What exactly is stress urinary incontinence?

Stress urinary incontinence (SUI) is a condition where urine leaks out when you exert pressure on your bladder by coughing, sneezing, laughing, or exercising. It significantly affects a person's social life, physical comfort, and psychological well-being. SUI is important because it drastically reduces the quality of life for many women, making everyday activities challenging and embarrassing.

What is a midurethral sling and why is it used?

A midurethral sling (MUS) is a surgical procedure used to treat stress urinary incontinence (SUI). It involves placing a synthetic mesh under the urethra to provide support and prevent leakage during activities that cause pressure on the bladder. MUS is significant because it has become a popular and effective surgical option for women who haven't found relief from SUI through other treatments.

Can you explain what the transobturator sling procedure is?

The transobturator sling (TOT) is a specific type of midurethral sling procedure used to treat stress urinary incontinence (SUI). In the TOT procedure, the sling is placed through the obturator foramen, a large opening in the pelvic bone. TOT is important because it offers a potentially effective surgical option, but understanding its long-term performance and any potential complications is crucial for making informed decisions about SUI treatment.

What is the ICIQ-SF questionnaire and how is it used?

The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) is a standardized survey used to assess the severity and impact of urinary incontinence. It's a tool that helps doctors quantify a patient's symptoms and measure the success of treatments like the transobturator sling. Using the ICIQ-SF allows for objective comparison of outcomes across different studies and patient groups. A score of zero is considered a sign that the surgery has successfully addressed their incontinence.

What does 'urgency' mean in the context of urinary problems?

Urgency, in the context of urinary incontinence, refers to a sudden and strong need to urinate that can be difficult to control. The presence of urgency alongside stress urinary incontinence can indicate mixed urinary incontinence, which may affect the success of certain surgical treatments like the transobturator sling. Understanding whether a patient experiences urgency is important for predicting the likely success of the surgery.

Digital illustration of a woman confidently walking forward, symbolizing renewed freedom from urinary incontinence after transobturator sling surgery.

SUI Surgery: Is the Transobturator Sling Still a Solid Choice After 5 Years?

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"A new study examines the long-term effectiveness and patient satisfaction of transobturator sling surgery for stress urinary incontinence."

Urinary incontinence (UI) is a widespread issue impacting countless women, often taking a toll on their social lives, physical comfort, and overall psychological well-being. For those who haven't found relief through conservative treatments, surgery can be a viable option to regain control and improve their quality of life.

Among the surgical options available, midurethral slings (MUS) have emerged as a popular and effective choice for addressing stress urinary incontinence (SUI). Both tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures have demonstrated consistent positive outcomes. However, the long-term performance of these procedures, especially the TOT, continues to be a topic of interest and ongoing research.

One specific area of focus is the transobturator sling (TOT) procedure. While studies have shown promising results in the short and medium term, understanding its long-term efficacy and potential complications is crucial for both surgeons and patients. A recent study dives deep into this topic, evaluating the experiences of 152 women who underwent the TOT procedure with the same surgeon, providing valuable insights into the factors that contribute to lasting success and satisfaction.

Transobturator Sling Surgery: What the Study Revealed

Digital illustration of a woman confidently walking forward, symbolizing renewed freedom from urinary incontinence after transobturator sling surgery.

Researchers conducted a retrospective study, looking back at women who had transobturator sling surgery between 2005 and 2011. They contacted these women and asked them to participate in a survey, using a standard questionnaire called the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), along with some additional questions about their satisfaction with the surgery. A score of zero on the ICIQ-SF was considered a sign that the surgery had successfully addressed their incontinence.

After a median follow-up period of 87 months, the study found some noteworthy results:

A total of 152 patients (70.6%) completed the questionnaire.
The majority of patients (94.7%) were diagnosed with stress urinary incontinence, while a smaller percentage (5.3%) had mixed urinary incontinence.
Complications occurred in 16% of patients (25 individuals).
Based on the ICIQ-SF scores, roughly 65% of patients (99 individuals) were considered cured.
In terms of satisfaction, 66% of patients felt cured, 28% felt improved, 4.6% reported no change, and only one patient felt their incontinence had worsened.

Digging deeper, the researchers looked for risk factors that might lead to surgical failure. They discovered that the primary risk factor was the presence of urgency, a sudden and strong need to urinate (p < 0.001). Interestingly, the surgeon's increasing experience didn't seem to have a significant impact on complication rates.

The Takeaway: Is the Transobturator Sling Right for You?

This study offers valuable insights for women considering surgical options for stress urinary incontinence. The transobturator sling appears to be an effective solution with a good long-term satisfaction rate and a relatively low risk of complications. However, it's crucial to discuss your individual risk factors, especially the presence of urgency, with your doctor to determine if this procedure is the best choice for you.