Impact of Retropubic vs. Transobturator Slings for Urinary Incontinence on Myofascial Structures of the Pelvic Floor, Adductor and Abdominal Muscles

Abstract

Suburethral tension-free slings (tapes or bands) are an essential component in the operative treatment of urinary incontinence. In the present contribution the influence of the type of suburethral sling (retropubic vs. transobturator) on the myofascial structures of the abdominal, adductor and pelvic floor muscles is examined. For this purpose, 70 patients were prospectively observed clinically and physiotherapeutically. Significant differences were seen in the improvement of the pelvic floor musculature (strength, endurance, speed) after placement of a suburethral sling, irrespective of whether it was of the retropubic or the transobturator type. Thus, after surgical treatment patients should be encouraged to undertake further pelvic floor exercising or this should be prescribed for them. There were no significant changes in the abdominal and adductor muscles but there were slight increases with regard to pain level, pain on palpation, and trigger points after placement of both types of sling; thus this is not a criterion in the decision as to which type of sling to use.

Zusammenfassung

Suburethrale spannungsfreie Bänder sind fester Bestandteil der operativen Therapie der Harninkontinenz. In der vorliegenden Arbeit wurde der Einfluss der Art des suburethralen Bandes (retropubisch vs. transobturatorisch) auf die myofaszialen Strukturen der Abdominal-, Adduktoren- und Beckenbodenmuskulatur untersucht. Dazu wurden 70 Patientinnen prospektiv klinisch und physiotherapeutisch beobachtet. Signifikante Unterschiede zeigten sich in der Verbesserung der Beckenbodenmuskulatur (Kraft, Ausdauer, Schnelligkeit) nach der Einlage eines suburethralen Bandes, unabhängig ob retropubisches oder transobturatorisches Band. Daher sollten die Patientinnen nach einer operativen Therapie zu weiterem Beckenbodentraining ermuntert bzw. dieses verordnet werden. In der Abdominal- und Adduktorenmuskulatur ergaben sich keine signifikanten Veränderungen, aber eine leichte Zunahme in Bezug auf Schmerzhaftigkeit, Druckdolenzen und Triggerpunkte nach der Einlage beider Bänder, sodass das kein Kriterium in der Entscheidung für eine Art des Bandes sein muss.

Key words

urinary incontinence - retropubic sling - transobturator sling - postoperative pain - pelvic floor function

Schlüsselwörter

Harninkontinenz - retropubisches Band - transobturatorisches Band - postoperative Schmerzen - Beckenbodenfunktion

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