Obstetrics & Gynecology

Skip Navigation LinksHome > January 2007 - Volume 109 - Issue 1 > Retropubic Compared With Transobturator Tape Placement in Tr...
Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000249607.82768.a1
Original Research

Retropubic Compared With Transobturator Tape Placement in Treatment of Urinary Incontinence: A Randomized Controlled Trial

Laurikainen, Eija MD1; Valpas, Antti MD, PhD2; Kivelä, Aarre MD, PhD3; Kalliola, Tuomo MD4; Rinne, Kirsi MD5; Takala, Teuvo MD6; Nilsson, Carl Gustaf MD, PhD7

Free Access
Article Outline
Collapse Box

Author Information

From the 1Department of Obstetrics and Gynecology, Turku University Central Hospital, 2Central-Ostrobothnian Central Hospital, 3Oulu University Hospital, 4Central-Finland Central Hospital, 5Kuopio University Hospital, 6Päijät-Häme Central Hospital, and 7Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.

The authors thank Mikko Taalikka, MSc, for performing the statistical analysis.

Corresponding author: Professor Carl Gustaf Derrick Nilsson, Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, Haartmaninkatu 2, Helsinki, Finland 00029 HUS; e-mail: carl.nilsson@hus.fi.

Collapse Box


OBJECTIVE: To compare the intraoperative and immediate postoperative performance of the retropubic tension-free vaginal tape (TVT) procedure with that of the transobturator tension-free vaginal tape (TVT-O) procedure as primary treatment for female urinary stress incontinence.

METHODS: Randomized multicenter comparative trial including four university hospitals and three central hospitals in Finland. Assessment preoperatively and 2 months postoperatively included a cough stress test and the following condition-specific quality of life questionnaires: the Urinary Incontinence Severity Score (UISS), the Detrusor Instability Score, the Incontinence Impact Questionnaire–Short Form, the Urogenital Distress Inventory–Short Form, and a visual analog scale (VAS). Operation time, theater time, hospital stay, intraoperative and immediate postoperative complications were recorded.

RESULTS: Of the 273 originally randomized patients, 267 underwent the allocated operation, 136 in the TVT group and 131 in the TVT-O group. No significant differences in objective or subjective cure rates were detected. Patients in the TVT-O group had a significantly longer hospital stay, needed significantly more postoperative opiate analgesia and had significantly more complications than the patients in the TVT group. Patients in both groups had a significant postoperative improvement in quality of life, as indicated by the results of all the questionnaires used, with no difference between the groups.

CONCLUSION: The TVT and the TVT-O procedures perform equally in terms of objective and subjective cure. The statistically significant higher complication rate in the TVT-O group is not regarded as clinically significant.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00379314


The tension-free vaginal tape (TVT) procedure, first described by Ulmsten and Petros,1 is the most widely documented minimally invasive surgical procedure for treatment of female stress urinary incontinence. It has become the standard minimally invasive procedure in many centers. Good short- and long-term cure rates, varying between 84% and 95%, have been reported.2–4 The most common complications related to the TVT procedure are voiding difficulties (8–17%), bladder perforations (2.7–17%), and symptoms of urgency (5–15%), all of which are complications normally associated with incontinence surgery.4–12 Because of the blind passage of the tape retropubically, a potential risk of injury to organs within the pelvis exists. Bowel perforations, necrotizing fascitis, and injury to large blood vessels have indeed been reported.13–18

To avoid these more serious complications, Delorme19 developed a procedure by which the tape is passed from a lateral approach through the obturator foramen on each side to support the mid-urethra, thus sparing the retropubic space. More recently de Leval20 developed an inside-out transobutator tape technique (TVT-O). Both transobturator techniques are thought to minimize the risk of serious complications as well as postoperative voiding difficulties. Short-term cure rates with the transobturator technique are promising.19–23

The present multicenter randomized clinical trial was initiated to compare the TVT procedure with the TVT-O procedure (both using the same polypropylene tape) in terms of intraoperative and immediate postoperative complications, cure rates, and health economic aspects. We here report on the intraoperative and the first 2-month postoperative events.

Back to Top | Article Outline


Seven centers in Finland (four university hospitals and three central hospitals) participated in the clinical trial. Eight specialists in gynecology with wide experience in urogynecology and TVT surgery were specially trained in performing the TVT-O procedure and accepted to participate in this study. After the training period, they had performed at least five of the new TVT-O procedures independently before including patients into the study.

