Tension-free vaginal and transobturator suburethral-tape positioning in stress urinary incontinence treatment: Effectiveness and management of complications

Objective: The aim of this study was to compare the effectiveness of tension-free vaginal tape (TVT) versus transobturator tape (TOT). Design: This was a prospective selected cohort study of 169 women with urodynamically proven stress urinary incontinence (SUI). Methods: Women affected by intrinsic sphinteric deficiency, defined as stress incontinence identified on a urodynamic study and associated with little or no urethral mobility and low Valsalva leak-point pressure (?60 cm H2O), according to the McGuire classification, were selected for the TVT approach, whereas the other subjects underwent a TOT positioning procedure. Results: In total, 169 patients were enrolled, with urodynamically proven SUI; 61 patients were assigned to the TVT and 108 to the TOT group, whereas those with previous incontinence surgery and pelvic organ prolapse greater than stage I were excluded. The Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) were filled in preoperatively and then at 3, 6, and 12 months, annually, postoperatively. The overall cure rate for TOT was 93% and, for the TVT approach, was 90%. Vaginal erosions occurred in 2 women of both groups. During the TVT procedure, in 7 cases and in 4 for the TOT procedure, the bladder was perforated. Further, 4 patients of the TOT and 7 of the TVT group refereed a "de novo" urgency. Also, 4 patients in the TOT and 9 in the TVT group had voiding disorders. Median operative time was 20 minutes in the TOT and 28 in the TVT group. Women started to be sexually active about 39 days after surgery. Patients were able to resume usual activities at 19 (TOT group) and 23 days (TVT group). Conclusions: TVT and TOT are easy to perform but are not free from complications, which are avoidable by an accurate preoperative diagnosis and a correct follow-up.