A Medium to Long-Term Study Comparing Stress Urinary Incontinence Procedures.

Background and objectives: Concerns remain regarding the safety of the retropubic tape (TVT) procedure. We assess the efficacy, satisfaction and long-term outcomes of the TVT procedure and compare it to the autologous fascial sling (AFS), colposuspension, and urethral bulking procedures.

Methods: A review of prospective data of all patients post stress urinary incontinence (SUI) surgery in our tertiary center between January 2012 and December 2020 was performed. Patients were invited to complete three validated questionnaires: International Consultation of Incontinence Modular Questionnaire Vaginal Symptoms (ICIQ-VS), ICIQ Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and ICIQ satisfaction (ICIQ-S). Fisher's exact test was used to evaluate complications. Kruskal-Wallis test was used to evaluate satisfaction.

Key findings: Eight hundred fifty-three SUI procedures were performed in the study period. The responses from 395 questionnaires were analyzed. Median follow up: 5.9 years (range 1-10.1). The TVT and AFS procedures were the most efficacious procedures: 64% TVT, 62% AFS, 40% Colposuspension, 26% urethral bulking, p < 0.001. The AFS group had the lowest reported rate of complications: 22.6% AFS, 65.7% TVT, 67.1% colposuspension, 71.74% Urethral bulking (p < 0.001). Pain was the most reported complication and the AFS group had the lowest reporting of severe pain: 68% AFS, 74% TVT, 80% Colposuspension, 78% urethral bulking (p = 0.350).

Limitations: Mesh exposure was not evaluated due to the lack of validated questionnaires.

Conclusion: The AFS and TVT procedures are reported as the most successful procedures for the surgical management of SUI. Due to the associated risk of mesh complications, we recommend AFS as the procedure of choice for the surgical management of SUI.