TVT versus TOT - A prospective randomized study for the treatment of female stress urinary incontinence at a follow-up of 1 year

Purpose: The aim of this prospective randomized study was to evaluate the safety and efficacy of tension-free vaginal tape (TVT) versus transobturator vaginal tape (TOT) for the surgical therapy of female stress urinary incontinence (SUI). Material and Methods: Clinical and urodynamic examinations were carried out in 110 women suffering from stress urinary incontinence. Mean age was 51 years (range, 37-75). Patients with overactive bladder symptoms, pelvic prolapse and previous surgery for stress urinary incontinence were excluded from the study. The women were randomized into two groups, TVT (n = 52) and TOT (n = 53). The tapes were positioned without tension under the junction between the mid and distal urethra. The women received spinal and general anesthesia according to patient preference. 105 women were re-examined 12-17 months after these procedures. Results: Patient characteristics and urodynamic evaluations were similar in the two groups. The cure rate at follow-up was 86% for the TVT procedure and 84% for the TOT procedure. In both groups urethral pressure profiles demonstrated a significant improvement in Dep.Q (p < 0.05). We observed no prolonged pain or sling rejection. Operation time was significantly shorter in the TOT group (15 min vs 26). No bladder injuries and no vascular (hematoma or bleeding) complications occurred in the TOT group versus 13% (n = 7) in the TVT group. In 5 cases (12%-TVT) and 6 cases (10%-TOT) we observed new onset detrusor instability. Conclusion: The TOT procedure appears to be as effective as TVT for the surgical treatment of female stress urinary incontinence at 15 months follow-up. TOT avoids damage to the urethra and bladder and, therefore, makes cystoscopy unnecessary. Overall, the TOT seems to be a good alternative to the TVT.