From March 2004 to November 2005, 273 women were randomly assigned to either the TVT or the TVT-O procedure. Acceptance was obtained from the Helsinki University Central Hospital Ethics Committee, and each patient gave written informed consent. The investigator called the randomization center to enter the patient in the allocated group. Patients were randomized using computer-generated random allocations in a ratio of 1:1 in balanced blocks of four.

The sample size calculation was performed assuming a 95% success rate with the TVT procedure and that a 10% difference in either success rate or rates of complications would be clinically important. With 70% power to show 10% difference, the sample size should be 260 patients, 130 patients in each group.

Inclusion and exclusion criteria are shown in the box. Preoperative evaluation comprised patient history, urine analysis, and physical examination including a cough stress test performed with the patient in a semilitothomy position and having arrived for the visit with her bladder comfortably filled (200–300 mL).

Figure. No caption a...
Image Tools

A 24-hour pad weighing test was included to be performed preoperatively and at the 1-, 3-, and 5-year follow-up visits. The following validated questionnaires were to be used preoperatively, at the 2-month follow-up, and at the 1-, 3-, and 5-year follow-up visits for condition-specific assessment: the Urinary Incontinence Severity Score (UISS), the Detrusor Instability Score (DIS), a visual analog scale (VAS 0–100), the Incontinence Impact Questionnaire–Short Form (IIQ-7), and the Urogenital Distress Inventory–Short Form (UDI-6).24–26 Quality-of-life assessment was carried out with the EuroQoL-5D questionnaire, which includes questions that assess mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. A thermometer-like scale, on which the patient draws a line to indicate how good or bad the state of her health is at the moment, was also used.27,28

The TVT and the TVT-O procedures were performed as originally described by Ulmsten1 and de Leval,20 respectively. Correct position of the patient on the operating table was given careful attention. The angle of the thighs in the stirrups was to be 70° during the TVT procedure and between 90° and 110° during the TVT-O procedure. Both procedures were performed under local anesthesia, using 75–135 mL prilocaine plus adrenalin diluted to 0.25%. Light intravenous sedation was used, enabling the patient to cooperate in performing the intraoperative cough test. The cough test was performed with a bladder volume of 300 mL, with the goal of adjusting the tape to allow a drop of saline to escape from the outer meatus of the urethra on strong coughing. Cystoscopy, using a 70° optic lens, was performed twice during the TVT procedure, after each passing of the needle retropubically, and once during the TVT-O procedure at the end of the operation to assure an intact bladder. The vaginal incision was made in the same fashion in both procedures, ie, a 1–1.5 cm sagittal incision starting 0.5 cm from the outer meatus of the urethra. The polypropylene tape was identical in both procedures, and commercially available TVT and TVT-O kits were used (Gynecare, Ethicon, Johnson & Johnson, Somerville, NJ). The TVT-O procedure was an “inside-out” procedure. A specific introducer, a winged guide, was pushed into the dissected pathway from the vaginal incision toward the obturator membrane to protect the bladder when the helical TVT-O passer was brought from the vaginal incision through the obturator membrane to its exit point 2 cm above the urethral level and 2 cm lateral to the tight folds. All patients received intravenous prophylactic antibiotic therapy at the beginning of the operation: a single dose of cefuroxime 1,500 mg or metronidazole 500 mg. No urinary catheter was left in the bladder, and the patients were asked to void spontaneously in the 3 hours immediately after the operation. Postvoid residual urine volumes were measured by catheterization or by ultrasonography.

Postoperative evaluation at 2 months was performed by a study nurse and an independent physician or the operating surgeon. The evaluation consisted of a clinical examination, a cough stress test performed in the same manner as preoperatively, residual urine measurement, and urine analysis. Postoperative bleeding and infection and other complications, rehospitalization, and the true duration of the sick leave were recorded. The Urinary Incontinence Severity Score, Detrusor Instability Score, visual analog scale, EuroQoL-5D, Incontinence Impact Questionnaire–Short Form, and Urogenital Distress Inventory–Short Form questionnaires were completed. Objectively cured was defined as a negative stress test. Subjective cure rates were evaluated by the above mentioned quality-of-life questionnaires.

Statistical analysis was performed with SAS 8.2 for Windows (SAS Institute, Cary, NC). For analysis of continuous variables, the independent-sample t test and the paired-sample t test were used to calculate statistical differences between and within the study groups. The χ2 test was applied for categorical variables. P<.05 was considered to indicate statistical significance.

