Tension-free Vaginal Tape Group Research Articles

A prospective randomized trial of comparing the clinical outcome of tension-free vaginal tape and transobturator tape for stress urinary incontinence

To compare the morbidity and efficacy of tension-free vaginal tape (TVT) and transobturator tape (TVT-O) procedures in the treatment of stress urinary incontinence. A total of 315 women were randomly assigned to undergo the procedure of either TVT (n = 160) or TVT-O (n = 155). Some patients underwent vaginal repair, hysterectomy, hysterosalpingo-oophorectomy, posterior intravaginal slingplasty or sacrospinous ligament fixation as concomitant procedures as indicated. Fifteen patients were lost to follow-up. And the median follow-up period was 27 months. The curing rates were 93.5%, 89.6%, 87.2% and 82.9% in the TVT group and 91.1%, 89.8%, 86.2% and 83.3% in the TVT-O group at 6, 12, 24 and 36 months respectively. No significant difference could be found for the curing rates between two groups at the same follow-up time and between 6-36 months follow-up in each group (P > 0.05). The median operative duration of the TVT-O group was significantly shorter than that of the TVT group [(18.7 ± 4.2) vs (24.3 ± 4.5) min] (P < 0.01). Compared with the TVT group, the TVT-O group had more patients complaining of groin and thigh pain (P < 0.05). Both approaches appear to lower the peri- and post-operative complication rates and have an equal efficacy in the surgical treatment of stress urinary incontinence during a 3-year follow-up. However, TVT-O has a shorter operative duration with a higher rate of groin and thigh pain.

Functional Results After Tape Removal for Chronic Pelvic Pain Following Tension-Free Vaginal Tape or Transobturator Tape

When first-line management of stress urinary incontinence based on pelvic floor muscle retraining fails, surgical management is indicated. Placement of a surgical sling with a transobturator tape (TOT) or a retropubic tension-free vaginal tape (TVT) has medium-term and long-term efficacy for stress urinary incontinence. Insertion of the sling is associated with a variable incidence of pelvic pain ranging from 0% to 30%. A meta-analysis of 11 randomized, controlled studies comparing the 2 methods reported a higher rate of pain with the TOT (12%) than with the TVT procedure (1.3%). Few studies have investigated the pain induced by insertion of the sling, and there is no consensus on pain management. The pathogenesis of pain after insertion of the suburethral tape remains poorly understood. This prospective study assessed the functional results (changes in pain and continence) after removal of suburethral tape and also investigated the influence of the route of tape insertion on the incidence of pain. A total of 32 patients who were undergoing removal of suburethral tape, causing chronic pelvic and perineal pain, were prospectively followed between 2004 and 2009. The study subjects were divided into 2 groups based on the type of sling employed: group 1 (TOT, n = 15) and group 2 (TVT, n = 17). Tape removal for every patient in the TVT group was performed using transperitoneal laparoscopy. TOT group tape removal was performed through a transvaginal approach with an incision in the proximal painful thigh; the painful thigh was incised for unilateral pain, and both the thighs were incised for bilateral pain. Pain was assessed using a visual analog scale (VAS) which rated pain from 0 (no pain) to 10 (maximal pain) before surgery and during follow-up. In almost all patients, pelvic pain developed immediately or several days after surgery. Surgical removal of the tape in the TVT group showed an abnormal position or excessive traction of the tape in most patients (88%, 15/17). In the overall patient population, tape removal was associated with improvement of pain (at least 50% improvement in the VAS score) in 68% (22/32) of the patients at a mean follow-up of 10 months; the mean VAS score before and after surgery was 7.3 ± 1.5 and 3.4 ± 3, respectively. Pain relief was stable over time. There was no statistically significant difference between the 2 groups with respect to reduction of pain. Although recurrence of incontinence was observed after tape removal in 22% (7/22) of cases, incontinence was minimal in most cases (6 of 7). These findings show that surgical removal of suburethral tape improves pain in 68% of patients, with about a 20% risk of recurrence of urinary incontinence. There was no difference in pain relief between the TVT and TOT groups.

