title: Long-term outcomes of transobturator tapes in women with stress urinary incontinence: E-TOT randomised controlled trial.
abstract: OBJECTIVE
  To assess the long-term patient-reported outcomes and adverse events following surgery using transobturator tension-free vaginal tape (TO-TVT).
  
  
  METHODS
  Postal follow-up of the E-TOT randomised controlled trial (RCT).
  
  
  METHODS
  A tertiary urogynaecology centre in the UK; all procedures took place in 2005-2007.
  
  
  METHODS
  A total of 341 women were randomised to receive either 'inside-out' TVT-O (Ethicon Inc., Somerville, NJ, USA) or 'outside-in' TOT-ARIS (Coloplast Corp., Minneapolis, MN, USA) procedure.
  
  
  METHODS
  Long-term follow-up (median 9 years) using validated symptom severity and quality-of-life (QoL) questionnaires. Statistical analysis was performed using spss 22.0 and GraphPad statistics 2014.
  
  
  METHODS
  The primary outcome was patient-reported success rate, defined as 'very much/much improved' on the Patient's Global Impression of Improvement (PGI-I) scale. Secondary outcomes included impact on women's QoL and sexual function, adverse events, and re-operations for stress urinary incontinence (SUI).
  
  
  RESULTS
  The adjusted response rate was 67.8% and the median follow-up period was 9.2 years. The overall patient-reported success rate was 71.6%, with a further 14% reporting 'improvement', and there was no significant difference between inside-out and outside-in groups (P = 0.76; odds ratio, OR 0.8676; 95% confidence interval, 95% CI 0.4744-1.5865). The success rate showed a significant reduction compared with 1-year results (71.6 versus 80%; P = 0.004), but a clinically insignificant reduction when compared with the 3-year results (71.6 versus 73.1%). A total of 7.96% underwent further continence surgery, the tape extrusion/erosion rate was 4.5%, and groin pain/discomfort was reported in 4.32%, with only 1.4% requiring treatment.
  
  
  CONCLUSIONS
  This is the largest and longest follow-up randomised trial of TO-TVT. TO-TVT is associated with 71.6% patient-reported success rate, 4% groin pain/discomfort, and 8% continence re-operation rate at a median of 9 years follow-up. The success rate is almost stable after 3 years.
  
  
  CONCLUSIONS
  The success rate for TO-TVT is 71% at 9 years, and is almost stable after 3 years; 8% required repeat surgery.
authors.affiliation: Urogynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: D
authors.initials: D
authors.lastname: Karmakar
authors.affiliation: Urogynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mostafa
authors.affiliation: Urogynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: M
authors.initials: M
authors.lastname: Abdel-Fattah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D011184:Postoperative Period; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D053825:Suburethral Slings / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000523:psychology / Q000601:surgery*
keywords: 
  ARIS
  ; TVT-O; stress urinary incontinence; tension-free vaginal tapes; transobturator tape