Back to Top | Article Outline


Two hundred sixty-seven patients of the originally randomized 273 patients underwent the allocated operation, 136 in the TVT group and 131 in the TVT-O group. After randomization six patients dropped out. Four patients refused the operation, and one patient underwent an eye operation at the time she was scheduled for her incontinence procedure. In one patient, who was randomized to the TVT-O operation, the procedure could not technically be performed and was therefore altered to a TVT procedure. This patient is excluded from the analysis. One operation in the TVT-O group was erroneously performed under spinal anesthesia. This patient is included in the analysis. Table 1 shows the demographics of both groups. Figure 1 shows the flow chart of the trial. There was no statistically significant difference in any parameters between groups except the duration of symptoms, which was significantly shorter in the TVT group: 7 years (range 1–30) compared with 10 years (range 1–30), P=.003.

Table 1
Table 1
Image Tools
Fig. 1
Fig. 1
Image Tools

Table 2 shows operation time, theater time, hospital stay, need for analgesics, length of sick leave, and intraoperative and postoperative complications for both groups. The mean hospital stay was significantly shorter in the TVT group 14 (range 4–54) hours compared with 17 (range 5–80) hours, P=.027. Significantly more patients in the TVT-O group required postoperative opiate analgesia than in the TVT group, 28 (21.4%) compared with 16 (11.8%), P=.034, respectively. The number of patients complaining of postoperative groin pain was significantly greater in the TVT-O group than in the TVT group, 21 (16.0%) compared with 2 (1.5%), P<.001, respectively. The groin pain of the TVT patients disappeared within 5–10 days, whereas the groin pain of the TVT-O patients persisted for 2 weeks in ten patients, for 4 weeks in three patients, and for 2 months in one patient, the rest having pain for a few days.

Table 2
Table 2
Image Tools

There were no major intraoperative complications. One patient in the TVT group needed two units of blood transfusion because of a retropubic hematoma, and one patient in the TVT group had a intraoperative bleeding of 800 mL, which was managed by drainage on the side of bleeding. One patient in the TVT group experienced a wound infection. Eight percent of patients in the TVT group and 13% in the TVT-O group, respectively, were postoperatively treated because of urinary tract infections.

Postoperative voiding parameters are presented in Table 3. Return to normal voiding, defined as a postvoid residual urine volume less than 100 mL, was significantly more rapid in the TVT group than in the TVT-O group: mean (range) of 6 (1–54) hours compared with 9 (1–168) hours, P=.033. One patient in the TVT group needed repeated catheterization on the second postoperative day, while two patients in the TVT-O group were managed by self-catheterization for 1 and 3 weeks, respectively.

Table 3
Table 3
Image Tools

The objective cure rate, defined as a negative cough stress test at the 2-month follow-up visit, was similar in both groups, with 134 of 136 patients (98.5%) in the TVT group and 125 of 131 patients (95.4%) in the TVT-O group having negative cough stress tests. Subjective cure, measured by the condition-specific quality-of-life questionnaires were equal in both groups, showing a highly significant improvement, P<.001, Table 4. The EuroQoL-5D index values used as instruments to assess general health for five dimensions also showed a highly significant improvement at the 2-month follow-up, P<.001, with no difference between the groups, Tables 5 and 6.

Table 4
Table 4
Image Tools
Table 5
Table 5
Image Tools
Table 6
Table 6
Image Tools

Fifty patients (27 in the TVT group and 23 in the TVT-O group) had urgency symptoms before intervention, which was defined as having both urgency and frequency of moderate or severe degree in their Urogenital Distress Inventory–Short Form questionnaire. At the 2month follow-up visit, only one patient in each group had urgency symptoms by the same definition. Thus, 96 % in both groups were relieved of their urgency by surgery. Three patients in both groups had new symptoms of urgency postoperatively, either frequency or urgency, moderate or severe in their Urogenital Distress Inventory, or a score greater than 7 in the Detrusor Instability Score, the rate of de novo urge symptoms thus being 2.3%

Back to Top | Article Outline


None of the surgical procedures for treatment of female urinary stress incontinence that are described in the literature are ideal in the sense of resulting in complete cure without risks of complications. The TVT procedure is proven to be as effective as open colposuspension29 and more effective than laparoscopic mesh colposuspension30 in randomized clinical trials. Clinical reports also suggest that the TVT is associated with fewer postoperative complications than colposuspension.29 Reports on intraoperative complications of more severe nature, resulting from the inability to see into the retropubic space when performing the TVT operation have, however, encouraged surgeons to find alternative routes for placing the suburethral tape. However, modifications of a successful procedure do not necessarily result in improvement of clinical outcome.

