Serious complications and recurrences after retropubic versus transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue American Journal of Obstetrics and Gynecology Année : 2024

Serious complications and recurrences after retropubic versus transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register

Complications sérieuses et récidives après bandelette sous-urétrale par voie rétropubienne versus transobturatrice pour 2682 patientes participant au registre VIGI-MESH

1 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
2 RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale
3 CHU Estaing [Clermont-Ferrand]
4 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
5 UM - Université de Montpellier
6 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
7 UNISTRA - Université de Strasbourg
8 Clinique Beau Soleil [Montpellier]
9 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
10 Université de Lille
11 AP-HP - Hôpital Antoine Béclère [Clamart]
12 UP11 - Université Paris-Sud - Paris 11
13 Hôpital Saint Vincent de Paul de Lille
14 GHICL - Groupement des Hôpitaux de l'Institut Catholique de Lille
15 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
16 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
17 Groupe hospitalier de La Rochelle
18 Hôpital Foch [Suresnes]
19 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
20 MIP - Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance
21 CIC 0004 - Nantes - Centre d'investigation clinique (CIC) de Nantes -CIC Plurithématique
22 CHU Bordeaux
23 Centre Hospitalier Dunkerque
24 CHU Limoges
25 MRU - Maternité Régionale Universitaire - CHRU de Nancy
26 Groupe Hospitalier Diaconesses Croix Saint-Simon
27 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
28 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
29 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
30 HFME - Hôpital Femme Mère Enfant [CHU - HCL]
31 PHB - Polyclinique de Hénin Beaumont [Hénin-Beaumont]
32 CHU de Poitiers Site de Châtellerault [Châtellerault]
33 CHU Pitié-Salpêtrière [AP-HP]
34 SU - Sorbonne Université
35 UP - Université de Poitiers = University of Poitiers
Grégoire Capon
  • Fonction : Auteur
Tristan Gauthier
  • Fonction : Auteur

Résumé

Background: Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. Objective(s): To compare serious complications and reoperations for recurrence after midurethral sling procedures by the retropubic and transobturator routes for female stress urinary incontinence. Study Design: This analysis covers patients included in the French multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence by the retropubic or transobturator route, excluding single-incision slings. Follow-up continued to October 2021. Serious complications (Clavien-Dindo classification ≥ Grade III) imputable to the midurethral sling and reoperations for recurrence were compared by Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. Results: 1830 participants received a retropubic sling and 852 a transobturator sling in 134 French centers, placed by 167 surgeons. The cumulative two-year estimate of serious complications was 5.8% (95% CI 4.8-7.0%) in the retropubic group and 2.9% (95% CI 1.9–4.3%) in the transobturator group, that is, after adjustment, half that of the retropubic group (adjusted HR 0.41; 95% CI 0.3-0.6). The cumulative two-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% CI 2.0-3.6) in the retropubic group and 2.8% (95% CI 1.7-4.2) in the transobturator group, with risk of revision for recurrence higher in the transobturator group after adjustment (adjusted HR 1.9; 95% CI 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. Conclusions: The transobturator route for midurethral slings is associated with a lower risk of serious complications but a higher risk of surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring.
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Dates et versions

inserm-04333318 , version 1 (09-12-2023)

Identifiants

Citer

Camille Armengaud, Arnaud Fauconnier, Hocine Drioueche, Sandrine Campagne Loiseau, Renaud de Tayrac, et al.. Serious complications and recurrences after retropubic versus transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register. American Journal of Obstetrics and Gynecology, 2024, 230 (4), pp.428.e1-428.e13. ⟨10.1016/j.ajog.2023.11.1241⟩. ⟨inserm-04333318⟩
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