Voiding dysfunction requiring surgery: 2.7% vs 0% (P=0.004)
Mesh exposure: 2.7% vs 0.7%
Median blood loss: 50 vs 25 ml
TO
Higher with Transobturator
Neurologic symptoms: 9.4% vs 4.0% (P=0.01)
Groin numbness and leg weakness
Vaginal epithelial perforation: 4.3% vs 2.0%
Take-Home Message
Retropubic and transobturator midurethral slings achieve equivalent objective cure rates for stress urinary incontinence at 12 months. However, their complication profiles differ — retropubic slings carry more voiding dysfunction and bladder perforation risk, while transobturator slings have more neurologic symptoms. Sling route selection should be individualized based on patient anatomy, risk tolerance, and shared decision-making.