The present randomized trial was designed to detect possible differences in complication and success rates when using identical tapes placed suburethrally either by the retropubic or the obturator route. The data presented here are part of the results of one of the few randomized clinical trials within the field of incontinence surgery that has succeeded in recruiting the number of patients that power calculations required.

Statistically significant differences were found. The TVT procedure was associated with a shorter postoperative hospital stay, a smaller number of patients complaining of postoperative pain, and apparently therefore, a lesser need of postoperative opiate analgesia than the TVT-O procedure. Return to normal voiding was also more rapid in the TVT group. Although statistically significant, the differences between the groups were small and hardly clinically significant. The total numbers of registered intra- and immediate postoperative complications were 18 (13.2%) in the TVT group and 41 (31.3%) in the TVT-O group. This difference was also significant but mostly because of the greater number of complaints of groin pain in the TVT-O patients, a problem that was resolved already at the 2-month follow-up visit.

The success rate of incontinence operations is usually reported either as short- or long-term subjective and/or objective cure rates. A 2-month follow-up period is too short for objective outcome measures to reveal the benefits of surgery, whereas subjective outcome measures potentially reveal the impact of adverse events on patients degree of satisfaction already at 2 months. Of objective outcome measures, only the stress test was performed at the 2-month follow-up visit, showing no difference between the groups, but a more than 95% success rate in both groups. There was a highly significant improvement in scores on the condition-specific and general health questionnaires compared with preoperative figures, with no difference between the groups.

De novo urge symptoms have been a problem with the traditional incontinence operations.31,32 It is, therefore, remarkable that fewer than 3% of the patients in both groups of the present trial developed new symptoms of urge. Also noteworthy is the finding that, as many as 96% of that 19% of patients who suffered preoperatively from urge symptoms were relieved of this problem at 2 months after the intervention. There was no difference between the groups regarding the effect of surgery on urge symptoms. Corresponding findings on relief of urge symptoms after TVT surgery have been reported in the literature.3,33 The present results do not support the opinion presented in the literature describing the transobutrator route that it causes fewer urge symptoms than the retropubic one.34

The fear of simple complications, such as bladder perforation, as well as more severe intra-abdominal organ injury, has been the objective of modifying the TVT procedure. The obturator route of placing the suburethral tape has been claimed to be more safe.21 The first prospective observational studies on the performance of the TVT procedure reported low rates of minor complication and no major or severe complications.2–4,9,35 The only published systematic follow-up reports on nationwide registries of complications associated with the TVT procedure also indicated a low rate of minor complications and very rare cases of major complications.8,36 As the TVT procedure has gained worldwide popularity, case reports on major complications have appeared.13,15,17,18 The number of prospective observational studies on the performance of the different transobturator procedures is growing, revealing the same optimism about low risk of complications. No systematic registry of complications associated with the transobturator procedure has yet been published. Reports on both bladder perforations and other complications not thought to occur with the obturator procedure have begun to appear (Hamilton Boyles S, Gregory WT, Clark A, Edwards SR. Complications associated with trans-obturator sling procedures [abstract]. Neurourol Urodyn 2005;24:423–5).22,37

Introduction of new surgical procedures for treatment of stress incontinence requires comparison with established and widely accepted surgical operations within randomized clinical trials to be able to detect equality or superiority in effectiveness and in rates of complications. Even modifications of effective operations need the same thorough evaluation before superiority can be claimed. Many of the new minimally invasive mid-urethral tape procedures have been offered for routine clinical use with the clinical experience of only a small number of patients with inadequate follow-up. The present study is a randomized, multicenter clinical trial in which the TVT-O procedure is compared with the TVT procedure. Contrary to what had been expected, we did not find a lower rate of complications with the TVT-O procedure. The overall number of minor complications was actually higher in the TVT-O group. All the complications in both groups were, however, minor and caused no clinical problem to the patients when evaluated 2-months postoperatively. The overall rate of complications was low in both groups, indicating that, with proper training and standardization of procedures, even multicenter studies come out with good results.

Back to Top | Article Outline


1. Ulmsten U, Petros P. Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 1995;29:75–82.

2. Olsson I, Kroon U. A three-year postoperative evaluation of tension-free vaginal tape. Gynecol Obstet Invest 1999;48:267–9.

3. Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2001;12 suppl:S5–8.

4. Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Magatti F, et al. Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2001;12 suppl:S24–7.

5. Ulmsten U. The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence. Urologe A 2001;40:269–73.

6. Soulie M, Cuvillier X, Benaissa A, Mouly P, Larroque JM, Bernstein J, et al. The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: a French prospective multicentre study. Eur Urol 2001;39:709–14.

