Retropubic vs. Transobturator Sling for Stress Leaks: How the Two Routes Compare

A mid-urethral sling is a narrow strip of tape placed under the urethra to support it, a common minimally invasive surgery for stress leaks (leaking with coughing, sneezing or exercise).¹ The tape can be passed two ways:¹

• Retropubic: behind the pubic bone, with small openings on the lower belly
• Transobturator: through the openings in the pelvic bones, with small openings in the groin

What a large review found

The Cochrane review included 81 trials with more than 12,000 women.¹ It didn’t cover single-incision “mini” slings.¹

	Retropubic	Transobturator
Women reporting cure, up to 1 year	71% to 97%	62% to 98%
Women reporting cure, beyond 5 years	51% to 88%	43% to 92%
Bladder perforation during surgery	4.5%	0.6%
Trouble emptying after surgery	More common	Less common
Groin pain (short-lived)	1.3%	6.4%
Lower-belly pain (short-lived)	2.9%	0.8%
Tape exposure in the vagina	about 2 in 100	about 2 in 100
Repeat leak surgery long term	Less likely	More likely (limited, low-quality data)

¹

In the first year, cure rates were similar between routes.¹ The retropubic route had more bladder injuries, bleeding and emptying problems, while the transobturator route had more groin pain and, in a few trials, more need for repeat surgery later.¹ The authors concluded that slings have a good safety profile.¹

Before you choose

• Try pelvic floor therapy first if you haven’t. Our guides to pelvic floor exercises and pelvic floor physical therapy costs explain options.
• Know the alternatives: bulking injections, a continence pessary or a sling made from your own tissue.
• Review the consent issues in our mesh sling questions.
• If you also have urge leaks, a sling may not fix them. See mixed incontinence.

Questions to ask your surgeon

1. Which route do you recommend for me, and why?
2. How many of each do you perform each year?
3. What happens if the tape needs to be removed later?
4. Would urodynamic testing help before surgery?

Try: “I leak with coughing and running and pelvic floor therapy helped only a little. Which sling route would you choose for me, and what are the trade-offs?”

Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to record how often you leak and with which activities before your surgical consultation.