Are Transobturator Slings as Durable as Retropubic Slings?

Background: Retropubic midurethral slings (RP-MUS) have demonstrated durable long-term outcomes, with 10-year studies confirming high continence and low complication rates. Transobturator midurethral slings (TO-MUS) have a potential advantage over RP-MUS in terms of a lower risk of bladder perforation and voiding dysfunction; however, data on long-term durability are limited, with few large, long-term cohort studies available. The aim of the study was to evaluate long-term subjective cure, reoperation, and complication rates after TO-MUS placement and to contextualize these outcomes relative to established retropubic (RP) durability data. Methods: This is a retrospective cohort study of 295 women who underwent TO-MUS surgery performed by a single high-volume surgeon between 2010 and 2014. Demographics, surgical details, and follow-up outcomes (subjective cure, reoperation, complications) were abstracted. Statistical analyses included Chi-square tests and logistic regression. Results: Nineteen percent of patients had ≥ 10 years of follow-up. Follow-up duration ranged from less than 1 month to 12.44 years, with a median of 3.0 years. At 10 years, 76.8% reported continued continence. The overall reoperation rate was 6.8%, including recurrent stress urinary incontinence (4.1%) and mesh-related complications (2.4%). Intraoperative bladder perforation occurred in 1.3% of cases, self-limited urinary retention in 9.2%, and postoperative urinary retention requiring reoperation in 0.3%; no significant bleeding events were observed. No independent predictors of recurrence or reoperation were identified. Conclusions: In this large single-surgeon cohort, TO-MUS demonstrated durable long-term continence rates and low reoperation rates, with outcomes comparable to published RP series. These findings support TO-MUS as a safe and effective alternative to RP-MUS.