A Prospective Randomized Trial Comparing Transobturator Vaginal Tape and Tension Free Vaginal Tape Obturator Inside-Out for Surgical Treatment of Stress Incontinence

Lim, Ju Hyun; Kim, Myung Ki; Park, Young Kyung

Abstract

PURPOSE
The aim of our study was to compare the outcomes of the transobturator vaginal tape(TOT) and tension free vaginal tape obturator inside-out(TVT-O) procedures in patients with stress urinary incontinence.
MATERIALS AND METHODS
Between August 2004 and March 2005, 77 women with stress incontinence were randomly assigned to either TOT(n=36) or TVT-O(n=41). The preoperative evaluation included a careful history taking, physical examination, stress test, a quality of life questionnaire and a comprehensive urodynamic examination. Follow up evaluation was carried out after 1 month, 6 months. Patients assessment was made by a clinical examination in the first 1 month and satisfaction rate expressed and uroflowmetry with postvoid residual urine to compare voiding disorder suggesting bladder outlet obstruction after 6 months. RESULTS: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar between the 2 groups. Mean operative time was similar between the 2 groups(17 min vs 16 min). The rate of postoperative urinary retention was 8.3%(n=3) in the TOT group and 9.8%(n=4) in the TVT-O group. The cutting of tape was required to treat urinary retention in 2.8%(n=1) of the TOT group and 4.9%(n=2) of the TVT-O group at 14 days after the procedure. The rates of cure(66.7% vs 65.9%), improvement(27.8% vs 29.3%), and failure (5.6% vs 4.9%) were similar for the TOT and TVT-O groups, respectively. In terms of bladder outlet obstruction, no difference were found after TOT and TVT-O. CONCLUSION: Both procedures are equally a simple, safe and effective treatment for female stress urinary incontinence in terms of rate of cure, operation time and complications. However, further studies and long term follow-up are needed for the complications and cure rate.