Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures.
OBJECTIVE
To sequentially compare the postoperative urodynamic changes in patients with urodynamic stress incontinence (USI) who underwent tension-free vaginal tape (TVT) or transobturator tape (Monarc TOT) procedure.


METHODS
Between January 2001 and December 2005, 50 consecutive patients with USI who underwent TVT (n = 24) or TOT (n = 26) procedures were studied, and postoperative urodynamic changes were sequentially compared by one-way ANOVA test with Bonferroni's correction.


RESULTS
There were no significant between-group postoperative changes in urodynamic parameters of uroflowmetry, filling and voiding cystometry. However, the TVT group had a higher objective cure rate (100% vs. 69.2%, P = 0.004) by pad test, urethral closure pressure area [40.4 cm(2) H(2)O, 95% confidence interval (CI) = 22.3-58.5 cm(2) H(2)O vs. 3.9 cm(2) H(2)O, 95% CI = -10.9 to 18.7 cm(2) H(2)O, P = 0.036], and continence area (34.4 cm(2) H(2)O, 95% CI = 16.1-52.7 cm(2) H(2)O vs. -3.5 cm(2) H(2)O, 95% CI = -16.7 to 9.8 cm(2) H(2)O, P = 0.001) at 12 months than those of the TOT group.


CONCLUSIONS
This study demonstrated that tension-free vaginal tape and transobturator tape procedures had no significant difference of impact on bladder voiding and storage functions. However, this study demonstrated that TVT procedure resulted in a higher cure rate with a significantly increased urethral closure pressure area and continence area than did TOT procedure 12 months postoperatively. Thus, TVT procedure might be a better therapeutic choice to achieve continence than TOT.
Hsiao
Sheng-Mou
SM
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Pan-Chiao, Taipei, Taiwan, Republic of China.
Chang
Ting-Chen
TC
Chen
Chi-Hau
CH
Lin
Ho-Hsiung
HH
D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery