Tension-Free Vaginal Tape Versus Transobturator Vaginal Tape Inside-Out for the Treatment of Female Stress Urinary Incontinence
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Tension-Free Vaginal Tape Versus Transobturator Vaginal Tape Inside-Out for the Treatment of Female Stress Urinary Incontinence,HOSSAM M. ALKADY and ADEL EID
Abstract
Objective: The purpose of this study is to prospectively and randomly compare tension-free vaginal tape (TVT) with the transobturator inside-out tension free vaginal tape (TVT-O) for the surgical treatment of stress urinary incontinence (SUI) in women.
Study Design: A prospective randomized observational clinical study carried out at Kuwait Maternity Hospital between January 2007 and January 2009.
Patients and Methods: Thirty women with genuine stress urinary incontinence were randomly assigned to either TVT (n=15) or TVT-O (n=15). The pre- and post-operative evalu-ation included a symptom, specific questionnaire, urogynae-cological examination, comprehensive urodynamic studies, stress test and the assessment of postoperative efficacy and safety at 6 and 12 months. The main outcome measures were operative time, operative blood loss, intraoperative complica-tions, ambulation, duration of hospital stay, postoperative complications, catheter duration, post-voided residual urine volume, cure and/or improvement rates (objective and sub-jective).
Results: Patients characteristics, preoperative quality of life and urodynamic evaluation were similar in the 2 groups. Mean operative time was significantly shorter in the TVT-O group than in TVT group (22±34 vs 15±25 minutes, respec-tively), (p<0.001). There was no significant difference in the operative blood loss, duration of hospital stay and post-voided residual urine volume between the two operative procedures (p>0.05). No bladder injury occurred in the TVT-O group versus 6.7% (n=1) in the TVT group (p>0.05). The incidence of suprapubic haematoma was 6.7% (n=1) in the TVT group versus 0% in the TVT-O group. The rate of postoperative urinary retention was 13% (n=2) in the TVT group versus 6.7% (n=1) in the TVT-O group (p>0.05). The rates of cure (86.6% vs 93.3%) improvement (6.7% vs 6.7%), and failure (6.7% vs 0%) were similar for the TVT and TVT-O groups, respectively (p>0.05). No vaginal or urethral erosions occurred in TVT-O group while urethral erosion was observed in one patient (6.7%) 6 months after TVT procedure. In terms of bladder outlet obstruction, no differences were found after TVT and TVT-O.
Conclusion: The results of this study indicate that tran-sobturator inside-out surgical technique for treating SUI is
feasible, accurate, and quick. This technique avoids damage to the urethra and bladder and, therefore, makes cystoscopy not necessary. TVT-O appears to be equally efficient to TVT for surgical treatment of stress urinary incontinence after 12 months follow-up. TVT-O route is appealing and promissory because of its simplicity and anticipated increased safety.