Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study


      To describe surgical complications in 597 women over a 24-month period after randomization to retropubic or transobturator midurethral slings.

      Study Design

      During the Trial of Midurethral Slings study, the Data Safety Monitoring Board regularly reviewed summary reports of all adverse events using the Dindo Surgical Complication Scale. Logistic regression models were created to explore associations between clinicodemographic factors and surgical complications.


      A total of 383 adverse events were observed among 253 of the 597 women (42%). Seventy-five adverse events (20%) were classified as serious (serious adverse events); occurring in 70 women. Intraoperative bladder perforation (15 events) occurred exclusively in the retropubic group. Neurologic adverse events were more common in the transobturator group than in retropubic (32 events vs 20 events, respectively). Twenty-three (4%) women experienced mesh complications, including delayed presentations, in both groups.


      Adverse events vary by procedure, but are common after midurethral sling. Most events resolve without significant sequelae.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ogah J.
        • Cody J.D.
        • Rogerson L.
        Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women.
        Cochrane Database Syst Rev. 2009; (CD006375)
        • Latthe P.M.
        • Foon R.
        • Toozs-Hobson P.
        Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications.
        BJOG. 2007; 114: 522-531
        • Barber M.D.
        • Kleeman S.
        • Karram M.M.
        • et al.
        Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial.
        Obstet Gynecol. 2008; 111: 611-621
        • Albo M.E.
        The trial of mid-urethral slings (TOMUS): design and methodology.
        J Appl Res. 2008; 8: 1-13
        • Richter H.E.
        • Albo M.E.
        • Zyczynski H.M.
        • et al.
        Retropubic versus transobturator midurethral slings for stress incontinence.
        N Engl J Med. 2010; 362: 2066-2076
        • Dindo D.
        • Demartines N.
        • Claiven P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Tsivian A.
        • Kessler O.
        • Mogutin B.
        • et al.
        Tape related complications of the tension-free vaginal tape procedure.
        J Urol. 2004; 171: 762-764
        • Latthe P.M.
        • Singh P.
        • Foon R.
        • Toozs-Hobson P.
        Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials.
        BJU Int. 2010; 106: 68-76
        • Novara G.
        • Artibani W.
        • Barber M.D.
        • et al.
        Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence.
        Eur Urol. 2010; 58: 218-238
        • Albo M.E.
        • Richter H.
        • Brubaker L.
        • et al.
        Burch colposuspension versus fascial sling to reduce urinary stress incontinence.
        N Engl J Med. 2007; 356: 2143-2155