Stress urinary incontinence in women: Is single incision sling as effective as transobturator sling?

This study aimed to evaluate whether single incision sling (SIS) was as effective and safe as transobturator sling (TOS) for the treatment of stress urinary incontinence in women. The main finding was that SIS was as safe and effective as the TOS.

Stress urinary incontinence (SUI) is the involuntary leakage of urine due to physical activity such as coughing, laughing, or running. It can affect 4-35% of women. The TOS Obtryx II (Boston Scientific, Marlborough, MA) is a system commonly used to treat SUI. The system involves permanently implanting a strip of mesh the vagina and two groin incisions to stabilize the urethra. Thigh pain is a common complication associated with this treatment.

The SIS Solyx (Boston Scientific, Marlborough, MA) may also be used to treat SUI. This involves the implantation of mesh but using only a single incision in the vagina. It is thought that the single incision may reduce the risk of leg pain. However, this has not been widely investigated. It is important to compare the 2 treatment methods in terms of effectiveness in women with SUI.

281 patients were enrolled in this study. 50% received a SIS and 50% received a TOS. Patients were followed for 36 months after the procedure. A negative cough stress test (meaning that there was no urine leakage after coughing) and improvement in SUI based on a questionnaire called the Patient Global Impression of Improvement were the main outcomes of interest after 36 months. Serious side effects, mesh damage/movement and quality of life were also analyzed.

Treatment was successful in 90.4% of the SIS group and 88.9% in the TOS group. The rates of urine leakage reported by patients following surgery were 0% for the SIS group and 2.1% in the TOS group.

Side effects were low for both groups (10.6% for the SIS group vs. 15.7% for the TOS group). The most common side effects experienced by both groups were the movement of the device outside of the vagina, inability to pass urine, and urinary tract infections.

This study suggested that there were similar effectiveness and safety of SIS compared to TOS for the treatment of SUI in women.

The participants in this study were non-randomly assigned to either of the treatments. This may have led to bias in the selection of participants or the interpretation of the data.