A modified inexpensive transobturator vaginal tape inside-out procedure versus tension-free vaginal tape for the treatment of SUI: a prospective comparative study

To prospectively compare, in terms of efficacy and safety, the tension-free vaginal tape (TVT) and our modified transobturator vaginal tape inside-out (TVT-O) procedure with self-tailored monofilament macroporous polypropylene mesh for stress urinary incontinence (SUI). A total of 150 women with SUI were assigned to modified TVT-O (n = 95) and TVT (n = 55), respectively, the surgical outcomes compared 1 year later. A cough stress test was applied to the objective outcomes, while urinary incontinence specific quality of life (IQoL) questionnaire, to the subjective outcomes. The objective success rates defined as a negative stress test were found to be 95% in the TVT group and 96% in the modified TVT-O group, respectively. No significant difference was found between these two groups in the cure, improvement and failure rates (all P > 0.05), with significant improvement in quality of life (QoL) and no significant difference in patient satisfaction rates in two groups. In the TVT group were found three cases of bladder injuries. In the modified TVT-O group, operative duration, blood loss and medical cost were significantly reduced compared with those in the TVT one (P < 0.01). In the study, the modified TVT-O procedure could be defined to be quicker, more economic with fewer bladder complications than the TVT approach while both were found to be manually simple and clinically mini-invasive with similar efficacy.

De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence

ObjectiveTo determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). Study designProspective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. ResultsThe study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). ConclusionTreatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

Does Body Mass Index Impact Passing Voiding Trial After Midurethral Sling Procedures for Stress Urinary Incontinence?

: To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI). : The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial. Patients with concomitant pelvic organ prolapse surgeries were not included in this analysis. : Sixty-seven patients underwent TVT, whereas 69 had TOT procedures. In the TVT group, 30 patients (42%) were unable to void immediately postoperatively compared with 11 patients (16%) in the TOT group (P = 0.0003). The mean (SD) age and BMI of patients who failed or passed voiding trials was 58.6 (12.0) years and 28.0 (4.9) kg/m or 53.5 (12.3) years and 29.8 (5.7) kg/m, respectively. Of 38 patients who did not pass a voiding trial on the day of the procedure, 31 (82%) passed on postoperative day 1, and all patients had passed a voiding trial by postoperative day 11. The mean (SD) BMI for 7 patients who did not pass voiding trial by postoperative day 1 was 28.3 (5.2) kg/m. : Women with higher BMIs were more likely to pass voiding trials after midurethral sling procedures. Patients who had TOT placement had greater success passing a postprocedure voiding trial than did patients who had TVT placement.

Tension-Free Vaginal Tape Versus Transobturator Suburethral Tape: Five-Year Follow-up Results of a Prospective, Randomised Trial

BackgroundMany studies have assessed the equivalent effectiveness of tension-free vaginal tape (TVT) and transobturator suburethral tape (TVT-O) at short- to medium-term follow-up, but no long-term randomised trials appear in the literature. ObjectiveWe compared the use of TVT to TVT-O, providing a longer follow-up than currently appears in the literature. Design, setting, and participantsSeventy-two consecutive patients affected by stress urinary incontinence (SUI) were included in this randomised, controlled trial. Patients were randomly allocated to the TVT or TVT-O procedure using a predetermined, computer-generated randomisation code. InterventionAfter preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. MeasurementsThis 5-yr study represents the extension of our original randomised trial, which was designed to assess the incidence of long-term complications (primary end point) and successes (secondary end point) for both techniques. Results and limitationsAt 60-mo follow-up, 52 patients (72%) were objectively cured of SUI (72.9% after TVT-O and 71.4% after TVT), but only 44 patients (61%) were satisfied. The late complication rate was 16.6% (10 women): five women (16.1%) in the TVT-O group and five women (17.2%) in the TVT group (p=1). In this follow-up, 62% of the patients from the TVT-O group and 60% from the TVT group (p=1) expressed that they were satisfied or very satisfied with the results. The mean cause of dissatisfaction was the development of sexual dysfunction resulting from dyspareunia or incontinence during intercourse, which was found in 6 of 16 dissatisfied patients (37.5%). The limitations of our study included the adequate but small sample size and the lack of questionnaires. ConclusionsBoth surgical techniques are safe, with similar results (72.9% and 71% of patients objectively cured after TVT-O and TVT, respectively) and low complication rates (16.6%: 16.1% and 17.2%, respectively, for TVT-0 and TVT), even after 5-yr follow-up.

