Which type of mid-urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape.
OBJECTIVE
To compare tension-free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency.


METHODS
Retrospective study.


METHODS
Gynecology department, Bakirkoy Women and Childrens' Hospital, Istanbul.


METHODS
Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid-urethral sling procedures (TVT = 180, TOT = 120).


METHODS
Before the operation, a complete medical history was taken and a gynecologic examination was performed. Subjects with detrusor overactivity or previous sling surgery were excluded. Clinical checkups were conducted at 3, 6, and 12 months, and then annually.


METHODS
Intraoperative complications, postoperative complications, and subjective cure rates.


RESULTS
There were no significant differences in demographics between the TVT and TOT groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy. At a mean follow-up of 31.2 +/- 9.1 (range 12-46) months, the overall cure rates were 78.3% for TVT and 52.5% TOT (p < 0.0001). The risk of treatment failure in women who received TOT was 4.9 times higher than in women who underwent TVT. There were no significant differences in perioperative and postoperative complication rates between the two groups.


CONCLUSIONS
TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.
Gungorduk
Kemal
K
Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Childrens' Hospital, Istanbul, Turkey. maidenkemal@yahoo.com
Celebi
Ibrahim
I
Ark
Cemal
C
Celikkol
Ozgu
O
Yildirim
Gokhan
G
D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000175:diagnosis / Q000601:surgery*