Transobturator Versus Minisling for Urinary Incontinence: A Randomized Controlled Trial.

IMPORTANCE: The comparison between single-incision slings (SISs) and midurethral slings has been documented in the literature, but results vary according to the SIS device. OBJECTIVES: The purpose of this study is to assess whether SIS (Solyx) is noninferior to transobturator (TOT) (Obtryx) sling for treating women with confirmed stress-predominant urinary incontinence. STUDY DESIGN: A prospective, parallel, nonblinded, multicenter, noninferiority, randomized controlled study with 114 patients were randomized and followed 6 and 12 months after surgery. Interventions were midurethral TOT sling (Obtryx-halo; n = 58) or SIS (Solyx; n = 56). The primary outcome was improvement in the Patient Global Impression of Improvement (PGI-I). Secondary outcomes were the Kings Health Questionnaire (KHQ) instruments after treatment, subjective improvement, and surgical outcomes. RESULTS: Both groups were homogeneous ( P = NS) regarding sociodemographic and clinical variables. There was improvement in the PGI-I after 6 ( P = 0.001) and 12 months ( P = 0.001) of treatment for women who underwent TOT sling. After 6 months, KHQ scores improved in the TOT group for the following domains: role limitations ( P = 0.026) and physical limitations ( P = 0.006). After 12 months, the TOT group presented better KHQ scores that were statistically significant from the SIS group in incontinence impact ( P = 0.012), physical limitations ( P = 0.001), and severity measures ( P = 0.017). Moreover, the TOT group presented higher subjective improvement after 6 months ( P = 0.006) than the SIS group. Mesh erosion was higher in the SIS group ( P = 0.006). Reoperations were not statistically different between groups. CONCLUSION: There were higher scores in the PGI-I score and higher subjective improvement for the TOT sling after 6 and 12 months of treatment when compared with the SIS group.

Severity of urinary incontinence is associated with prevalence of sexual dysfunction.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) affects overall health-related and sexual quality of life (QoL) in women. There is no consensus on the impact of severity and type of UI on the prevalence of sexual dysfunction (DS). The aim of this study was to evaluate the association between types and severity of UI and DS. METHODS: A cross-sectional study of women with UI. INCLUSION CRITERIA: women complaining of UI and > 18 years old. Women with a history of previous treatment for UI, recurrent urinary tract infections, renal lithiasis, previous radiation therapy or pelvic organ prolapse above stage 2 in the Pelvic Organ Prolapse Quantification (POP-Q) system were excluded. Clinical and epidemiological data were collected, and the following questionnaires were applied: ICIQ-SF, ICIQ-OAB, King's Health Questionnaire (KHQ) and Female Sexual Function Index (FSFI). RESULTS: Concerning the type of UI, the majority of women had MUI (69.1%) and 56.8% reported having coital UI. The mean score was 20.81 ± 8.45 in the FSFI questionnaire. There was a prevalence of SD in 71.6% of women, with no difference in types of UI (p = 0.753) and loss during sexual intercourse (p = 0.217). There was a correlation between severity of UI (ICIQ-SF) and arousal (r = -0.26; p = 0.008), lubrication (r = -0.25; p = 0.009), orgasm (r = -0.25; p = 0.009), pain (r = -0.26; p = 0.007) and total (r = -0.28; p = 0.004) domain scores. CONCLUSIONS: There is a high prevalence of SD in women with urinary incontinence, irrespective of the type of UI and urine leakage during sexual intercourse. However, the greater the severity of UI is, the worse the sexuality questionnaire scores.