TVT compared with TVT-O and TOT: results from the Norwegian National Incontinence Registry

The aim of this study is to compare the outcome and complication rates of the tension-free vaginal tape (TVT) operations with the transobturator vaginal tape (TVT-O and TOT) operations in the treatment of urinary stress incontinence. This is a multicenter, prospective cohort study. Preoperative and postoperative assessments included a validated Stress and Urge Incontinence Questionnaire, a 24-h pad test, and a standardized stress test. The study included 5,942 women--4,281 women had a TVT operation and 731 and 373 women had TVT-O and TOT operations, respectively. Median follow-up time was 8 months. Women in the TVT group had less leakage during stress test and fewer subjective stress incontinence symptoms, and were more satisfied with the operation compared with the women in TVT-O and TOT groups, but more complications were reported after TVT operation. The TVT operation is more efficient than TVT-O and TOT operations in treating stress incontinent women.

Transobturator TVT-O versus retropubic TVT: results of a multicenter randomized controlled trial at 24 months follow-up

The purpose of this study is to compare the retropubic tension-free vaginal tape (TVT) procedure with the inside-out transobturator approach (TVT-O). Multicenter randomized controlled trial. One hundred forty-nine patients were randomly allocated to either TVT (n = 75) or TVT-O (n = 74). Interview, medical examination, pain scores, success rates, and quality of life assessment were recorded pre-operatively, and 2, 6, 12, and 24 months post-operatively. One hundred forty-nine patients underwent surgery, and 132 completed a 24-month follow-up. Bladder injury rate was 5% (4/75) in the TVT group and 2% (2/74) in the TVT-O group (p = 0.68). There was no significant difference between the two groups, concerning overall cure rate and the patients' satisfaction rate at 24 months follow-up. The range of mean pain scores was significantly higher after the TVT-O procedure post-operatively but not at 24 months follow-up. TVT and TVT-O procedures both have an outcome associated with an increase in quality of life with no significant differences in satisfaction rates at 2 years follow-up.

A randomized trial comparing tension-free vaginal tape with tension-free vaginal tape-obturator: 36-month results

This is a randomized multicenter study comparing two mid-urethra tape procedures, the tension-free vaginal tape (TVT) with the tension-free vaginal tape-obturator (TVT-O) in terms of cure rate and complication rate. Seven Finnish hospitals participated. Power calculations required 130 women in each group to detect a 10% difference in cure rate. A total of 267 underwent the allocated operation. Follow-up was scheduled at 2, 12, 36 and 60 months. A cough stress test was used as an objective outcome measure. Subjective outcome was assessed by five different condition-specific quality of life questionnaires. At 36 months of follow-up, 96% of the patients were evaluated. Objective cure rate was 94.6% in the TVT group and 89.5% in the TVT-O group (p = 0.131). Subjective cure rates were significant with no difference between the groups. The TVT and the TVT-O are equally effective in the treatment of stress urinary incontinence after 36-month follow-up with no difference in complication rates.

Do the Advantage slings work as well as the tension-free vaginal tapes?

There is currently no data on the safety and efficacy of the Advantage sling despite its widespread use. We compared the efficiency and safety outcome data of 556 tension-free vaginal tape (TVT) and 108 Advantage slings after assessing for potential confounding factors. The two groups proved comparable. Bladder injury rates were 4.6% for the Advantage group and 2.9% for the TVT group (p = 0.36). Subjective stress incontinence cure were 83.3% and 85.3%, respectively (p = 0.66). Incidences of de novo urgency, urge incontinence, and voiding difficulties were 22.2% vs 14.7% (p = 0.06), 9.3% vs 7.4% (p = 0.55), and 11.1% vs 6.7% (p = 0.11), respectively. No major differences between the two slings were observed apart from a non-significant trend towards more de novo urgency and voiding difficulty symptoms with the Advantage group. It may be possible that due to its different biomechanical properties, the Advantage slings should be left looser.

Tension-Free Vaginal Tape versus Secure Tension-Free Vaginal Tape in Treatment of Female Stress Urinary Incontinence

Objective: To study the safety and efficacy of both tensionfree vaginal tape (TVT) and secure tension-free vaginal tape (TVT secur) in treatment of female stress urinary incontinence. Patients and Methods: Sixty female patients diagnosed as stress urinary incontinence were evaluated in the urogynecology clinic of the Benha Faculty of Medicine. All patients completed the impact of Incontinence on Quality of Life Questionnaire. They were randomly divided into 2 equal groups: group I (n = 30) underwent TVT procedure and group II (n = 30) underwent TVT secur procedure. The 2 techniques were compared regarding operative time, intraoperative bleeding, duration of catheterization, intra- and post-operative complications and hospital stay. All patients were followed up for 9 months and subjected to evaluation by history, examination, and urodynamics pre- and post-operatively. Results: Operative time and intra-operative morbidity were significantly lower in the TVT secur group than in the TVT group. No significant difference could be detected regarding catheterization period and success rate. The cure rate was 90.1% in group I and 93.4% in group II and this difference was statistically insignificant. Patients with a Valsalva leak point pressure lower than 60 cm H2O had poor outcome in both groups. Conclusion: TVT secur could be considered as a safe, easy and effective alternative to TVT with less morbidity.