7. Arunkalaivanan AS, Barrington JW. Randomized trial of porcine dermal sling (Pelvicol implant) vs tension-free vaginal tape (TVT) in the surgical treatment of stress incontinence: a questionnaire-based study. Int Urogynecol J Pelvic Floor Dysfunct 2003;14:17–23.

8. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 2002;81:72–7.

9. Ulmsten U, Falconer C, Johnson P, Jomaa M, Lanner L, Nilsson CG, et al. A multicentre study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1998;9:210–3.

10. Wang A, Lo TS. Tension-free vaginal tape: a minimally invasive solution to stress urinary incontinence in women. J Reprod Med 1998;43:429–34.

11. Moran P, Ward KL, Johnson D, Smirni WE, Hilton P, Bibby J. Tension-free vaginal tape for primary genuine stress incontinence: a two-centre follow-up study. BJU Int 2000;86:39–42.

12. Boustead GB. The tension-free vaginal tape for treating female stress urinary incontinence. BJU Int 2002;89:687–93.

13. Leboeuf L, Tellez CA, Ead D, Gousse AE. Complication of bowel perforation during insertion of tension-free vaginal tape. J Urol 2003;170:1310–1.

14. Amna MB, Randrianantenaina A, Michel F. Colic perforation as a complication of tension-free vaginal tape procedure. J Urol 2003;170:2387.

15. Fourie T, Cohen PL. Delayed bowel erosion by tension-free vaginal tape (TVT). Int Urogynecol J 2003;14:362–4.

16. Johnson DW, Elhajj M, O`Brien-Best Miller HJ, Fine PM. Necrotizing fasciitis after tension-free vaginal tape (TVT) placement. Int Urol J 2003;14:291–3.

17. Vierhout ME. Severe hemorrhage complicating tension-free vaginal tape (TVT): a case report. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:139–40.

18. Zilbert A, Farrell S. External iliac artery laceration during tension-free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:141–3.

19. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of urinary stress incontinence in women [in French]. Prog Urol 2001;11:1306–13.

20. de Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 2003;44:724–30.

21. Mellier G, Benayed B, Bretones S, Pasquier JC. Suburethral tape via the obturator route: is the TOT a simplification of the TVT? Int Urugynecol J Pelvic Floor Dysfunct 2004;15:227–32.

22. Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Ballanger P, et al. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multi-center study. Eur Urol 2004;46:102–6.

23. Waltregny D, Reul O, Bonnet P, de Leval J. Inside-out transobturator vaginal tape (TVT-O): short-term results of a prospective study. Neurourol Urodyn 2004;23:22.

24. Stach-Lempinen B, Kujansuu E, Laippala P, Metsänoja R. Visual analogue scale, urinary incontinence severity score and 15 D-psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women. Scand J Urol Nephrol 2001;35:476–83.

25. Kauppila A, Alavaikko P, Kujansuu E. Detrusor instability score in the evaluation of stress urinary incontinence. Acta Obstet Gynecol Scand 1982;61:137–41.

26. Uebersax J, Wyman J, Shumaker S, McClish D, Fantl A. Short forms to access life of quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and Urogenital Distress Inventory. Neurourol Urodyn 1995;14:131–9.

27. Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med 2001;33:328–36.

28. Manga A, Sculpher MJ, Ward K, Hilton P. A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. BJOG 2003;110:255–62.

29. Ward KL, Hilton P; UK and Ireland TVT Trial Group. A prospective multicentre randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 2004;190:324–31.

30. Valpas A, Kivelä A, Penttinen J, Kujansuu E, Haarala M, Nilsson CG. Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol 2004;104:42–9.

31. Alcalay M, Monga A, Stanton SL. Burch colposuspension: a 10–20 year follow-up. Br J Obstet Gynaecol 1995;102:740–5.

32. Dietz HP, Wilson PD. Colposuspension success and failure: a long-term objective follow-up study. Int Urogynecol J Pelvic Floor Dysfunct 2000;11:346–51.

33. Rezapour M, Ulmsten U. Tension-free vaginal tape (TVT) in women with mixed urinary incontinence: a long-term follow-up, Int Urogynecol J Pelvic Floor Dysfunct 2001;12 suppl:S15–8.

34. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transobturator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol 2005;48:799–804.

35. Nilsson CG, Kuuva N. The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. BJOG 2001;108:414–9.

36. Tamussino KF, Hanzal E, Kolle D, Ralph G, Riss PA; Austrian Urogynecological Working Group. Tension-free vaginal tape operation: results of the Austrian registry. Obstet Gynecol 2001;98:732–6.

