TVT vs. TVT-O: does surgical approach affect cure rate?

Clinic of Urology MSMSU

Introduction & Objectives:

An objective of the study was comparison of efficacy and safety of tension-free vaginal tape (TVT) applied via retro pubic or transobturator approaches in females suffering stress urinary incontinence (SUI). In order to gain this objective other factors influencing cure rate shall be minimized, such as surgeons' experience, tape characteristics or recurrent incontinence SUI.

Material & Methods:

Since 1999 to 2005, 460 patients with SUI underwent surgical treatment in Urology Dept. of MSMSU. Patients with detrusor over activity, recurrent incontinence and those cases when the tape other than macro pore polypropylene was used were ruled out from the study. Same experienced urologists did the surgery in both groups. Only 310 patients from 460 met these inclusion criteria. In accordance with that 202 patients formed Group 1 when retro pubic TVT was utilized. Group 2 included 108 females treated with TVT via transobturator approach. Mean age in group 1 was 54,7 ± 11,9 yrs. (29 - 76), and 53,6 ± 12,5 yrs. (35 - 79) for group 2 (p = 0,446). There were no significant difference between the group 1 and 2 in matter of menopause (66,6 % vs. 59,3 %; p = 0,54), BMI (24 ± 3,2 vs. 25,2 ± 4,3; p = 0,058) and parity (2,3 ± 0,9 vs. 2,0 ± 1,9; p = 0,6) accordingly. Mean postoperative follow-up ranged 4 ± 4,3 yrs for group 1 and 3,1 ± 3,14 yrs for group 2 patients (p= 0,061).

Results:

According to our results, the cure rate in group 1 (retro pubic TVT - 93,53 %) and group 2 (transobturator TVT - 92,95 %) has no significant difference (p = 0,58). Comparison of complication rate showed no statistical significance as well. Four patients in each group failed treatment (1,98 % in TVT group and 3,70 % after TVT-O; p = 0,36). One patient in group 1 developed bladder perforation (0,49 %). No bladder injury was found in group 2. De novo urgency appeared in 4,46 % and 3,70 % cases in group 1 and 2 (p = 0,73). Hematomas requiring intervention were noticed in 2,97 % cases in group 1 and 0,93 % cases in group 2(p = 0,24).

Conclusions:

We have ruled out additional affecting factors like tape bio-physical characteristics, surgeons' experience and cases with recurrent SUI for adequate comparison of retro pubic and transobruratorTVT. The study results revealed no difference in efficacy and safety when comparing retro pubic and transobturator approaches of TVT placement. There is no significant difference in complication rate for both methods. Retro pubic and transobturator TVT procedures are equally effective and safe in treatment of female SUI. Surgical approach of TVT application does not affect cure rate.