Comparison of Effectiveness between Tension-Free Vaginal Tape (TVT) and Trans-Obturator Tape (TOT) in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency

• Published in: PloS one Vol. 11; no. 5; p. e0156306
• Main Authors: Kim, Hyeong Gon, Park, Hyoung Keun, Paick, Sung Hyun, Choi, Woo Suk
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26-05-2016; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Bladder; Care and treatment; Comparative analysis; Diagnosis; Female; Females; Health aspects; Humans; Medicine; Medicine and Health Sciences; Middle Aged; Multivariate analysis; Patient outcomes; Patients; People and Places; Pressure; Research and Analysis Methods; Retrospective Studies; Risk factors; Sphincter; Studies; Suburethral Slings; Success; Surgeons; Surgery; Tension; Tension-free vaginal tape; Urethra - physiopathology; Urinary Bladder Diseases - complications; Urinary Bladder Diseases - physiopathology; Urinary Bladder Diseases - surgery; Urinary incontinence; Urinary Incontinence, Stress - complications; Urinary Incontinence, Stress - physiopathology; Urinary Incontinence, Stress - surgery; Urine; Urodynamics; Urologic Surgical Procedures - methods; Urology; Vagina; South Korea; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156306

The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD).
This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) < 60 cmH2O in a urodynamic study. Cases of neurogenic bladder, previous SUI surgery, and concomitant cystocele repair were excluded. The primary outcome was treatment success at 12 months, defined by self-reported absence of symptoms, no leakage episodes recorded, and no retreatment.
Among the 157 women who were included in the final analysis, 105 patients received TVT and 52 patients received TOT. Age, underlying diseases, Stamey grade, cystocele grade, and presence of urge incontinence were not significantly different between the two groups. Urodynamic parameters including maximal urethral closing pressure, detrusor overactivity, VLPP, urethral hypermobility (Q-tip ≥ 30°), were also comparable between the two groups. Success rate was significantly higher in the TVT group than in the TOT group (95.2% vs. 82.7%, p = 0.009). On multivariate analysis, only TOT surgery (OR = 3.922, 95%CI = 1.223-12.582, p = 0.022) was a risk factor for failure following surgical treatment.
TVT is more effective than TOT in treatment of female SUI with ISD.