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

Abstract

Objective: To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency.

Design: Retrospective study.

Setting: Gynecology department, Bakirkoy Women and Childrens' Hospital, Istanbul.

Sample: Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid-urethral sling procedures (TVT = 180, TOT = 120).

Methods: 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.

Main outcome measures: Intraoperative complications, postoperative complications, and subjective cure rates.

Results: 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.

Conclusion: TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.