title: Evaluation of transobturator tapes (E-TOT) study: randomised prospective single-blinded study comparing inside-out vs. outside-in transobturator tapes in management of urodynamic stress incontinence: short term outcomes.
abstract: OBJECTIVE
  To compare the "inside-out (TVT-O)" vs. "outside-in (ARIS)" transobturator tapes in the management of female urodynamic stress incontinence (USI) and to identify independent risk factors of failure of transobturator tapes.
  
  
  METHODS
  A prospective, single blinded, randomised trial. Women undergoing transobturator tapes as sole procedure in the period April 2005 and April 2007 were randomised to TVT-O for the inside-out approach and TOT-ARIS for the outside-in approach. The primary outcome measure at 6 months was the absence of USI on urodynamics. Secondary outcomes included; patient-reported success rates, overall patient satisfaction and peri-operative complications.
  
  
  RESULTS
  341 women were recruited: 171 in the outside-in group and 170 in the inside-out. Severe post-operative thigh pain was twice as common in the inside-out group but this was not statistically significant (6.7% vs. 3.5%, p=0.19). 317 women completed the 6 months follow-up; objective cure rates and patient-reported success rates were 85.4 and 80.5%, respectively, with no significant difference between the groups (p=0.28 and p=0.138, respectively). On multivariate analysis: low maximum urethral closure pressure (MUCP) (<30 cm H2O) and previous incontinence surgery were confirmed as independent risk factors for objective failure of transobturator tape with increased odds of failure of 7.06 (2.85-17.48) and 6.22 (2.34-16.52), respectively.
  
  
  CONCLUSIONS
  This study shows no significant differences in the objective cure rates and patient-reported success rates between the "inside-out (TVT-O)" and "outside-in (ARIS)" transobturator tape procedures in the management of female USI at 6 months follow-up. Previous incontinence surgery and low MUCP were significant risk factors for failure of transobturator tapes.
authors.affiliation: Division of Applied Health Sciences, University Of Aberdeen, UK. m.abdelfattah@abdn.ac.uk
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-fattah
authors.forename: Iain
authors.initials: I
authors.lastname: Ramsay
authors.forename: Stewart
authors.initials: S
authors.lastname: Pringle
authors.forename: Chris
authors.initials: C
authors.lastname: Hardwick
authors.forename: Hassan
authors.initials: H
authors.lastname: Ali
mesh_terms: D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011446:Prospective Studies; D019919:Prosthesis Implantation; D011788:Quality of Life; D012720:Severity of Illness Index; D016037:Single-Blind Method; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics