Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures

Abstract

To sequentially compare the postoperative urodynamic changes in patients with urodynamic stress incontinence (USI) who underwent tension-free vaginal tape (TVT) or transobturator tape (Monarc TOT) procedure. Between January 2001 and December 2005, 50 consecutive patients with USI who underwent TVT (n = 24) or TOT (n = 26) procedures were studied, and postoperative urodynamic changes were sequentially compared by one-way ANOVA test with Bonferroni's correction. There were no significant between-group postoperative changes in urodynamic parameters of uroflowmetry, filling and voiding cystometry. However, the TVT group had a higher objective cure rate (100% vs. 69.2%, P = 0.004) by pad test, urethral closure pressure area [40.4 cm(2) H(2)O, 95% confidence interval (CI) = 22.3-58.5 cm(2) H(2)O vs. 3.9 cm(2) H(2)O, 95% CI = -10.9 to 18.7 cm(2) H(2)O, P = 0.036], and continence area (34.4 cm(2) H(2)O, 95% CI = 16.1-52.7 cm(2) H(2)O vs. -3.5 cm(2) H(2)O, 95% CI = -16.7 to 9.8 cm(2) H(2)O, P = 0.001) at 12 months than those of the TOT group. This study demonstrated that tension-free vaginal tape and transobturator tape procedures had no significant difference of impact on bladder voiding and storage functions. However, this study demonstrated that TVT procedure resulted in a higher cure rate with a significantly increased urethral closure pressure area and continence area than did TOT procedure 12 months postoperatively. Thus, TVT procedure might be a better therapeutic choice to achieve continence than TOT.