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Armengaud C, Fauconnier A, Drioueche H, Campagne Loiseau S, De Tayrac R, Saussine C, Panel L, Cosson M, Deffieux X, Lucot JP, Pizzoferrato AC, Ferry P, Vidart A, Thubert T, Capon G, Debodinance P, Gauthier T, Koebele A, Salet-Lizee D, Hermieu JF, Game X, Ramanah R, Lamblin G, Lecornet E, Carlier-Guérin C, Chartier-Kastler E, Fritel X. Serious complications and recurrences after retropubic vs transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register. Am J Obstet Gynecol 2024; 230:428.e1-428.e13. [PMID: 38008151 DOI: 10.1016/j.ajog.2023.11.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. OBJECTIVE This study aimed to compare serious complications and reoperations for recurrence after midurethral sling procedures when using the retropubic vs the transobturator route for female stress urinary incontinence. STUDY DESIGN This analysis was of patients included in the French, multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence either by the retropubic or the transobturator route and excluded patients with single-incision slings. Follow-up continued until October 2021. Serious complications (Clavien-Dindo classification ≥ grade III) attributable to the midurethral sling and reoperations for recurrence were compared using Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. RESULTS A total of 1830 participants received a retropubic sling and 852 received a transobturator sling in 27 French centers that were placed by 167 surgeons. The cumulative 2-year estimate of serious complications was 5.8% (95% confidence interval, 4.8-7.0) in the retropubic group and 2.9% (95% confidence interval, 1.9-4.3) in the transobturator group, that is, after adjustment, half of the retropubic group was affected (adjusted hazard ratio, 0.41; 95% confidence interval, 0.3-0.6). The cumulative 2-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% confidence interval, 2.0-3.6) in the retropubic group and 2.8% (95% confidence interval, 1.7-4.2) in the transobturator group with risk for revision for recurrence being higher in the transobturator group after adjustment (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. CONCLUSION The transobturator route for midurethral sling placement is associated with a lower risk for serious complications but a higher risk for surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring.
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Affiliation(s)
- Camille Armengaud
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 "Risques cliniques et sécurité en santé des femmes et en santé périnatale" (RISCQ), Montigny-le-Bretonneux, Service de Gynécologie-Obstétrique, CHI Poissy-Saint-Germain, Poissy, France
| | - Hocine Drioueche
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France
| | | | - Renaud De Tayrac
- Service de Gynécologie-Obstétrique, CHU Carémeau, Nîmes, Université de Montpellier, Montpellier, France
| | - Christian Saussine
- Service d'urologie, CHU de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laure Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - Michel Cosson
- Service de Gynécologie-Obstétrique, CHU de Lille, Université de Lille, Lille, France
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, APHP Antoine-Béclère, Université Paris-Sud, Clamart, France
| | - Jean Philippe Lucot
- Service de Gynécologie-Obstétrique, Hôpital Saint-Vincent-de-Paul, Lille, France; Groupe des hôpitaux de l'institut catholique de Lille (GHICL), Lille, France
| | - Anne Cécile Pizzoferrato
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France; Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC, France
| | - Philippe Ferry
- Service de Gynécologie-Obstétrique, CH de La Rochelle, La Rochelle, France
| | | | - Thibault Thubert
- Service de Gynécologie, CHU de Nantes, Centre d'investigation clinique, CHU de Nantes, Laboratoire Motricité, Interactions, Performances (MIP) - UR 4334 - UFR STAPS - Nantes Université, Nantes, France
| | | | | | - Tristan Gauthier
- Service de Gynécologie-Obsétrique, Hôpital Mère-Enfant, CHU Limoges, Limoges, France
| | - Antoine Koebele
- Service de Gynécologie, Maternité régionale universitaire, Nancy, France
| | - Delphine Salet-Lizee
- Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Service de gynécologie, Paris, France
| | | | - Xavier Game
- Service d'urologie, CHU Rangueil, Toulouse, France
| | | | - Gery Lamblin
- Service de Gynécologie-Obstétrique, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, Lyon, France
| | - Emilie Lecornet
- Service d'urologie, Polyclinique d'Hénin Beaumont, Groupe AHNAC, Henin-Beaumont, France
| | | | | | - Xavier Fritel
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
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