Long‐Term Outcomes After Retropubic and Transobturator Sling Procedures: Reoperation for Recurrent Stress Urinary Incontinence

OBJECTIVE: To evaluate long-term failure rates and complications after retropubic and transobturator midurethral sling procedures for primary stress urinary incontinence (SUI). DESIGN: Retrospective cohort study. SETTING: Academic medical centre. POPULATION: A previously described cohort of patients (n = 1881) who underwent midurethral sling procedures (2002-2012) and a covariate-matched cohort of patients with retropubic (n = 570) or transobturator (n = 317) slings. METHODS: Health record review with follow-up extended by 9 years (through December 31, 2022). MAIN OUTCOME MEASURES: Treatment failure (reoperation for recurrent SUI) and procedure-associated complications. RESULTS: The duration of assessment was extended by 6.9 years for the retropubic group and by 6.4 years for the transobturator group. The median (IQR) follow-up was 11.1 (5.1-14.5) years (retropubic, 11.4 [5.9-14.6]; transobturator, 9.6 [2.6-13.7]). Higher risk of reoperation was observed with transobturator (8.8%) than retropubic (4.4%) slings (unadjusted hazard ratio [HR], 2.29 [95% CI, 1.49-3.54]; p < 0.001; covariate-matched analysis HR, 1.91 [95% CI, 1.15-3.17]; p = 0.01). The increased risk of reoperation with a transobturator sling was higher when the procedure was combined with prolapse repair (unadjusted HR, 6.34 [95% CI, 3.09-13.02]; p < 0.001; covariate-matched analysis HR, 3.96 [95% CI, 1.35-11.58]; p = 0.01). Higher rates of reoperation for urinary retention were observed for the retropubic group than for the transobturator group (covariate-matched analysis HR, 8.39 [95% CI, 1.11-63.22]; p = 0.04). CONCLUSION: In this long-term follow-up study, midurethral slings had a low failure rate. Women with SUI undergoing transobturator sling placement plus prolapse repair had a greater risk of reoperation. However, women with retropubic slings had a greater risk of urinary retention requiring intervention.