A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence

Authors


  • Protocol registered on Clinicaltrials.gov: Tension Free Vaginal Tape versus the Miniarc sling: NCT00843908.

Dr M Basu, Research Fellow in Urogynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK. Email mayabasu@aol.com

Abstract

Please cite this paper as: Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02513.x.

Objective  To compare a mini-sling with a retropubic tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) and urodynamic stress incontinence (USI).

Design  Randomised trial.

Setting  Urogynaecology unit in large UK district general hospital.

Population  Women with USI resistant to conservative management and requiring a suburethral sling.

Methods  A total of 71 women with SUI and confirmed USI were randomised to undergo treatment with either a retropubic TVT or mini-sling. Follow-up was at 6 weeks, with a history, examination and quality of life questionnaire, and at 6 months with further subjective evaluation and twin-channel subtraction cystometry and pressure-flow studies.

Main outcome measures  The presence of SUI at 6 weeks and 6 months after treatment.

Results  The mini-sling was associated with a significantly higher rate of persistent SUI at 6 weeks (OR 9.49, 95% CI 2.8–32.6) and 6 months (OR 8.14, 95% CI 2.7–24.7), and of USI at 6 months (OR 7.58, 95% CI 2.7–24.7). The rate of complication was similar in the two groups.

Conclusions  The mini-sling is associated with a higher failure rate than a retropubic TVT. Longer term and multicentre outcome data are necessary to explore these findings further. Until this is available, the mini-sling should be used with caution.

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