Comparison of retropubic and transobturator tension-free vaginal implants for the treatment of stress urinary incontinence

Objective To compare the perioperative complications, failure rate, operating time, and length of hospital stay associated with 2 minimally invasive suburethral slings in the management of stress urinary incontinence in women. Methods Women diagnosed with stress urinary incontinence were treated with tension-free vaginal tape (TVT) or transobturator tape (TOT). The participants were followed for the next 2 years, with scheduled evaluations 6 weeks, then 3, 6, 12, and 24 months after surgery. Results Of the 104 participants, 55 were treated with TVT and 49 were treated with TOT. The condition was classified as “cured” in 81.8% of cases in the TVT group and 83.7% in the TOT group, and improvement occurred in 10.9% and 10.2% of cases, respectively. The mean operating time was shorter for patients treated with TOT than for those treated with TVT. There were no significant differences between the groups in terms of perioperative complications (abnormal voiding dysfunction, urinary infections, and de novo overactive bladder). The temporary and permanent urinary obstruction rates in the TVT group were approximately twice those in the TOT group. Conclusion Comparable complications and outcomes were observed with TVT and TOT. Tension-free vaginal implants are effective for the treatment of female stress urinary incontinence.

Outcome and Complications of Retropubic and Transobturator Midurethral Slings Translated into Surgical Therapeutic Indices

A number of studies have demonstrated that retropubic and obturator tape procedures are equally effective for cure of female stress urinary incontinence at 1 year after surgery. The use of the concept of risk/benefit in incontinence surgery is similar to pharmacology where the therapeutic index represents the ratio of desired effect to toxic effect. The surgical therapeutic index (STI) is the ratio between the cure and complication rate, with a high STI indicating greater safety. The aim of this retrospective cohort study was to determine and compare STIs of the retropubic tension-free vaginal tape (TVT) and 2 transobturator tape (TOT) procedures (Monarc and tension-free vaginal tape obturator [TVT-O]). Between 1998 and 2006, data was collected and analyzed for 237 patients with predominately female stress urinary incontinence, who underwent TVT (n = 257), Monarc (n = 95), or TVT-O (n = 85) procedures in a teaching hospital in the Netherlands. STIs were calculated for both groups by dividing cure by complication rate. The STI data for Monarc and TVT-O were presented as one combined group (TOT). Patients were followed for 2 and 12 months after surgery. At the 2-month follow-up, the STI in the TOT group was significantly higher than the TOT group (P < 0.05). After 12 months, however, no significant differences between the STIs in these groups were found. The similarity of STIs at 12 months was apparently due to longer lasting cure rates in the TVT group (P = 0.029) and an increased complication rate in the TOT group. These findings show that the benefit/risk of TVT and TOT based on the STI favors TOT in the short-time, but long-term results are similar among both groups. Both surgical procedures appear to have their own benefits and patients can choose between these two approaches.

Comparison of Three Kinds of Mid-Urethral Slings for Surgical Treatment of Female Stress Urinary Incontinence

A study was conducted to compare the efficacy and complications of tension-free vaginal tape (TVT), transobturator vaginal tape inside-out TVT-O and transobturator vaginal tape out-inside (TOT) procedures for the surgical treatment of female stress urinary incontinence SUI. This study is a prospective randomized trial involving 187 women with primary SUI; 77 received TVT, 65 received TVT-O, and 45 patients were treated with TVT-O between June 2002 and December 2009. Before the operation, a complete medical history was taken and a gynecologic examination was performed, including subjective symptoms, history and urodynamic studies. Postoperative data included mean operation time, days of hospitalization, postoperative complications and efficacy evaluation. Therapeutic effect was assessed by presence or absence of incontinence when abdominal pressure increased. The history, physical examination and urodynamic studies among the three groups have no significant difference (P>0.05). The total cure rate was 91.4%. The cure rate in TVT, TVT-O and TOT groups were 90.9%, 92.3% and 91.1%, respectively. There was no significant difference (P>0.05). Mean operative time showed no significant difference between TVT-O and TOT groups, but both were significantly shorter than TVT group (26.90±16.80, 20.00±13.50 vs 48.20±21.90). The mean postoperative hospital stay showed no significant difference between TVT and TVT-O groups, but both groups were significantly longer than TOT group. Mean postoperative hospital stay of TVT, TVT-O and TOT were 5.00±2.40 days, 4.00±2.20 days and 2.30±0.80 days, respectively. The complication rate in TVT, TVT-O and TOT groups was 15.60%, 9.20% and 8.90%, respectively. In TVT group, 4 patients experienced bladder perforation, postoperative dysuria or retention occurred in 7 cases and was cured by urethral dilation, hematomas of retropubic space in 1 patient. No bladder injury occurred in TVT-O and TOT group, 3 patients had postoperative dysuria or retention and 3 patients had transient dysfunction of both lower limbs postoperatively in TVT-O group, 2 patients had postoperative dysuria or retention and 2 patients had transient dysfunction of both lower limbs postoperatively in TOT group. The three tension-free urethral suspension techniques have similar efficacy, all of them are safe and effective procedures for the treatment of female SUI. Compared with TVT, TVT-O and TOT are simpler, less invasive and have fewer complications.

