The aim of this study was to examine the position of the transobturator sling 15 years postoperatively and assess its impact with outcome. Another aim was to compare the position of the sling and subjective cure with the results of the 3 months follow-up visit.

This is a cohort study of 54 consecutive patients who underwent the transobturator sling operation between 2006 and 2008 in our hospital. Study inclusion criteria included patients, who suffered from stress or mixed urinary incontinence and did not response to conservative treatment, a positive cough stress test (CST) and the post void residual volume (PVR) less than 100 ml. The pre- and postoperative data and the results of 3 months control visit were retrieved from the medical records.

The position of the sling was determined by vaginal and perineal ultrasound at rest and on Valsalva. Objective cure was defined as a negative CST. To evaluate the subjective outcome the validated and standardized questionnaires were completed. UISS and the DIS questionnaires, the Urogenital Distress Inventory -short form (6 items, UDI-6) and the Incontinence Impact Questionnaire -short form (7 items, IIQ-7) were used for a condition specific assessment. Subjective cure was defined as an answer of “never” or “slightly” to the UDI-6 question “Does urine leak when you are physically active, cough or sneeze?”

Of the 54 patients initially participating in the study, 32 (59 %) patients were included in the evaluation at the mean of 15 years after the transobturator operation. The mean age at surgery was 54 years (range 40 to 70). Before the operation 51 (94 %) women suffered from SUI and 3 (6 %) from MUI. Two (4 %) women were previously operated on due to urinary incontinence; one patient had undergone Burch operation and one patient had TVT-operation. One patient had concomitant surgery.

At the 15 years follow-up 23 (72 %) patients had negative CST. Two (6%) of the 32 patients were found to have vaginal tape erosions, which were asymptomatic. Surgical treatment was not required. There were not any retention problems postoperatively and there was no need to cut or remove the tape. The patient characteristics and status findings at the 15 years follow-up are presented in Table 1.

Tapes were visualized on ultrasound at the 3 months postoperative visit and at the 15 years follow-up visit. At the 3 months visit the mean distance from the bladder neck to to the proximal edge of the tape (BNTD) was 20.70 mm and from the external opening of the urethra and distal edge of the tape (EOUTD) was 14.91 mm. Tape-urethra distance (TUD) was not measured at 3 months visit. At the 15 years follow-up BNTD was 17.15 mm and EOUTD was 8.35 mm and TUD was 2.76 mm.

At the 3 months postoperative visit only 18 patients had completed the UDI-6 and 17 of them were subjectively cured. At the 15 years follow-up all 32 patients had completed the UDI-6 and 21 (69 %) patients were subjectively cured.

At the 15 years follow-up the transobturator sling is still in a good position when assessed by ultrasound. There were no long-term side effects and most of the patients were still objectively and subjectively cured. When evaluating the results, it should be taken into account that the study population in the 15 years follow-up was quite small.

In this study the transobturator slings seems to be effective and safe in long-term for women who suffer from SUI or MUI. The results of transobturator sling are still good, and it can also be considered as a therapeutic alternative for SUI.