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International Urogynecology Journal
Published in: International Urogynecology Journal 1/2018

01-01-2018 | Original Article

A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence

Authors: René P. Schellart, Sandra E. Zwolsman, Jean-Philippe Lucot, Dirk J. M. K. de Ridder, Marcel G. W. Dijkgraaf, Jan-Paul W. R. Roovers

Published in: International Urogynecology Journal | Issue 1/2018

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Abstract

Introduction and hypothesis

Midurethral sling procedures are the first surgical option in women undergoing surgery for stress urinary incontinence (SUI). Single-incision midurethral-slings (SIMS) were designed to provide similar efficacy to traditional midurethral slings but with reduced morbidity. In this international trial we compared the efficacy of a SIMS (MiniArc) and a transobturator standard midurethral sling (SMUS; Monarc) in the treatment of SUI in terms of subjective and objective cure rates and morbidity over a long-term follow-up.

Methods

This was a randomized controlled nonblinded extended trial with a follow-up period of 36 months. Women with symptomatic SUI were eligible. The primary outcome was subjective cure, defined as an improvement in the Patient Global Impression of Improvement (PGI-I) score. Secondary outcomes were objective cure (negative cough stress test), disease-specific quality of life, surgical parameters and morbidity. An intention to treat analysis was performed. Differences in dichotomous variables were tested using the chi-squared test. Differences in continuous variables were tested using Student’s t test or the Mann-Whitney U test. We hypothesized that MiniArc would be noninferior to Monarc concerning subjective cure.

Results

We randomized 97 women to the MiniArc group and 96 to the Monarc group. The attrition rate was 23% in the MiniArc group and 22% in the Monarc group after 3 years. At 36 months, the subjective cure rates were 86% in the MiniArc group and 87% in the Monarc group (risk difference −0.6%, 95% CI −12 to 11%). The objective cure rates were 89% and 88%, respectively (risk difference 1.3%, 95% CI −9 to 11%). Both procedures were associated with low complication rates.

Conclusions

After a follow-up of 36 months, MiniArc (SIMS) is non-inferior to Monarc (SMUS) with respect to subjective and objective cure.
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Metadata
Title
A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence
Authors
René P. Schellart
Sandra E. Zwolsman
Jean-Philippe Lucot
Dirk J. M. K. de Ridder
Marcel G. W. Dijkgraaf
Jan-Paul W. R. Roovers
Publication date
01-01-2018
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 1/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3362-z

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