Comparison at Short Follow-Up of the Changes in the Voiding Phase Induced by Sub-Urethral Tapes Using a Mathematical Micturition Model

Aim: Our purpose was to compare at short follow-up the changes in the voiding phase induced by a sub-urethral tension-free vaginal tape (TVT) or TVT-obturator (TVT-O) for cure of stress urinary incontinence. Patients and Method: Twenty-two women underwent a TVT procedure and 22 a TVT-O procedure. Free uroflows were recorded before surgery and at 1-month follow-up. Results: Maximum flow rate decreased after surgery (p < 0.05); notable change of the shape of the flow curve (prolonged flow time, p < 0.017, or polyphasic curve) was observed (more frequently after TVTO). Modelling (VBN® micturition model) applied to uroflows, allows simulation of pathophysiological hypothesis to be analyzed, and to identify and quantify the mechanical effects of each tape on the urethra. Conclusion: Both tapes appear to induce a urethral compression in many patients. That compression is more frequent in the TVT group while its magnitude is higher in the TVT-O group. The reasons for this difference seem to be the position and the direction of the tape.

Ensayo clínico, aleatorizado, abierto y prospectivo, de 3 años de seguimiento, que compara la eficacia del TVT y la colposuspensión de Burch como tratamiento de la incontinencia urinaria de esfuerzo femenina

Background Evidence comparing the effectiveness of tension-free vaginal tape (TVT) with Burch colposuspension (CS) over a long-term follow-up is scarce. Purpose To compare TVT with CS as primary treatment for female stress urinary incontinence (SUI). Design Open randomised clinical trial with a three-year follow-up period. Participants 49 consecutive women aged 35 to 70 with SUI demonstrated by a urodynamic study. Setting Urology department of Severo Ochoa general hospital in Leganés, Madrid, Spain. Intervention 24 random patients treated with TVT and 25 with CS. Measurements Main variable: assessment before treatment and at six months, one year and three years after the operation using the incontinence severity symptoms index (SSI) and the incontinence impact symptoms index (SII). Secondary variable: three groups for assessing cure, improvement and failure rates. Results Time in surgery, consumption of postoperative analgesics and length of the postoperative hospital stay were lower in the TVT group (41.1 ± 10.9 minutes; 6 [2.8-10.5] capsules and 1 [1-2] days vs. 57.1 ± 18.3 minutes, 23.5 [18.0-31.5] capsules and 3 [3-3] days [p < 0.0001]). There was a significant reduction in SSI and SII scores in both groups and no differences in surgical complications, urgency, obstruction, one-hour pad test, urine culture, flowmetry, costs and cure rates at any moment during follow-up (cured/improved 76.2%, 78.3% and 77.3% at six months, one year and three years for TVT vs. 87.5%, 87.5% and 91.3% for CS; p = 0.32, p = 0.4 and p = 0.19). Limitations The trial is open, which can create observer bias. A study with a higher number of patients or a longer follow-up time could show differences between the procedures that we were unable to observe in this study, due to our budget and time limits. Discussion Based on both short-term and long-term results, TVT is as effective as CS for the treatment of SUI, and has similar subjective cure and surgical complication rates. Time in surgery, consumption of analgesics and length of postoperative hospital stay are all lower in the TVT group. In our clinical setting, with a one-day postoperative stay for TVT, the two procedures have similar costs.

