title: Long-term outcomes of transobturator tension-free vaginal tapes as secondary continence procedures.
abstract: OBJECTIVE
  To assess the long-term patient-reported outcomes following TO-TVT as a secondary continence procedure in women with recurrent stress urinary incontinence (R-SUI).
  
  
  METHODS
  A secondary analysis of the 9-year follow-up of the E-TOT study was performed: 341 women with predominant SUI symptoms were randomised to undergo either Inside-out or Outside-in TO-TVT between April 2005 and April 2007. Forty-six women had R-SUI following previously failed continence surgery at time of randomisation and are the basis of this analysis as a one single cohort. Primary outcome was the patient-reported success rate defined as very/much improved on Patient's Global Impression of Improvement (PGI-I). Secondary outcomes included late adverse events and impact on women's quality of life and sexual function. Statistical analysis was performed using SPSS version 23.
  
  
  RESULTS
  Sixty-three per cent completed the 9-year follow-up. The success based on the PGI-I was 62.1% with no significant difference between groups (OR 5.33; 95% CI 1.03, 27.76; p = 0.094). Clinically significant improvement in QoL was found in 84.2%. Adverse events included vaginal erosions (n = 3) and groin pain (n = 2). The small sample size is a limitation in this study; nevertheless, this is one of the largest cohorts reported for women with R-SUI and the first to report the long-term outcomes of TO-TVT as a secondary continence procedure.
  
  
  CONCLUSIONS
  TO-TVT operations are associated with good patient-reported success rates (62%) in women with previous failed continence surgery with up to 9-years follow-up. There is a non-significant trend towards better outcomes with the inside-out TO-TVT.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Second Floor, Aberdeen Maternity Hospital, Foresterhill, AB25 2ZD, Aberdeen, UK. m.abdelfattah@abdn.ac.uk.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cao
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Second Floor, Aberdeen Maternity Hospital, Foresterhill, AB25 2ZD, Aberdeen, UK.
authors.forename: Alyaa
authors.initials: A
authors.lastname: Mostafa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D053825:Suburethral Slings / Q000009:adverse effects / Q000523:psychology; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000523:psychology / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods
keywords: Mid-urethral slings; Stress urinary incontinence; Tension-free vaginal tape; Transobturator tapes; Urinary incontinence