No difference in urinary continence after surgery between retropubic and transobturatoric transvaginal sling operations when correcting for predisposing factors A Kjaeldgaard1), F Taheri-Johansson2), M Ankardal3) Dept. Gynecol Obstet. 1)Karolinska University Hospital, 2)Värnamo County Hospital, 3)Sahlgrenska University Hospital , SWEDEN

Material & Methods

• Registerdata 2006-2009 from National Quality Register on Incontinence Surgery in Sweden • High validity (94% included, 8% drop-outs) • Questionaire preop , 2 months and 12 months - same questions asked every time • 4024 patients with 2 months follow-up • 1935 of these have also one year • Continence the primary outcome • Chi 2 test . Significance level p follow-up <0,05)

Risk groups

•

low risk

: no risk factors •

risk

- Urge incontinence - History of incontinence or prolapse surgery - Hysterectomy - BMI > 30 - Elderly (age > 75 yy) •

high risk

: all risk factors present

Continence at 2 and 12 months follow-up ( unselected registerdata )

• TVT superior already at 8 w (p<0.002) • TVT also better at one year (p<0.02

) • No difference between TOT and TVT-O • Treatment results decrease only by a good 5% in one year 80% 70% 60% 50% 40% 30% 20% 10% 0% % continent after 8 weeks % continent after one year TVT** TVT-O TOT mean

Predisposing factors-

A clinical problem seldomly adressed by RCTs > 80% of our patients present with some risk factor • Urge incontinence ~60% • Over-weight ~20% • Over-aged ~10% • Previous vaginal surgery ~ 15% • Hysterectomy ~10% 70% 60% 50% 40% 30% 20% 10% • TO has significant over-representation of risk factors TVT TVT-O TOT 0% no traditional risk factor urge incontinence BMI>30 age > 75 yy hysterectomy Risk factors w ith significant overrepresentation in transobturatoric slings

Risk group does matter when it comes to treatment results

• No difference between TVs in low-risk patients • Slightly better (p<0,02) result for TVT in risk patients • Results are reduced by ~20% in the risk group • Only 50% continent in high risk patients Continence at 2 months follow-up related to risk group 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% low risk risk group high risk TVT TVT-O TOT

Influence of a single riskfactor on continence after 2 months

Urge

Conclusions

The Swedish National Quality Register for Incontinence Surgery • In low risk patients all sling operations go very well • However >80% of our patients have some risk factor reducing treatment result at 2 months by nearly 20% • Significantly more patients with one or more risk factors are treated with transobturatoric methods • Previous hysterectomy is no risk factor • No influence of age

per se

can be demonstrated until >75 yy.

• Presenting with all risk factors reduces postoperative continence at 2 months follow-up from nearly 90% to less than 40% • RCTs will not tell us the fate of the many risk patients

Influence of a single riskfactor on continence after 2 months

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% never almost never 1-3 times a month 1-3 times a week daily Postop continent 8 w Postop continent 1 y Treatment results in low risk group 90% 85% 80% 75% 70% 65% Treatment results in low risk patients % continent 8w 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% BMI*<30 BMI 30-35 BMI>40 no hysterectomy % continent after 8 weeks