title: Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency.
abstract: OBJECTIVE
  To compare the efficacy of tension-free vaginal tape (TVT) to transobturator tape in the treatment of women with stress urinary incontinence (SUI) and intrinsic sphincter deficiency at 3-year follow-up.
  
  
  METHODS
  One hundred sixty-four women were randomized to either TVT or transobturator tape after diagnosis of urodynamic stress incontinence and intrinsic sphincter deficiency. Concomitant pelvic organ prolapse surgery was not an exclusion criterion. The primary outcome assessed at 3-year follow-up was symptomatic stress incontinence requiring repeat surgery. Secondary outcomes were quality-of-life parameters assessed by validated questionnaires and numerical success score.
  
  
  RESULTS
  One hundred sixty-four women were enrolled in the study. At 3 years, 15 of the 75 (20%) women in the transobturator tape group underwent repeat surgery to correct SUI compared with one of the 72 (1.4%) in the TVT group. In other words, if TVT had been used exclusively, repeat surgery would have been avoided in one in six patients. The risk ratio of repeat surgery was 15 (95% confidence interval 2-113; P<.001) times greater in the transobturator tape group. In the transobturator tape group, the median time to repeat surgery was 15.6 months compared with 43.7 months for TVT (P<.001). The quality-of-life outcomes did show an improvement in both groups before and after surgery but no difference between the two slings in the Urogenital Distress Inventory short form, the Incontinence Impact Questionnaire short form, and a patient-rated numerical success score.
  
  
  CONCLUSIONS
  The long-term cure rates for retropubic TVT are significantly greater than for transobturator tape in women with urodynamic stress incontinence and intrinsic sphincter deficiency. Urethral functions tests such as urethral closure pressure and Valsalva leak point pressures are of value in determining what surgery to perform.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12608000093381.
  
  
  METHODS
  I.
authors.affiliation: Department of Urogynecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia. lschierlitz@mercy.com.au
authors.forename: Lore
authors.initials: L
authors.lastname: Schierlitz
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.forename: Christine
authors.initials: C
authors.lastname: Murray
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.forename: Alison
authors.initials: A
authors.lastname: De Souza
authors.forename: Richard
authors.initials: R
authors.lastname: Hiscock
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011312:Pressure; D016016:Proportional Hazards Models; D011788:Quality of Life; D012086:Reoperation; D012307:Risk Factors; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D013997:Time Factors; D014521:Urethra / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*