Complications and causes of readmission following retropubic versus transobturator midurethral sling surgery in 88,880 patients.

Abstract

<h4>Introduction</h4>Stress urinary incontinence (SUI) is a major public health concern. The success rate of synthetic mid-urethral sling (MUS) procedures generally remains high. However, safety concerns persist. This study aimed to evaluate MUS removal rates removal rates between transobturator (TOT) and retropubic (TVT), with secondary outcomes focusing on complication incidence and the occurrence of new MUS placement after TVT and transobturator TOT procedures.<h4>Material</h4>Data were extracted from the French national hospital database for all hospitalizations related to MUS procedures performed between 2016 and 2024. Only patients treated with MUS from 2016 to 2019 were included to ensure a 5-year follow-up. Complications were recorded during the initial hospitalization and any subsequent rehospitalizations within 60 months postoperatively. MUS associated with pelvic organ prolapse mesh placement were excluded using the CCAM codes.<h4>Results</h4>Between 2016 and 2019, 69,879 TOT and 19,001 TVT procedures were included. The TVT group exhibited higher rates of sling removal (HR 0.50, CI95%=[0.47-9.53], P<0.001) and urinary tract infections (0.7 vs. 0.5%, P<0.01). In contrast, the TOT group had a 19% higher reintervention rate for SUI (HR=1.19, CI95%=[1.10-1.29], P<0.001).<h4>Conclusion</h4>Although TVT is associated with a slightly higher rate of perioperative complications, it has become more efficient over time compared to TOT. However, the available evidence does not support preferential use of TOT given its higher risk of repeat surgery for SUI. Further large-scale studies are needed to more accurately assess comparative complication profiles.<h4>Level of evidence: 4</h4>