title: Inside-out versus outside-in transobturator tension-free vaginal tape: a 5-year prospective comparative study.
abstract: OBJECTIVE
  To compare the 1-year and 5-year outcomes of transobturator tension-free vaginal tape with outside-in and inside-out approaches in women with urinary stress incontinence, and to identify risk factors for treatment failure at 5 years.
  
  
  METHODS
  A prospective observational study was carried out for women with urinary stress incontinence who underwent transobturator tension-free vaginal tape from September 2004 to March 2008 in a tertiary urogynecology center. Women (n = 213) had either an outside-in (n = 124) or inside-out (n = 89) procedure. They were followed up annually until 5 years after the operation. Subjective cure was defined as women not experiencing any urine loss on physical activity. Objective cure was defined as no urine leak at cough during a standard urodynamic study.
  
  
  RESULTS
  At a mean follow up of 59.2 months, the subjective cure rates were 81.7% and 84.1%; the objective cure rate were 82.6% and 82.5% for the outside-in and inside-out approach, respectively. There was no statistically significant difference between the procedures. De novo overactive bladder syndrome (10.6% in outside-in and 14.6% in inside-out approach; P = 0.40) and de novo detrusor overactivity (5.8% in outside-in and 15% in inside-out approach; P = 0.11) was also comparable between the two groups. Complications at the fifth year were low and not significantly different among both methods.
  
  
  CONCLUSIONS
  The outside-in approach and inside-out approach are both safe and effective in treating women with urinary stress incontinence up to 5 years.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Rachel Yau Kar
authors.initials: RY
authors.lastname: Cheung
authors.forename: Symphorosa Shing Chee
authors.initials: SS
authors.lastname: Chan
authors.forename: Ka Wah
authors.initials: KW
authors.lastname: Yiu
authors.forename: Tony Kwok Hung
authors.initials: TK
authors.lastname: Chung
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D053825:Suburethral Slings; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: long-term outcome; transobturator tape; urodynamic stress incontinence