title: Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis.
abstract: OBJECTIVE
  One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies.
  
  
  METHODS
  This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5 years) efficacy and safety of MUS in women affected by SUI were included.
  
  
  RESULTS
  A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out-in and in-out) were 61.6% (95% CI: 58.5-64.8%) and 76.5% (95% CI: 73.8-79.2%), and 64.4% (95% CI: 61.4-67.4%) and 81.3% (95% CI: 78.9-83.7%) respectively. When considering TOT using the out-in technique (TOT-OI) and TOT using the in-out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7-60.7%) and 81.6% (95% CI: 78.8-84.4%), and 68.8% (95% CI: 64.9-72.7%) and 81.3% (95% CI: 77.9-84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49-1.53], I2= 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46-1.55], I2= 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97-9.51], I2= 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40-8.48], I2= 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54-1.28], I2= 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17-3.46], I2= 86%, p = 0.73).
  
  
  CONCLUSIONS
  Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132, Genova, Italy. ulrm@me.com.|Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy. ulrm@me.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: Department of Urology, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Finazzi Agrò
authors.affiliation: Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Soligo
authors.affiliation: Department of Urology, Careggi University Hospital, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Li Marzi
authors.affiliation: Department of Urogynaecology, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Digesu
authors.affiliation: Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000706:statistics & numerical data; D053825:Suburethral Slings / Q000706:statistics & numerical data*; D013995:Time; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Sling; Stress urinary incontinence; Surgery; TOT; TVT