Babcock or Scissor Tensioning: Effectiveness & intervention at 5 years after Mid-Urethral Sling

Objectives: Achieving tension-free status for retropubic mid-urethral slings can be achieved through various methods, however minimal evidence presently exists to determine if long-term outcomes differ by technique. Prior work suggests that grasping a measured loop of mesh with a Babcock clamp may result in less post-operative bladder outlet obstruction than the more commonly used technique of a Mayo scissor spacer, with no difference in subjective and objective SUI cure rates at 1 year. The objective of this study is to obtain longer term follow-up data to inform surgeon decision making about which technique to employ in one’s practice.

Methods: All participants in a randomized trial comparing the Babcock vs. Mayo Scissor tensioning technique (MUST Trial) were invited to join a follow-up study at 5 years post-surgery. Participants completed the standardized questionnaires utilized in MUST: the Incontinence Severity Index (ISI), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Long Form (ICIQ-FLUTS-LF), Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Primary outcome was presence of significantly bothersome SUI symptoms, as defined as a score of ³2 on question 3 of the UDI-6. Secondary outcomes included significantly bothersome OAB symptoms, as defined as a score of ³2 on question 1 or 2 of the UDI-6; proportions of repeat SUI surgery; and, proportions receiving intervention on their MUS for outcomes of mesh erosion or voiding dysfunction. Due to restrictions on non-essential hospital visits due to COVID19, no in person research follow-up could be offered for physical examination.

Results: Two hundred and sixty (81.8%) of the original 318 participants took part in the 5-year follow-up. No significant differences were found between the two groups. Primary outcome of SUI symptoms at 5 years occurred in 30.83% of Scissor respondents (n=41/133) and 26.77% of Babcock respondents (n=34/127, p=0.47). OAB symptoms were present at 5 years in 52.63% of the Scissor group (n=70/133) and 42.53% in the Babcock group (n=54/127, p=0.10). A total of 23 participants underwent a repeat SUI procedure over the subsequent 5 years, 9.02% (n=12/133) in the Scissor and 8.66% in the Babcock group (n=11/127, p=0.92). The intervention rate intervention rate for MUS complications in the first 5 years after surgery was 8.18% for the Scissor group (n=13/159, all completed in the OR setting for sling lysis) and 3.77% in the Babcock group (n=6 all completed in the ambulatory setting for mesh erosion), p=0.08).

Conclusions: MUS effectiveness, rates of repeat SUI procedures and MUS mesh intervention did not differ between the Babcock and Scissor spacer groups at 5 years. Taken together with the original RCT and 1 year follow-up data, Babcock tensioning offers lower immediate voiding dysfunction and similar 5-year SUI cure rates to the more commonly known Mayo Scissor technique.