Intravaginal slingplasty sling is associated with increased risk of vaginal erosion

Two structurally different polypropylene tapes are used in tension-free vaginal tape (TVT) and intravaginal slingplasty sling (IVS) procedures for the treatment of female stress urinary incontinence. This study aimed to compare TVT and IVS operations for late postoperative complications, especially vaginal erosion. A retrospective study. Oulu University Hospital, Finland. The study sample was constituted by 373 patients operatively treated for female urinary incontinence between January 2000 and June 2004. A total of 293 patients underwent the TVT operation and 80 patients the IVS operation. We analyzed the data using Fisher's Exact test, Pearson's chi-squared test, and log linear test. For categorical variables we used risk ratios with 95% confidence intervals. The incidence of late complications, especially vaginal erosion. Symptomatic erosion (p < 0.001; risk ratio 13.7; 95% confidence interval 4.03-46.8) was seen in 3 patients (1%) in the TVT group and in 13 patients (16%) in the IVS group. The median time to the onset of symptoms was 9 and 12 months in these groups, respectively. We suggest that the high vaginal erosion rate in the IVS group is associated with the tape material.

Tension-free vaginal tape versus tension-free vaginal tape obturator (inside-outside) in the surgical treatment of female stress urinary incontinence

The objective of this study was to compare TVT (tension-free vaginal tape) and TVT-O (tension-free vaginal tape obturator from inside to outside) procedures for the female surgical treatment of stress urinary incontinence: results, complications, and effectiveness after 1 year. A prospective randomized study was carried out. The patients were followed up for 12 months. A total of 114 patients were operated on using TVT procedure and 150 patients - TVT-O procedure. There was no significant difference in age, body mass index, parity, menopausal status, and prolapse (no patients had cystocele greater than stage II) comparing both groups. The mean time in surgery was significantly shorter in the TVT-O group (19+/-5.6 min) as compared with the TVT group (27+/-7.1 min). No differences in the effectiveness of both procedures were found: TVT - 94.6% and TVT-O - 94.6% after one year, respectively. Hospital stay was significantly shorter in the TVT-O group (1.5+/-0.5 days) than in the TVT group (4.0+/-1.6 days). Significantly fewer complications were observed in the TVT-O group. TVT and TVT-O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT-O group had shorter time in surgery and showed a lower rate of complications.

Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence

The aim of this review was to assess the recent evidence on the effectiveness and complications of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for female stress urinary incontinence between January 2008 and March 2009. A meta-analysis of recent studies revealed that the short-term objective cure rate was borderline worse in the TOT group compared with TVT [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.37-1.00; P = 0.05]. Bladder perforation (OR 12.23; 95% CI 2.86-52.34) was significantly more common, whereas groin/thigh pain was significantly less in the TVT group (OR 0.32; 95% CI 0.11-0.92; P = 0.022). Postoperative urinary retention was slightly more in women undergoing TVT than those undergoing TOT (OR 1.6; 95% CI 0.90-3.12; P = 0.06). The rates of vaginal erosion (OR 0.34; 95% CI 0.09-1.33), de-novo urgency (OR 1.21; 95% CI 0.52-2.79) and urinary tract infection (OR 0.88; 95% CI 0.56-1.38) were comparable in both procedures. In addition, TVT appeared to be more obstructive than TOT, as evidenced by ultrasonographic and urodynamic findings. Changes in sexual function need further investigation because this issue has not been well studied for either sling procedure. TOT has the advantages over TVT with shorter operative time and a relatively lower complication rate. For women with intrinsic sphincter deficiency, however, TVT appears to be a better option because it is more obstructive.

Which type of mid‐urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension‐free vaginal tape or transobturator tape

To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency. Retrospective study. Gynecology department, Bakirkoy Women and Childrens' Hospital, Istanbul. Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid-urethral sling procedures (TVT = 180, TOT = 120). Before the operation, a complete medical history was taken and a gynecologic examination was performed. Subjects with detrusor overactivity or previous sling surgery were excluded. Clinical checkups were conducted at 3, 6, and 12 months, and then annually. Intraoperative complications, postoperative complications, and subjective cure rates. There were no significant differences in demographics between the TVT and TOT groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy. At a mean follow-up of 31.2 +/- 9.1 (range 12-46) months, the overall cure rates were 78.3% for TVT and 52.5% TOT (p < 0.0001). The risk of treatment failure in women who received TOT was 4.9 times higher than in women who underwent TVT. There were no significant differences in perioperative and postoperative complication rates between the two groups. TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.