37. de Tayrac R, Deffieux X, Droupy S, Chauveaud-Lambling Calvanese-Benamour L, Fernandez H. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 2004;190:602–8.

Cited By:

This article has been cited 52 time(s).

International Urogynecology Journal
Pain after suburethral sling insertion for urinary stress incontinence
Duckett, J; Baranowski, A
International Urogynecology Journal, 24(2): 195-201.
International Urogynecology Journal
Long-term outcomes of the Ajust(A (R)) Adjustable Single-Incision Sling for the treatment of stress urinary incontinence
Naumann, G; Hagemeier, T; Zachmann, S; Al-Ani, A; Albrich, S; Skala, C; Laterza, R; Linaberry, M; Koelbl, H
International Urogynecology Journal, 24(2): 231-239.
Journal of Minimally Invasive Gynecology
Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up
Heinonen, P; Ala-Nissila, S; Raty, R; Laurikainen, E; Kiilholma, P
Journal of Minimally Invasive Gynecology, 20(1): 73-78.
Expert Review of Medical Devices
The use of synthetic mesh and the management of mesh extrusion in vaginal surgery
Sheth, S; Chughtai, B; Lee, R; Tyagi, R; Kavaler, E
Expert Review of Medical Devices, 9(4): 437-442.
Journal of Obstetrics and Gynaecology
Trans-obturator tape: A single centre experience
Al-Singary, W; Gayen, A; Wilby, D; Patel, HRH
Journal of Obstetrics and Gynaecology, 29(1): 40-43.
Better Short-term Outcomes With the U-Method Compared With the Hammock Technique for the Implantation of the TVT-SECUR Under Local Anesthesia
Gagnon, LO; Tu, LM
Urology, 75(5): 1060-1064.
International Urogynecology Journal
A multi-centre, randomised clinical control trial comparing the retropubic (RP) approach versus the transobturator approach (TO) for tension-free, suburethral sling treatment of urodynamic stress incontinence: the TORP study
Barry, C; Lim, YN; Muller, R; Hitchins, S; Corstiaans, A; Foote, A; Greenland, H; Frazer, M; Rane, A
International Urogynecology Journal, 19(2): 171-178.
Przeglad Menopauzalny
A medium-term assessment of efficacy in surgical treatment of female stress urinary incontinence with the retropubic and transobturator approach
Szymanski, J; Siekierski, PB; Baranowski, W
Przeglad Menopauzalny, 7(5): 248-255.

Gynecologie Obstetrique & Fertilite
Suburethral sling procedures for stress urinary incontinence
Sergent, F; Gay-Crosier, G; Marpeau, L
Gynecologie Obstetrique & Fertilite, 37(4): 353-357.
Progres En Urologie
Guidelines for the surgical treatment of female urinary stress incontinence in women using the suburethral sling
Hermieu, JF; Debodinance, P
Progres En Urologie, 20(): S112-S131.

Journal of Urology
Factors influencing the outcome of mid urethral sling procedures for female urinary incontinence
Paick, JS; Cho, MC; Oh, SJ; Kim, SW; Ku, JH
Journal of Urology, 178(3): 985-989.
Panminerva Medica
Evaluation and treatment of female urinary incontinence
Gamble, T; Sand, PK
Panminerva Medica, 49(3): 159-175.

American Journal of Obstetrics and Gynecology
Transobturator tapes for stress urinary incontinence: Results of the Austrian registry
Tamussino, K; Hanzal, E; Koelle, D; Tammaa, A; Preyer, O; Umek, W; Bjelic-Radisic, V; Enzelsberger, H; Lang, PFJ; Ralph, G; Riss, P
American Journal of Obstetrics and Gynecology, 197(6): -.
ARTN 634.e1
International Urogynecology Journal
Body mass index as a risk factor for cystotomy during suprapubic placement of mid-urethral slings
Dunivan, GC; Connolly, A; Jannelli, ML; Wells, EC; Geller, EJ
International Urogynecology Journal, 20(9): 1127-1131.
Actas Urologicas Espanolas
Effectiveness evaluation of tension-free vaginal tapes in the treatment of urinary incontinence and satisfaction of 241 patients
Gutierrez, IZ; Valero, JD; Botija, JB; Medina, TP; Fernandez, MD; Arenas, JMB
Actas Urologicas Espanolas, 32(6): 637-641.

