title: Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings.
abstract: OBJECTIVE
  The purpose of this study is to compare retropubic tension-free vaginal tape (TVT) with transobturator out-in TOT and in-out TVT-O for female stress urinary incontinence. Uroflow rate was primary; continence rates, quality of life (QoL) and complication pattern were secondary endpoints.
  
  
  METHODS
  A prospective randomised trial with 2:1:1 randomisation at two Swiss teaching hospitals. Patients were followed up at 12 months.
  
  
  RESULTS
  Eighty TVT, 40 transobturator tape (TOT) and 40 TVT-O were randomised. At 12 months, there was no difference in Qmax among the groups. Continence was comparable (≥ 89%). QoL was improved significantly in all groups (P < 0.05). Five vaginal tape exposures occurred (one TVT, four TOT, zero TVT-O; P = 0.028). Two percent (1/52) of sexually active patients after TVT, 17% (5/29) after TOT, but 0% (0/25) after TVT-O reported de novo female sexual dysfunction (P = 0.011). We considered this clinically important enough to stop enrolment.
  
  
  CONCLUSIONS
  There was no difference for Qmax at 12 months between TVT, TOT and TVT-O. Female sexual dysfunction and tape exposure may be higher with a transobturator tape.
authors: Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland. david.scheiner@usz.ch
authors: David A
authors: DA
authors: Scheiner
authors: Cornelia
authors: C
authors: Betschart
authors: Sandra
authors: S
authors: Wiederkehr
authors: Burkhardt
authors: B
authors: Seifert
authors: Daniel
authors: D
authors: Fink
authors: Daniele
authors: D
authors: Perucchini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057239:Early Termination of Clinical Trials; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D018709:Statistics, Nonparametric; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014554:Urination / Q000502:physiology*; D014563:Urodynamics