title: Comparison of Effectiveness between Tension-Free Vaginal Tape (TVT) and Trans-Obturator Tape (TOT) in Patients with Stress Urinary Incontinence and Intrinsic Sphincter Deficiency.
abstract: BACKGROUND
  The aim of this study was to compare the two types of mid-urethral slings for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD).
  
  
  METHODS
  This retrospective study included patients who underwent tension-free vaginal tape (TVT) procedure or transobturator tape (TOT) procedure by a single surgeon for SUI with ISD, defined as Valsalva leak point pressure (VLPP) < 60 cmH2O in a urodynamic study. Cases of neurogenic bladder, previous SUI surgery, and concomitant cystocele repair were excluded. The primary outcome was treatment success at 12 months, defined by self-reported absence of symptoms, no leakage episodes recorded, and no retreatment.
  
  
  RESULTS
  Among the 157 women who were included in the final analysis, 105 patients received TVT and 52 patients received TOT. Age, underlying diseases, Stamey grade, cystocele grade, and presence of urge incontinence were not significantly different between the two groups. Urodynamic parameters including maximal urethral closing pressure, detrusor overactivity, VLPP, urethral hypermobility (Q-tip ≥ 30°), were also comparable between the two groups. Success rate was significantly higher in the TVT group than in the TOT group (95.2% vs. 82.7%, p = 0.009). On multivariate analysis, only TOT surgery (OR = 3.922, 95%CI = 1.223-12.582, p = 0.022) was a risk factor for failure following surgical treatment.
  
  
  CONCLUSIONS
  TVT is more effective than TOT in treatment of female SUI with ISD.
authors.affiliation: Department of Urology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Hyeong Gon
authors.initials: HG
authors.lastname: Kim
authors.affiliation: Department of Urology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Hyoung Keun
authors.initials: HK
authors.lastname: Park
authors.affiliation: Department of Urology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Paick
authors.affiliation: Department of Urology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
authors.forename: Woo Suk
authors.initials: WS
authors.lastname: Choi
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D014521:Urethra / 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*