Single-Incision Mini-Sling Compared With Tension-Free Vaginal Tape for the Treatment of Stress Urinary Incontinence

• DOI: 10.1097/aog.0b013e318242a849
• Publication Date: 2012-01-24T13:53:10Z
• Authors: Matthew D. Barber; Alison C. Weidner; Andrew I. Sokol; Cindy L. Amundsen; J. Eric Jelovsek; Mickey M. Karram; Mark Ellerkmann; Charles R. Rardin; Cheryl B. Iglesia; Marc Toglia
• Keywords: Adult; Pain, Postoperative; Suburethral Slings; Chi-Square Distribution; Urinary Incontinence, Stress; Urinary Bladder; Kaplan-Meier Estimate; Middle Aged; Severity of Illness Index; Statistics, Nonparametric; 3. Good health; Urodynamics; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Confidence Intervals; Humans; Urologic Surgical Procedures; Female; Aged; Follow-Up Studies

To compare the efficacy of a single-incision mini-sling, placed in the "U" position, with tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence.Women with urodynamic stress incontinence with or without genital prolapse were randomized to receive a mini-sling or TVT (N=263). Those randomized to the mini-sling received two "sham" suprapubic incisions to facilitate blinding. The primary outcome was subjective cure (absence of any urinary incontinence or retreatment) as assessed at 1 year. This trial was a noninferiority study design.Participants receiving the mini-sling were less likely to have a bladder injury (0.8% compared with 4.8%; P=.0.46), more likely to be discharged without a catheter (78.5% compared with 63%; P=.008), and had less pain for postoperative days 1-3. One year after surgery, the rate of cure was similar between treatment groups (mini-sling 55.8% compared with TVT 60.6%; mean difference, 4.8%; 95% confidence interval, -16.7 to +7.2); however, this did not meet our predefined noninferiority criteria of -12%. Incontinence severity at 1 year was greater with the mini-sling than with TVT (mean severity score ± SD: 2.2±2.7 compared with 1.5±1.9; P=.015), resulting predominantly from a higher proportion of participants with "severe" incontinence postoperatively (16% compared with 5%; P=.025).The mini-sling placed in the "U" position results in similar subjective cure rates to TVT 1 year after surgery but postoperative incontinence severity is greater with the mini-sling than with TVT.I.