International Urogynecology Journal
Comparative results of two techniques to treat stress urinary incontinence: synthetic transobturator and aponeurotic slings
Tcherniakovsky, M; Fernandes, CE; Bezerra, CA; Del Roy, CA; Wroclawski, ER
International Urogynecology Journal, 20(8): 961-966.
European Journal of Obstetrics & Gynecology and Reproductive Biology
Surgical management of urinary stress incontinence in women: A historical and clinical overview
Hinoul, P; Roovers, JP; Ombelet, W; Vanspauwen, R
European Journal of Obstetrics & Gynecology and Reproductive Biology, 145(2): 219-225.
Risk of Infection After Midurethral Synthetic Sling Surgery: Are Postoperative Antibiotics Necessary?
Swartz, M; Ching, C; Gill, B; Li, JB; Rackley, R; Vasavada, S; Goldman, HB
Urology, 75(6): 1305-1308.
European Urology
TVT-O for the treatment of female stress urinary incontinence: Results of a prospective study after a 3-year minimum follow-up
Waltregny, D; Gaspar, Y; Reul, O; Hamida, W; Bonnet, P; de Leval, J
European Urology, 53(2): 401-410.
Bju International
Short-term assessment of a tension-free vaginal tape for treating female stress urinary incontinence
Oliveira, R; Silva, A; Pinto, R; Silva, J; Silva, C; Guimaraes, M; Dinis, P; Cruz, F
Bju International, 104(2): 225-228.
Cochrane Database of Systematic Reviews
Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women
Ogah, J; Cody, JD; Rogerson, L
Cochrane Database of Systematic Reviews, (4): -.
ARTN CD006375
Obstetrics and Gynecology Clinics of North America
Use of Mesh and Materials in Pelvic Floor Surgery
Murphy, M
Obstetrics and Gynecology Clinics of North America, 36(3): 615-+.
International Urogynecology Journal
TOT for treatment of stress urinary incontinence: how should we assess its equivalence with TVT?
EL-Hefnawy, AS; Wadie, BS; El Mekresh, M; Nabeeh, A; Bazeed, MA
International Urogynecology Journal, 21(8): 947-953.
International Journal of Gynecology & Obstetrics
Transobturator tape procedure versus tension-free vaginal tape for treatment of stress urinary incontinence
Wang, W; Zhu, L; Lang, J
International Journal of Gynecology & Obstetrics, 104(2): 113-116.
International Urogynecology Journal
Irritative symptoms are the main predictor of satisfaction rate in women after transobturator tape procedures
But, I; Pakiz, M
International Urogynecology Journal, 20(7): 791-796.
Journal of Urology
Risk Factors for Trocar Injury to the Bladder During Mid Urethral Sling Procedures
Stav, K; Dwyer, PL; Rosamilia, A; Schierlitz, L; Lim, YN; Lee, J
Journal of Urology, 182(1): 174-179.
Journal of Obstetrics and Gynaecology
Two-year comparison of tension-free vaginal tape and transobturator tape for female urinary stress incontinence
George, S; Begum, R; Thomas-Philip, A; Thirumalakumar, L; Sorinola, O
Journal of Obstetrics and Gynaecology, 30(3): 281-284.
Health and Quality of Life Outcomes
Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence
Gil, KM; Somerville, AM; Cichowski, S; Savitski, JL
Health and Quality of Life Outcomes, 7(): -.
International Urogynecology Journal
Single incision mini-sling versus a transobutaror sling: a comparative study on MiniArc (TM) and Monarc (TM) slings
De Ridder, D; Berkers, J; Deprest, J; Verguts, J; Ost, D; Hamid, D; Van der Aa, F
International Urogynecology Journal, 21(7): 773-778.
Acta Obstetricia Et Gynecologica Scandinavica
Trans-obturator suburethral tape for female stress incontinence: a cohort of 254 women with 1-year to 2-year follow-up
Poza, JL; Pla, F; Sabadell, J; Sanchez-Iglesias, JL; Martinez-Gomez, X; Xercavins, J
Acta Obstetricia Et Gynecologica Scandinavica, 87(2): 232-239.
International Urogynecology Journal
Management of persistent groin pain after transobturator slings
Roth, TM
International Urogynecology Journal, 18(): 1371-1373.
European Urology
Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: Results of a multicentre randomised trial
Porena, M; Costantini, E; Frea, B; Giannantoni, A; Ranzoni, S; Mearini, L; Bini, V; Kocjancic, E
European Urology, 52(5): 1481-1491.
International Urogynecology Journal
The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update
Waltregny, D; de Leval, J
International Urogynecology Journal, 20(3): 337-348.
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction
Complications of mid urethral sling procedures for surgical treatment of female stress urinary incontinence
Bader, G; Koskas, M
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 38(8): S201-S211.

