Related Experiment Video
Updated: Oct 21, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-term efficacy and complications of a multicentre randomised controlled trial comparing retropubic and
Objective:
There are concerns regarding the risks of mid-urethral slings (MUS) for stress urinary incontinence (SUI), particularly because of the lack of long-term data. We compare patient-reported outcomes of a multicentre randomised controlled trial of retropubic (TVT, GYNECARE™) versus transobturator (TOT, MONARC™) tape surgery at 12 years.
Design And Setting:
A multicentre study was performed in 11 tertiary referral centres.
Population:
A cohort of 180 participants from the original trial, the majority of whom had mixed urinary incontinence.
Methods:
Postal questionnaire survey of patient-reported outcome measures using the International Consultation on Incontinence Questionnaire, Patient Global Impression of Improvement questionnaire (PGI-I) and a numeric rating scale pain questionnaire.
Main Outcome Measures:
Comparison of the efficacy and complications between the TVT and TOT procedures in the long term.
Results:
A total of 110/180 responses were received: 55 for TVT and 55 for TOT. The mean follow-up was 12.8 ± 0.29 years (SD). TVT was significantly superior to TOT: 41.8% TVT with no SUI, versus 21.8% TOT (P = 0.04). Urgency urinary incontinence (UUI) was the most bothersome urinary symptom: 14.5% of respondents reported UUI after TVT and TOT. This was an improvement from the baseline levels: 61.8% TVT and 76.4% TOT. Seventeen patients (9 TVT and 8 TOT) out of 121 reported moderate or severe pain with severe pain in 3 with TVT and 2 with TOT. Overall, 80% TVT and 77% TOT participants reported their symptoms as improved on the PGI-I.
Conclusions:
TVT is superior to TOT for SUI cure. Efficacy is reduced by 12 years. There is low incidence of severe vaginal or groin pain. Careful patient counselling on long-term outcomes is required. The Retropubic tape appears to be an effective treatment for the majority of women with SUI.
Tweetable Abstract:
Retropubic tape has superior efficacy to transobturator tape. Complications are comparable with low rates.
