Retropubic vs. transobturator midurethral slings for urinary incontinence with sphincteric deficiency

Retropubic vs. transobturator midurethral slings for urinary incontinence with sphincteric deficiency

Jeffer D. Álvarez-Villarraga 1 , Herney A. García-Perdomo 2 , Andrea López-Sanmiguel 3

1 Departamento de Urología, Clínica DESA, Cali, Colombia; 2 UROGIV Research Group, School of Medicine, Universidad del Valle, Cali; Department of Surgery, Division of Urology/Urooncology, School of Medicine, Universidad de Valle, Cali; Colombia; 3 Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia

*Correspondence: Jeffer D. Álvarez-Villarraga. Email: davidalvarezurologia@gmail.com

Abstract

To determine the effectiveness and safety of the retropubic (TVT) versus the transobturator (TOT) anti-incontinence surgery technique in the management of female stress urinary incontinence (SUI) with sphincter deficiency (SD). A systematic review was conducted, including clinical trials of midurethral girdle surgery for the management of SUI associated with SD. We searched MEDLINE (OVID), EMBASE and the Cochrane Central Register of Controlled Trials available until 2023. The resulting significant surgical options of middle urethral slings, TVT and TOT, were compared. A total of 10 studies were included for analysis, including 1523 patients. The median age was 55 years. The cure of urinary incontinence associated with SD was greater with the placement of TVT tape (RR 1.22 95% CI [1.08 to 1.36] compared to the TOT sling technique (I2 = 70%). Sensitivity analysis adjusted to clinical trials identified a superiority in cure with the TVT technique (RR 1.21 CI 95% % [1.11 to 1.33] with low heterogeneity (I2= 0%). No statistically significant differences were found between postoperative complications for both surgical techniques (RR 1.19 95% CI [0.90 to 1.56]). The middle urethral sling type TVT is a superior surgical technique in terms of cure compared to the TOT type for the control of SUI associated with SD. More clinical trials are required to confirm the effectiveness of these techniques.

Keywords: Urinary incontinence; Intrinsic sphincteric deficiency; Suburethral sling; Transobturator sling; Retropubic sling

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