European Urology
Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: A systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices
Novara, G; Galfano, A; Boscolo-Berto, R; Secco, S; Cavalleri, S; Ficarra, V; Artibani, W
European Urology, 53(2): 288-309.
Journal of Urology
Complications of Mid Urethral Slings: Important Outcomes for Future Clinical Trials
Daneshgari, F; Kong, W; Swartz, M
Journal of Urology, 180(5): 1890-1897.
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction
Female stress urinary incontinence first line surgical treatment
Debodinance, P; Hermieu, JF; Lucot, JP
Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 38(8): S182-S200.

International Urogynecology Journal
A randomized trial comparing TVT with TVT-O: 12-month results
Rinne, K; Laurikainen, E; Kivela, A; Aukee, P; Takala, T; Valpas, A; Nilsson, CG
International Urogynecology Journal, 19(8): 1049-1054.
Neurourology and Urodynamics
Attachment of a Sling Rescue Suture to Midurethral Tape for Management of Potential Postoperative Voiding Dysfunction
Shobeiri, SA; Nihira, MA
Neurourology and Urodynamics, 28(8): 990-994.
Obstetrics and Gynecology Clinics of North America
Surgical Treatment for Stress and Urge Urinary Incontinence
Wai, CY
Obstetrics and Gynecology Clinics of North America, 36(3): 509-+.
International Urogynecology Journal
TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence
Araco, F; Gravante, G; Sorge, R; Overton, J; De Vita, D; Sesti, F; Piccione, E
International Urogynecology Journal, 19(7): 917-926.
International Urogynecology Journal
Tvt Obturator System Versus Tvt Secur: A Randomized Controlled Trial, Short Term Results
Hinoul, P; Vervest, HA; Venema, P; Den Boon, J; Milani, A; Roovers, JP
International Urogynecology Journal, 20(): S213.

International Urogynecology Journal
Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence
Ballert, KN; Kanofsky, JA; Nitti, VW
International Urogynecology Journal, 19(3): 335-340.
Journal of Materials Science-Materials in Medicine
Materials characterization and histological analysis of explanted polypropylene, PTFE, and PET hernia meshes from an individual patient
Wood, AJ; Cozad, MJ; Grant, DA; Ostdiek, AM; Bachman, SL; Grant, SA
Journal of Materials Science-Materials in Medicine, 24(4): 1113-1122.
Progres En Urologie
ACT (R) device: What place in the treatment of female urinary incontinence?
Nacir, M; Ballanger, P; Donon, L; Bernhard, JC; Douard, A; Marit-Ducamp, E; Ferriere, JM; Pasticier, G
Progres En Urologie, 23(4): 276-282.
International Urogynecology Journal
A comparative study of a single-incision sling and a transobturator sling: clinical efficacy and urodynamic changes
Sun, MJ; Sun, R; Li, YI
International Urogynecology Journal, 24(5): 823-829.
Nature Reviews Urology
Surgical management of female SUI: is there a gold standard?
Cox, A; Herschorn, S; Lee, L
Nature Reviews Urology, 10(2): 78-89.
Clinical Obstetrics and Gynecology
Midurethral Slings for Stress Urinary Incontinence
Clinical Obstetrics and Gynecology, 51(1): 124-135.
PDF (315) | CrossRef
Current Opinion in Obstetrics and Gynecology
Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence
Lim, YN; Dwyer, PL
Current Opinion in Obstetrics and Gynecology, 21(5): 428-433.
PDF (307) | CrossRef
Current Opinion in Urology
What's new in slings: an update on midurethral slings
Roth, CC; Winters, JC; Woodruff, AJ
Current Opinion in Urology, 17(4): 242-247.
PDF (123) | CrossRef
Current Opinion in Urology
A critical overview of the evidence base for the contemporary surgical management of stress incontinence
Koch, Y; Zimmern, P
Current Opinion in Urology, 18(4): 370-376.
PDF (100) | CrossRef
Current Opinion in Urology
To sling or not to sling at the time of anterior vaginal compartment repair
Togami, JM; Chow, D; Winters, JC
Current Opinion in Urology, 20(4): 269-274.
PDF (165) | CrossRef
Back to Top | Article Outline

© 2007 The American College of Obstetricians and Gynecologists



Looking for ABOG articles? Visit our ABOG MOC II collection. The selected Green Journal articles are free through the end of the calendar year.


If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Article Tools



Article Level Metrics