SUI: Mini-slings non-inferior to standard mid-urethral slings

Single-incision mini-slings were found to be non-inferior to standard mid-urethral slings in women with stress urinary incontinence (SUI).

The results could help patients and clinicians make an informed shared decision on SUI surgery1,2

Robust evidence regarding the effectiveness of mini-slings compared with the effectiveness of mid-urethral slings is lacking, said Prof. Mohamed Abdel-fattah (University of Aberdeen, UK). Therefore, his group conducted the pragmatic multicentre, non-inferiority, randomised-controlled SIMS trial, including 600 adult women with SUI who failed or declined conservative treatment, and received an adjustable anchored mini-sling or a tension-free standard mid-urethral sling. The patient global impression of improvement (PGI-I) questionnaire at 15 months was the primary measure of treatment success.

According to the PGI-I results at 15 months, the success rate of mini-slings (79.1%) was non-inferior to that of standard mid-urethral slings (75.6%). The 3-year results displayed a similar result, with success rates of 72.0% and 66.8% in the experimental arm and control arm, respectively. The post-operative hospital stay was shorter in the experimental arm than in the control arm (7.2 hr vs 9.7 hr).

However, no substantial difference was reported in the percentage of patients that had returned to normal activities within 28 days after surgery (75.2% vs 70.8%). Prof. Abdel-fattah added that the rates of ‘any degree’ groin or thigh pain were similar for both arms, with 14% of the patients experiencing these complaints at 36 months, but that the 36-month dyspareunia rate was higher in the experimental arm than in the control arm (11.7% vs 4.8%).

1. Abdel-fattah M, et al. Single-Incision Mini-Slings for Stress Urinary Incontinence in Women. Game-changing session 4, EAU 2022, 01–04 July.
2. Abdel-fattah M, et al. N Engl J Med 2022;386:1230-1243