1. No difference in urinary continence after surgery between retropubic and transobturatoric transvaginal sling operations when correcting for predisposing factors A Kjaeldgaard1), F Taheri-Johansson2), M Ankardal3) Dept. Gynecol Obstet. 1)Karolinska University Hospital, 2)Värnamo County Hospital, 3)Sahlgrenska University Hospital, SWEDEN A Kjaeldgaard1), F Taheri-Johansson2), M Ankardal3) Dept. Gynecol Obstet. 1)Karolinska University Hospital, 2)Värnamo County Hospital, 3)Sahlgrenska University Hospital, SWEDEN

2. Material & Methods Registerdata 2006-2009 from National Quality Register on Incontinence Surgery in Sweden High validity (94% included, 8% drop-outs) Questionaire preop, 2 months and 12 months - same questions asked every time 4024 patients with 2 months follow-up 1935 of these have also one year follow-up Continence the primary outcome Chi 2 test. Significance level p <0,05)

3. Risk groups low risk : no risk factors risk - Urge incontinence - History of incontinence or prolapse surgery - Hysterectomy -BMI > 30 -Elderly (age > 75 yy) high risk: all risk factors present

4. Continence at 2 and 12 months follow-up ( unselected registerdata ) TVT superior already at 8 w (p<0.002) TVT also better at one year (p<0.02 ) No difference between TOT and TVT-O Treatment results decrease only by a good 5% in one year

5. Predisposing factors- A clinical problem seldomly adressed by RCTs Urge incontinence ~60% Over-weight ~20% Over-aged ~10% Previous vaginal surgery ~ 15% Hysterectomy ~10% TO has significant over-representation of risk factors > 80% of our patients present with some risk factor

6. Risk group does matter when it comes to treatment results No difference between TVs in low-risk patients Slightly better (p<0,02) result for TVT in risk patients Results are reduced by ~20% in the risk group Only 50% continent in high risk patients Continence at 2 months follow-up related to risk group

7. Influence of a single riskfactor on continence after 2 months Urge

8. Conclusions The Swedish National Quality Register for Incontinence Surgery In low risk patients all sling operations go very well However >80% of our patients have some risk factor reducing treatment result at 2 months by nearly 20% Significantly more patients with one or more risk factors are treated with transobturatoric methods Previous hysterectomy is no risk factor No influence of age per se can be demonstrated until >75 yy. Presenting with all risk factors reduces postoperative continence at 2 months follow-up from nearly 90% to less than 40% RCTs will not tell us the fate of the many risk patients

10. Influence of a single riskfactor on continence after 2 months