RETROPUBIC VERSUS TRANSOBTURATOR MIDURETHRAL SLING AND ITS IMPACT ON THE OVERACTIVE BLADDER COMPONENT OFMIXED URINARY INCONTINENCE: A PROSPECTIVE RANDOMIZED STUDY
C. RONDINI1, M. URZUA1, M. GARATE 1, M. MONROY 1, O.STORME 1, J. ALVAREZ 2;
1Hosp.Padre Hurtado, Santiago, Chile, 2Urogyneccologydepartment, Hosp. Padre Hurtado, Santiago, Chile.
Introduction: Mid-urethralslings have become the gold standard of care for the treatment offemale urinary stress incontinence and retrospective studies haveshown some improvement in overactive bladder symptoms. However todate there are no prospective randomized studies comparing both midurethral slings from an OAB point of view.
Objective: Theaim of this study is to evaluate the improvement of OAB symptoms inpatients undergoing MUS surgery for mixed urinary incontinence andcompare the retropubic route (RPR) versus the transobturator“outside-in”(TOR).
Methods: Female patients evaluatedat a tertiary referral center with mixed urinary incontinence wereinvited to participate. Assuming a 50% reduction in OAB symptoms andin order to demonstrate a 20% difference with a significance of 0.05between both routes with a power of 80% and expecting a 10% loss offollow up we calculated a 198 patients were needed to be randomized.Exclusion criteria included previous incontinence surgery. Howeverother concomitant surgery such as hysterectomy or anteriorcolporraphy were not exclusion criteria. In order to demonstrate a20% difference in OAB symptoms during the first year followingsurgery Patients´ OAB symptoms were evaluated using validatedquestionnaires (UDI-6, KHQ y OAB-q). To analyze overall patientsatisfaction PGI-I and Analogue visual scale was used. Patients wereevaluated by a senior member of the urogynecology department prior tosurgery and at 6 and 12 months follow-up. At the same patients wereasked to answer questionnaire privately. For the statisticalanalysis, Chi square was used for categorical variables and MannWhitney or Wilcoxon for continuous non parametric variables. Theinformation presented is a preliminary analysis of 48% of therandomized pa
Results: One hundred and seventy six patientshave been randomized, however 96 have completed data for analysis.Currently 47 underwent the TOR and 49 the RPR. Demographic variablesand questionnaire scores were similar in both groups (Table no 1).Concomitant anterior colporraphy was similar in both groups (TOR21.3% vs., 18.4% RPR p: 0.721). When analyzing post-operativequestionnaire there was a clear overall improvement with respect tothe preoperative scores. However when comparing both techniques therewas no significant difference (Table 2). Overall patient satisfactionwas also similar in both groups. Postoperative 86.4% of patients inthe TOR and 95.5% RPR recommend the procedure (p: 0.138). The needfor further OAB treatment following MUS was also similar (17% vs14.3%, p=0.712). Post-operative complications were also similar inboth groups (14.9% vs 22.4% p=0.343). Only two patients had urinaryretention requiring sling loosening o section, both in the RPR. Tabla#1: Demographic characteristics and Questionnaire scores prior tosurgery
Tabla#2. Post-OperativeQuestionnaire scores
Conclusions: To date we havea found a tendency in favor of the retro pubic route when it comes toOAB symptoms however no significant difference so far. It isimperative that all patients be randomized and properly follow-upbefore making any final conclusions.