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Most sling operations for stress urinary incontinence cure symptoms after one year

A review of the evidence on types of surgery for stress urinary incontinence could help women make a more informed choice about treatment.

A common surgical approach involves the insertion of a sling behind the pubic bone coming out via the abdomen (the bottom-to-top ‘retropubic’ route), or alternatively from side-to-side coming out through the groin (the ‘transobturator’ route).

Researchers who reviewed information from 81 trials found moderate-quality evidence that at around 12 months, both routes had cured symptoms in 80% of women.

Transobturator insertion seemed to carry a lower risk of bladder damage during the operation, with around six in 1,000 experiencing this, compared with 50 in 1,000 in the retropubic group. Fewer in the transobturator group (40 in 1,000) had persistent difficulty in emptying their bladder completely, compared with the retropubic group (70 in 1,000).

However, the transobturator group experienced more short-term groin pain and there was limited evidence of a higher risk of repeat operation.

Overall, the rate of erosion of the tape into the vagina was 2%. The rate of pain during sexual intercourse was low in both groups.

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