Long-term Outcomes of TOT and TVT Procedures for the Treatment of Female Stress Urinary Incontinence: a Systematic Review and Meta-analysis

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2017 Feb 19

PMID 28213797

Citations 21

Authors

Umberto Leone Roberti Maggiore

Enrico Finazzi Agro

Marco Soligo

Vincenzo Li Marzi

Alex Digesu

Maurizio Serati

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypotheses: 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], I = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46-1.55], I = 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], I = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40-8.48], I = 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], I = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17-3.46], I = 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.

Citing Articles

The Impact of Pelvic Organ Prolapse on the Long-Term Outcomes of Transobturator Tape (TOT) Procedures-A Retrospective Study.

Hillmeyer A, Kennes L, Strauss M, Lube K, Stickeler E, Najjari L J Clin Med. 2025; 14(1.

PMID: 39797242 PMC: 11721789. DOI: 10.3390/jcm14010159.

Dyspareunia and pelvic pain: comparison of mid-urethral sling methods 10 years after insertion.

Lundmark Drca A, Alexandridis V, Andrada Hamer M, Teleman P, Westergren Soderberg M, Ek M Int Urogynecol J. 2023; 35(1):43-50.

PMID: 37428179 PMC: 10811085. DOI: 10.1007/s00192-023-05585-3.

Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence.

Salo H, Sova H, Laru J, Talvensaari-Mattila A, Nyyssonen V, Santala M Int Urogynecol J. 2023; 34(9):2249-2256.

PMID: 37074367 PMC: 10506929. DOI: 10.1007/s00192-023-05527-z.

Clinical Outcomes of Mid-Urethral Sling (MUS) Procedures for the Treatment of Female Urinary Incontinence: A Multicenter Study.

Chmaj-Wierzchowska K, Raba G, Dykczynski P, Wilczak M, Turlakiewicz K, Latanska I J Clin Med. 2022; 11(22).

PMID: 36431133 PMC: 9695694. DOI: 10.3390/jcm11226656.

The efficacy and complications of retropubic tension-free vaginal tapes after 20 years: A prospective observational study.

OLeary B, McCreery A, Redmond A, Keane D BJOG. 2022; 130(1):107-113.

PMID: 36053874 PMC: 10087949. DOI: 10.1111/1471-0528.17282.

References

Novara G, Artibani W, Barber M, Chapple C, Costantini E, Ficarra V . Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010; 58(2):218-38. DOI: 10.1016/j.eururo.2010.04.022. View

ElSheemy M, Fathy H, Hussein H, Elsergany R, Hussein E . Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study. Int Urogynecol J. 2015; 26(10):1533-40. DOI: 10.1007/s00192-015-2725-6. View

Tommaselli G, Carlo C, Formisano C, Fabozzi A, Nappi C . Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis. Int Urogynecol J. 2015; 26(9):1253-68. DOI: 10.1007/s00192-015-2645-5. View

Zhang Z, Zhu L, Xu T, Lang J . Retropubic tension-free vaginal tape and inside-out transobturator tape: a long-term randomized trial. Int Urogynecol J. 2015; 27(1):103-11. DOI: 10.1007/s00192-015-2798-2. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009; 62(10):1006-12. DOI: 10.1016/j.jclinepi.2009.06.005. View

Khan Z, Nambiar A, Morley R, Chapple C, Emery S, Lucas M . Long-term follow-up of a multicentre randomised controlled trial comparing tension-free vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women. BJU Int. 2014; 115(6):968-77. DOI: 10.1111/bju.12851. View

Costantini E, Kocjancic E, Lazzeri M, Giannantoni A, Zucchi A, Carbone A . Long-term efficacy of the trans-obturator and retropubic mid-urethral slings for stress urinary incontinence: update from a randomized clinical trial. World J Urol. 2015; 34(4):585-93. DOI: 10.1007/s00345-015-1651-z. View

Tommaselli G, DAfiero A, Carlo C, Formisano C, Fabozzi A, Nappi C . Tension-free vaginal tape-obturator and tension-free vaginal tape-Secur for the treatment of stress urinary incontinence: a 5-year follow-up randomized study. Eur J Obstet Gynecol Reprod Biol. 2015; 185:151-5. DOI: 10.1016/j.ejogrb.2014.12.012. View

Ross S, Tang S, Eliasziw M, Lier D, Girard I, Brennand E . Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial. Int Urogynecol J. 2015; 27(6):879-86. DOI: 10.1007/s00192-015-2902-7. View

10.

Haylen B, Ridder D, Freeman R, Swift S, Berghmans B, Lee J . An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2009; 21(1):5-26. DOI: 10.1007/s00192-009-0976-9. View

11.

Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, De Souza A . Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012; 119(2 Pt 1):321-7. DOI: 10.1097/AOG.0b013e31823dfc73. View

12.

Serati M, Bauer R, Cornu J, Cattoni E, Braga A, Siesto G . TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up. Eur Urol. 2013; 63(5):872-8. DOI: 10.1016/j.eururo.2012.12.022. View

13.

Cheung R, Chan S, Yiu K, Chung T . Inside-out versus outside-in transobturator tension-free vaginal tape: a 5-year prospective comparative study. Int J Urol. 2013; 21(1):74-80. DOI: 10.1111/iju.12196. View

14.

Valpas A, Ala-Nissila S, Tomas E, Nilsson C . TVT versus laparoscopic mesh colposuspension: 5-year follow-up results of a randomized clinical trial. Int Urogynecol J. 2014; 26(1):57-63. DOI: 10.1007/s00192-014-2454-2. View

15.

Chong E, Khan A, Anger J . The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep. 2011; 12(5):358-62. DOI: 10.1007/s11934-011-0209-x. View

16.

Chun J, Song M, Yoo D, Han J, Hong B, Choo M . A Comparative Study of Outside-In and Inside-Out Transobturator Tape Procedures for Female Stress Urinary Incontinence: 7-Year Outcomes. Low Urin Tract Symptoms. 2015; 6(3):145-50. DOI: 10.1111/luts.12052. View

17.

Asicioglu O, Gungorduk K, Besimoglu B, Ertas I, Yildirim G, Celebi I . A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence. Int J Gynaecol Obstet. 2014; 125(1):73-7. DOI: 10.1016/j.ijgo.2013.09.026. View

18.

Angioli R, Plotti F, Muzii L, Montera R, Benedetti Panici P, Zullo M . Tension-free vaginal tape versus transobturator suburethral tape: five-year follow-up results of a prospective, randomised trial. Eur Urol. 2010; 58(5):671-7. DOI: 10.1016/j.eururo.2010.08.004. View

19.

Lim R, Liong M, Leong W, Khan N, Yuen K . Effect of Stress Urinary Incontinence on the Sexual Function of Couples and the Quality of Life of Patients. J Urol. 2016; 196(1):153-8. DOI: 10.1016/j.juro.2016.01.090. View

20.

Schimpf M, Rahn D, Wheeler T, Patel M, White A, Orejuela F . Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014; 211(1):71.e1-71.e27. DOI: 10.1016/j.ajog.2014.01.030. View