A comparative study of two transobturator tape procedures: 'Outside-in' (TOT) and 'inside-out' (TVT-O) for surgical treatment of female stress urinary incontinence / 대한산부인과학회지

ABSTRACT

OBJECTIVE: To compare the outcomes of the 'outside-in' (TOT) and 'inside-out' (TVT-O) transobturator tape procedures for surgical treatment of female urinary incontinence. METHODS: We enrolled 320 stress urinary incontinence women who could be followed-up and they underwent the TOT procedure (N=184) and TVT-O procedure (N=136) from January 1, 2003 to June 30, 2006. The preoperative evaluation included a history taking, physical examination, residual urine check, pad test, Q-tip test and urodynamic test. And we investigated the patients' characteristics, success rates, operation times, concomitant surgeries, hospital days, hemoglobin changes and complications. RESULTS: There were no statistically significant differences in patients' characteristics and urodynamic tests except the intrinsic sphincter deficiency rate (ISD 5.6% vs. 30.6%, p=0.000). The success rates were similar in both groups (98.4% vs. 97.8%). Most common complication of TOT group is operation site erosion (2.1%), and TVT-O group is thigh or vaginal pain (3.6%). There were noted other complications, such as postoperative urinary retention, de novo urgency and urinary tract infection. Total complication rates of both groups were not statistically different (7.6% vs. 9.5%, p=0.415). There were no statistic differences in the postoperative complication rates of between only TOT group and TOT with colporrhaphy group (p=0.371), also between only TVT-O group and TVT-O with colporrhaphy group (p=0.692). There were no correlation with ISD and postoperative complications in TOT (p=0.373) and TVT-O group (p=0.082). CONCLUSIONS: The two procedures of transobturator tape procedure for female stress urinary incontinence appear to be equally effective and safe. However, long-term follow-up, surgeons' learning course, skill and experience for transobturator tape procedures should be evaluated at further studies.