Retropubic versus transobturator slings: Medium-term satisfaction and overactive bladder outcomes

Area of Science:

• Urology
• Gynecology
• Female Pelvic Medicine and Reconstructive Surgery

Background:

• Stress urinary incontinence (SUI) significantly impacts quality of life.
• Mid-urethral sling procedures, including retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT), are common surgical treatments for SUI.
• Comparative data on medium-term patient satisfaction and overactive bladder (OAB) symptom outcomes between TVT and TOT are essential for clinical decision-making.

Purpose of the Study:

• To compare the medium-term outcomes of retropubic tension-free vaginal tape (TVT) versus transobturator tape (TOT) for the surgical management of stress urinary incontinence (SUI).
• To evaluate patient satisfaction rates following TVT and TOT procedures.
• To assess the impact of TVT and TOT on overactive bladder (OAB) symptoms in patients with pre-existing OAB.

Main Methods:

• Prospective, single-surgeon cohort study of women with SUI undergoing either TVT or TOT.
• Follow-up at 26-41 months included chart review and patient interviews assessing satisfaction (≥75% = satisfied).
• Statistical analysis utilized Mann-Whitney U-test for continuous and Fisher's exact test for categorical variables; P < 0.05 was significant.

Main Results:

• High patient satisfaction was reported by 88.0% for TVT and 89.3% for TOT (P ≈ 1.00), with results robust to sensitivity analyses.
• Among patients with pre-existing OAB, symptom improvement was observed in 78.3% (TVT) and 61.1% (TOT) (P = 0.47).
• Complication rates were low and similar between groups, with one bladder perforation noted in the TVT group.

Conclusions:

• Both TVT and TOT procedures demonstrate high patient satisfaction and efficacy in improving OAB symptoms at medium-term follow-up (26-41 months).
• The low complication rates observed in both groups reinforce their established safety profile.
• These findings support the continued use of both TVT and TOT as safe and effective surgical options for managing SUI in the medium term.