoperative questionnaires that contained pain questions, but most relied on patients' recall or chart review. 39 In addition, many different descriptors of pain have been reported including vaginal, pelvic, groin, thigh, leg, suprapubic and lower abdominal pain, dyspareunia and "pain, patient self-report. "…”