Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence: Short-term Outcomes

Abstract

To evaluate short-term outcomes of autologous transobturator (ATO) urethral sling placement using rectus fascia for female stress urinary incontinence. We evaluated the outcomes of 33 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from 2013 to 2014. Patients were seen at 3 months postoperatively and mailed a questionnaire at least 1 year after surgery for further follow-up. Outcomes were measured by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score and compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Median patient age was 62 years old (interquartile range [IQR] 47.5; 70.5) with a median body mass index of 28.6 kg/m(2) (IQR 24.7 kg/m(2); 32.4 kg/m(2)). When isolated sling placement was performed, 88% (15/17) were outpatient procedures. Median follow-up was 14.9 months (IQR 3.6; 18.7), during which 5 patients underwent repeat anti-incontinence surgery. For those without retreatment, 25/28 (89%) completed ICIQ-FLUTS at last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 1 year or greater (N = 18) showed significant improvement in all domains: frequency (P = .007), voiding (P = .02), and incontinence (P = .004), and in quality of life related to frequency (P = .008), voiding (P = .002) and incontinence (P = .01). Among those who completed questionnaires both at 3 months and at least 1 year after surgery (N = 17), there was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 92% at 1 year. Notably, no patients suffered severe (Clavien III-V) complications or required sling release. ATO urethral sling placement appears safe, with promising short-term outcomes. Longer follow-up and external validation are needed.