乌鸦传媒

A single-incision mini-sling worked just as well as the standard midurethral sling in women with stress urinary incontinence (SUI), a randomized study found.

At 15 months, 79.1% of women who received the mini-sling reported success compared with 75.6% of those who received the midurethral sling (P<0.001 for noninferiority), said Mohamed Abdel-Fattah, MD, of Aberdeen Maternity Hospital in Scotland, and colleagues.

This difference was similar at 36-month follow-up, with success -- defined as a response of very much or much improved on the Patient Global Impression of Improvement questionnaire -- reported by 72.0% and 66.8% of patients, respectively, they noted in the .

"A key point from this trial is that after the placement of either type of urethral sling, most women reported a decrease in urinary incontinence," wrote Ingrid Nygaard, MD, and Peggy Norton, MD, both of the University of Utah School of Medicine in Salt Lake City, in an . "However, fewer than one third in each group reported having a 'cure' (i.e., no urinary leakage) at 36 months."

Specifically, a post-hoc analysis showed that cure occurred in 38.6% of patients in the mini-sling group versus 33.2% of those in the midurethral-sling group at 15 months, and in 32.4% and 30.7%, respectively, at 36 months.

"The success of a continence procedure depends on its definition, which can include various subjective and objective measures or a combination of measures," Nygaard and Norton pointed out.

The single-incision mini-sling was designed to minimize operation time and to decrease complications associated with surgery for the treatment of SUI. With limited data on the effectiveness and safety of mini-slings compared with midurethral slings, Abdel-Fattah and colleagues sought to compare the two among 596 women (mean age 50-51, mean BMI about 29) randomized 1:1 at 21 U.K. hospitals.

Mini-sling procedures were more likely to be performed with the patient under local anesthesia (72.8%), while midurethral sling procedures were more likely to be performed under general anesthesia (91.2%).

While the percentage of patients with groin or thigh pain was higher in the mini-sling group than in the midurethral-sling group at 15 months (14.9% vs 11.9%), these rates were similar between groups at 36 months (14.1% vs 14.9%).

About twice as many patients who received mini-slings underwent further surgical treatment over follow-up compared with patients who received midurethral slings (8.7% vs 4.6%), including for urinary incontinence (4.3% vs 2.3%), pain (2.5% vs 0.8%), and mesh exposure (2.5% vs 1.1%).

Quality of life and sexual function outcomes were similar between the two groups, with the exception of dyspareunia, which was experienced by 11.7% of women in the mini-sling group compared with 4.8% in the midurethral-sling group.

"This trial provides evidence that mesh surgeries for stress urinary incontinence are safe and effective -- data that are important both for restoring confidence in such surgeries and potentially for increasing their availability," Nygaard and Norton concluded.

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