Introduction: Transobturator techniques are frequently used for the surgical treatment of female stress urinary incontinence (SUI), due to their high success rates and few intraoperative complications. However, controversial results have been reported in the literature regarding their incidence. The aim of this study is to analyze the real incidence and trend over time of such complications, especially voiding dysfunctions and overactive bladder (OAB) symptoms. Methods: A comprehensive search using PubMed/MEDLINE, Scopus, and Cochrane databases was performed. The search string used was the following: (female stress urinary incontinence) AND (complication) AND ((midurethral sling) OR (transobturator tape) OR (TVT-O) OR (voiding dysfunctions) OR (de novo OAB) OR (recurrent UTI) OR (vaginal erosion)). We included randomized controlled trials, prospective controlled studies, prospective and retrospective observational studies. All selected articles were screened based on titles and abstracts. Relevant data were extracted and tabulated. Results: A total of 39 studies were included in our analysis. Transobturator tape procedures show a high objective cure rate for SUI, from 76.9% to 100%. Postoperative voiding dysfunctions are shown to be quite common, ranging from 0–22% of cases. Despite that, this percentage decreases to 0–1% after 12 months. De novo OAB incidence ranges from 3% to 14% at 12 months, with variability over time due to multiple factors. Tape-related complications usually occur after 12 months, with a variable incidence up to 7%. Urinary tract infections (UTIs) are quite common in the immediate postoperative period but sometimes can be recurrent, requiring long-term prophylactic antibiotic treatment. Conclusions: Voiding dysfunctions are generally transient complications, while de novo OAB may persist over time. An adequate preoperative counseling, along with accurate written informed consent, could enhance patient tolerance of these issues and contribute to long-term patient satisfaction.

Background/Objectives: Laparoscopic gynecologic surgery is widely utilized due to its minimally invasive nature. Postoperative discomfort, including intra-abdominal and referred shoulder pain, remains a challenge. This study evaluates the impact of deep neuromuscular blockade (NMB) reversed with sugammadex compared to moderate NMB reversed with neostigmine on postoperative pain, recovery, and surgical conditions in patients undergoing laparoscopic hysterectomy. Methods: This double-blind, randomized controlled trial included 228 patients undergoing laparoscopic hysterectomy under standardized pneumoperitoneum pressure (12 mmHg). Participants were randomized into two groups: deep NMB with sugammadex (SUG) and moderate NMB with neostigmine (NEO). Primary outcomes included postoperative pain (NRS) and neuromuscular recovery time (TOF ratio ≥ 0.9). Secondary outcomes were surgical conditions, surgeon satisfaction, extubation and recovery times, incidence of postoperative nausea and vomiting (PONV), and analgesic consumption. Results: The SUG group exhibited lower pain scores up to 24 h compared to the NEO group (p < 0.05). Pain reductions remained statistically significant up to 6 h postoperatively after Bonferroni correction, while differences beyond this time were not significant after adjustment. Neuromuscular recovery was markedly faster in the SUG group (147.58 ± 82.26 s vs. 488.02 ± 223.07 s, p < 0.05). Patients in the SUG group had shorter extubation (ΔT1), awakening (ΔT2), and recovery room transfer times (ΔT3). PONV was significantly lower in the SUG group. Deep NMB did not contribute to the improvement of surgical workspace conditions. Conclusions: Deep NMB with sugammadex enhances postoperative pain control and accelerates neuromuscular recovery in laparoscopic hysterectomy. These findings support the adoption of deep NMB with sugammadex as a valid anesthetic approach in laparoscopic hysterectomy procedures.

Introduction: Transobturator midurethral slings (MUSs) are commonly used to treat female stress urinary incontinence (SUI). Despite their high success rates, postoperative complications such as voiding dysfunction (VD) and de novo overactive bladder (OAB) symptoms may affect quality of life (QoL). This study aims to evaluate patient-reported outcomes regarding bladder dysfunction (VD and OAB) and SUI resolution. Methods: Patients undergoing transvaginal tension-free vaginal tape-obturator (TVT-O) for SUI without detrusor overactivity were enrolled from April 2018 to April 2023. Final 12-month follow-up was completed in April 2024. Follow-up at 6 and 12 months included physical examination, stress tests, and a 3-day voiding diary. The Urinary Symptom Profile (USP) questionnaire was administered at 12 months. A VAS score evaluated the subjective bother of voiding dysfunction. Objective cure was defined as a negative stress test at follow-up. Changes in daily leakage episodes were assessed using the 3-day voiding diary. Results: Ninety-two patients were enrolled, of whom eight-nine completed the 6- and 12-month follow-up and were included in the final analysis. The objective cure rate was, respectively, 93% at 6 months and 89% at 12 months. The USP questionnaire administered at 12 months showed that the SUI domain score was 0 in 80.9% of patients. De novo urgency was reported in 44% of patients. Urge incontinence and nocturia occurred, respectively, in 33% and 8% of patients. Patient-reported voiding symptoms, defined as LS $\ge 1$, were observed in 58.4% of patients. Among patients with LS $\ge 1$, 38/52 (73.1%) reported tolerable bother (VAS < 5), whereas 14/52 (26.9%) reported clinically important or intolerable bother (VAS $\ge 5$). Conclusions: TVT-O was associated with a high objective cure rate; however, patient-reported OAB and voiding symptoms were common at 12 months. These findings support a more comprehensive informed consent process for patients undergoing TVT-O surgery in order to increase patient awareness of the potential development of OAB and VD following the surgical procedure.