Comparative Analysis of the Efficacy of Different Surgical Modalities for the Treatment of Female Stress Urinary Incontinence: A Multicenter Retrospective Study.

Abstract

Objective: To compare the efficacy of autologous fascial retropubic midurethral sling, anterior vaginal wall epithelial flap midurethral suspension, tension-free vaginal tape-obturator and adjustable urethral suspension with a single incision for the treatment of female stress urinary incontinence.

Materials and methods: A total of 243 SUI patients who were admitted to Minda Hospital of Hubei Minzu University, were chosen and split into four groups based on various surgical techniques: the AFS group (59 cases), TVT-O group (61 cases), epithelial flap group (62 cases) and ASIS group (61 cases). A comparison of four patient groups' quality-of-life scores, urodynamic indices, urethral structure-related indices before and a year after treatment, complication rates and perioperative-related indices.

Results: There was no discernible difference in the treatment outcomes among the four groups(P>0.05). However, the ASIS group exhibited significantly reduced intraoperative hemorrhage, hospitalization duration and operative time compared to the mucosal flap and TVT-O groups(P<0.05). Both the TVT-O and ASIS groups demonstrated significantly higher hospitalization expenditures than the mucosal flap and AFS groups (P<0.05). No significant differences were observed in postoperative indwelling catheterization, IIQ-7 and I-QOL ratings, urodynamic indices or urethral structure-related indexes across the four patient groups(P>0.05). The TVT-O group showed a significantly higher incidence of postoperative medial thigh pain compared to the AFS, mucosal flap, and ASIS groups(P<0.05). Similarly, the AFS group had a significantly greater incidence of postoperative urine retention compared to the mucosal flap, TVT-O, and ASIS groups(P<0.05).

Conclusion: While all four surgical techniques demonstrated good efficacy and improved patients' quality of life, our study suggests that TVT-O had a significantly higher incidence of post-treatment medial thigh pain and ASIS may be a safer and less problematic surgical approach for the treatment of female SUI. This has important therapeutic implications.