The aim of this review was to assess the recent evidence on the effectiveness and complications of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for female stress urinary incontinence between January 2008 and March 2009.
A meta-analysis of recent studies revealed that the short-term objective cure rate was borderline worse in the TOT group compared with TVT [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.37–1.00; P = 0.05]. Bladder perforation (OR 12.23; 95% CI 2.86–52.34) was significantly more common, whereas groin/thigh pain was significantly less in the TVT group (OR 0.32; 95% CI 0.11–0.92; P = 0.022). Postoperative urinary retention was slightly more in women undergoing TVT than those undergoing TOT (OR 1.6; 95% CI 0.90–3.12; P = 0.06). The rates of vaginal erosion (OR 0.34; 95% CI 0.09–1.33), de-novo urgency (OR 1.21; 95% CI 0.52–2.79) and urinary tract infection (OR 0.88; 95% CI 0.56–1.38) were comparable in both procedures. In addition, TVT appeared to be more obstructive than TOT, as evidenced by ultrasonographic and urodynamic findings. Changes in sexual function need further investigation because this issue has not been well studied for either sling procedure.
TOT has the advantages over TVT with shorter operative time and a relatively lower complication rate. For women with intrinsic sphincter deficiency, however, TVT appears to be a better option because it is more obstructive.
aGraduate Institute of Medicine, College of Medicine, Taiwan
bDepartment of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
cDepartment of Obstetrics and Gynecology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
dDepartment of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
eDepartment of Public Health, College of Health Science, Taiwan
fDepartment of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Correspondence to Dr Chun-Shuo Hsu, Department of Obstetrics and Gynecology, Buddhist Dalin Tzu Chi General Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist. 812, Kaohsiung, Taiwan Tel: +886 7 803 6783ext3450; fax: +886 7 806 5068; e-mail: K83263@kmhk.kmu.edu.tw