Four-year functional results of the suburethral sling procedure for stress urinary incontinence: a French prospective randomized multicentre study comparing the retropubic and transobturator routes

Abstract

To evaluate long-term (over 4years) functional outcomes and quality of life of transobturator (TOR) and retropubic (RPR) routes in the cure of stress urinary incontinence (SUI). Prospective, randomized multicentre study involving 88 women with SUI from March 2004 to May 2005 (RPR group (n=42), TOR group (n=46)). Long-term functional results and quality of life were evaluated using validated questionnaires and compared with those observed at the first year. Eight patients (19%) in the RPR group and 9 patients (19.5%) in the TOR group were lost to follow-up (NS). The mean follow-up in the RPR and the TOR groups was 52.7months and 53.1months, respectively. In intention to treat, the success rate at 4years was 64.3% in the RPR group and 69.5% in the TOR group (NS). At 4years, no significant differences in the IIQ scores were observed in either group compared to the preoperative scores with no difference between the groups (RPR group: 32 vs. 14.9 (NS), TOR group: 25.7 vs. 21.4 (NS)). Compared to 1year UDIQ and IIQ scores, a decrease in quality of life was observed for both groups at 4years (RPR group: 4.7 vs. 34 (P<0.0001) and 2.6 vs. 14.9 (P<0.001), TOR group: 1.2 vs. 38.7 (P<0.0001) and 0 vs. 21.4 (P<0.0001)) without difference between the groups. This study shows similar relatively high long-term success rates for both the RPR and TOR procedures. Patients should be informed about a possible time-dependent alteration in functional results.