Clinical and ultrasonographic comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence.
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.
Long
Cheng-Yu
CY
Graduate Institute of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hsu
Chun-Shuo
CS
Liu
Cheng-Min
CM
Lo
Tsia-Shu
TS
Wang
Chiu-Lin
CL
Tsai
Eing-Mei
EM
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