Five-year clinical and imaging outcomes of primary transobturator midurethral sling procedures for uncomplicated urodynamic stress incontinence

Abstract Objectives To report 5-year clinical and imaging outcomes of primary transoburator midurethral sling (TOT) procedures for uncomplicated urodynamic stress incontinence (USI). Materials and Methods We retrospectively investigated the data of 136 women who underwent primary TOT procedures for uncomplicated USI. All women received preoperative as well as 1-year and 5-year postoperative assessments comprising clinical interview, pelvic examination, and introital four-dimensional (4D) ultrasound. The primary outcome was stress urinary incontinence (SUI), defined as the report of SUI in patient interview, a positive response to item 3 of the short form of the Urogenital Distress Inventory (UDI-6), or a positive cough stress test and negative dysuria or urinalysis. Secondary outcomes included SUI severity, SUI bother, scores on the short forms of the UDI-6 and Incontinence Impact Questionnaire (IIQ-7), rates of de novo overactive bladder (OAB) symptoms, de novo voiding dysfunction, groin/thigh pain, and sling exposure, as well as ultrasound manifestations of bladder neck, midurethra, and sling. Results At 1 and 5 years, rates for SUI (7.4% vs 8.8%, P =  0.824), de novo OAB symptoms (4.4% vs 5.1%, P =  1.000), de novo voiding dysfunction (11.2% vs 10.3%, P = 1.000), groin/thigh pain (3.7% vs 0.7%, P =  0.216), and sling exposure (2.2% vs 0.0%, P =  0.246) were similar. Scores on the UDI-6 and IIQ-7 were significantly decreased postoperatively. Sling location and a more cranioventral midurethral location were sustained during follow-up. Conclusions For uncomplicated USI, TOT has good and sustained clinical and imaging outcomes, though a notable rate of de novo voiding dysfunction.