Introduction and Hypothesis
Traditional slings, tension-free vaginal tape obturator inside-out (TVT-O) and tension-free vaginal tape (TVT), have well-documented continence outcomes but can cause serious complications. This study was aimed at evaluating whether slings with less synthetic material, Ajust™ and TVT-O Abbrevo™ (TVT-A), have comparable 6– to 12-month failure and complication rates, including risk of prolonged postoperative pain, compared with traditional slings.
Methods
A registry study from the Norwegian Female Incontinence Registry (NFIR) including 611 Ajust™, 2,772 TVT-A, and 18,612 traditional slings was carried out. Preoperative, surgical, and 6– to 12-month follow-up data from the period 2009–2021 were used. Objective failure was defined as ≥ 1-g leakage on standardized cough-jump stress test. Subjective failure was defined as stress index-score ≥ 3 on a validated questionnaire. Prolonged postoperative pain was defined as lasting > 3 months.
Results
At first follow-up after 6–12 months, the groups differed significantly. Objective failure rates were as follows: Ajust™ 15.4%, TVT-A 13.5%, and traditional slings 7.3%, p < 0.01. Subjective failure rates were as follows: Ajust™ 23.4%, TVT-A 23.8%, and traditional slings 18.8%, p < 0.01. Shorter slings had fewer overall complications (Ajust™ 4.9% vs TVT-A 6.5% vs traditional slings 9.3%, p < 0.01), but did not have less prolonged postoperative pain (TVT-A: 1.4% vs Ajust™ 0.8% vs traditional slings 0.7%, p < 0.01 < 0.01). All presented outcomes remained significant after adjusting for differences at baseline.
Conclusions
Shorter slings have inferior subjective and objective continence outcomes at 6–12 months, but fewer overall complications except for prolonged postoperative pain.
