title: Evaluation of transobturator tension-free vaginal tapes in the surgical management of mixed urinary incontinence: 3-year outcomes of a randomized controlled trial.
abstract: OBJECTIVE
  We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of mixed urinary incontinence in women at 3-year followup.
  
  
  METHODS
  In this secondary analysis of a prospective, single-blind, randomized controlled trial 83 of 341 women (24%) with mixed urinary incontinence were randomized to undergo an outside-in (Aris® transobturator sling system 42) or inside-out (TVT™-O 41) transobturator tension-free vaginal tape procedure. Patients were contacted by postal questionnaire at a minimum of 3 years postoperatively. The primary outcome was the patient reported success rate, defined as very much improved/much improved on the PGI-I (Patient Global Impression of Improvement). Secondary outcomes included improvement in quality of life, impact on preoperative urgency/urgency incontinence and repeat surgical treatment for stress urinary incontinence. Outcomes at 3 years were compared between groups (outside-in vs inside-out) and to 1-year outcomes. Analysis was performed using SPSS® version 20 with significance levels set at p = 0.05.
  
  
  RESULTS
  A total of 66 women with mixed urinary incontinence completed the 3-year followup (outside-in 35 vs inside-out 31). In each group 2 women underwent further continence surgery. The patient reported success rate was 73.8% with no significant differences between the groups (OR 1.035, 95% CI 0.342-3.134, p = 0.951). Overall 34 (50.1%) and 26 women (56.5%) reported cure of preoperative urgency and urgency incontinence, respectively, and 52 women (86.7%) had a clinically significant improvement in quality of life (18 points or more in total KHQ [King's Health Questionnaire] score) compared to baseline.
  
  
  CONCLUSIONS
  Transobturator tape procedures are associated with a good (73.8%) patient reported success rate at a minimum of 3 years of followup in the surgical management of mixed urinary incontinence in women with predominant stress urinary incontinence symptoms. Nearly half of the women reported cure of urgency/urgency incontinence.
authors.affiliation: University of Aberdeen, Aberdeen, United Kingdom. Electronic address: m.abdelfattah@abdn.ac.uk.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
authors.affiliation: University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Hopper
authors.affiliation: University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Alyaa
authors.initials: A
authors.lastname: Mostafa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation; D016037:Single-Blind Method; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000601:surgery*
keywords: MUI; MUS; OAB; QoL; RCT; RP-TVT; SUI; TO-TVT; UI; mid urethral sling; mixed urinary incontinence; overactive bladder; quality of life; randomized controlled trial; retropubic tension-free vaginal tape; stress urinary incontinence; suburethral slings; transobturator tension-free vaginal tape; urgency incontinence; urinary incontinence