Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence: Short-term Outcomes

Abstract

Objective: To evaluate short-term outcomes of autologous transobturator (ATO) urethral sling placement using rectus fascia for female stress urinary incontinence.

Materials and methods: We evaluated the outcomes of 33 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from 2013 to 2014. Patients were seen at 3 months postoperatively and mailed a questionnaire at least 1 year after surgery for further follow-up. Outcomes were measured by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score and compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method.

Results: Median patient age was 62 years old (interquartile range [IQR] 47.5; 70.5) with a median body mass index of 28.6 kg/m(2) (IQR 24.7 kg/m(2); 32.4 kg/m(2)). When isolated sling placement was performed, 88% (15/17) were outpatient procedures. Median follow-up was 14.9 months (IQR 3.6; 18.7), during which 5 patients underwent repeat anti-incontinence surgery. For those without retreatment, 25/28 (89%) completed ICIQ-FLUTS at last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 1 year or greater (N = 18) showed significant improvement in all domains: frequency (P = .007), voiding (P = .02), and incontinence (P = .004), and in quality of life related to frequency (P = .008), voiding (P = .002) and incontinence (P = .01). Among those who completed questionnaires both at 3 months and at least 1 year after surgery (N = 17), there was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 92% at 1 year. Notably, no patients suffered severe (Clavien III-V) complications or required sling release.

Conclusion: ATO urethral sling placement appears safe, with promising short-term outcomes. Longer follow-up and external validation are needed.