title: Clinical and ultrasonographic comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence.
abstract: OBJECTIVE
  The purpose of this study was to compare tension-free vaginal tape (TVT) and the TVT-obturator (TVTO) procedures.
  
  
  METHODS
  Multicenter retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Tertiary teaching hospitals.
  
  
  METHODS
  We reviewed 82 women with urodynamically proven stress incontinence undergoing either TVT (n = 53) or TVTO (n = 29) without concomitant surgery.
  
  
  METHODS
  TVT and TVTO procedure.
  
  
  RESULTS
  All subjects underwent urinalyses, 1-hour pad testing, perineal ultrasonography, and urodynamic studies, as well as validated questionnaires before and 1 year after surgery. Mean operative time was significantly shorter in the TVTO group (16.8 +/- 10.7 minutes vs 28.6 +/- 6.9min, p <.01; unpaired t-test). The subjective and objective cure rates were comparable for the TVT and TVTO groups (p = .085 vs .19, respectively; Fisher's exact test). At rest or during Valsalva, the middle of the TVTO tape localized more distally than that of TVT on ultrasound scanning (p <.01; unpaired t-test). A higher rate of urethral kinking during straining was noted in the TVT group compared with the TVTO group after surgery (87% vs 25%, p <.01; chi2 test). After TVT, maximum urethral closure pressure increased significantly (83.6 +/- 24.6 cm H2O vs 69.2 +/- 25.9 cm H2O, p <.05), but this was not the case in the TVTO group (67.8 +/- 15.0 cm H2O vs 63.2 +/- 12.3 cm H2O, p >.05; paired t test).
  
  
  CONCLUSIONS
  With comparable subjective and objective cure rates, TVTO has the advantages over TVT with shorter operative time. However, the TVTO tape is at a less acute angle and localizes to a more distal part of the urethra, resulting in a lower rate of urethral kinking and less urethral compression.
authors.affiliation: Graduate Institute of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Long
authors.forename: Chun-Shuo
authors.initials: CS
authors.lastname: Hsu
authors.forename: Cheng-Min
authors.initials: CM
authors.lastname: Liu
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Chiu-Lin
authors.initials: CL
authors.lastname: Wang
authors.forename: Eing-Mei
authors.initials: EM
authors.lastname: Tsai
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D053825:Suburethral Slings; D014463:Ultrasonography; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics