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

This study compares medium-term outcomes of retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) for stress urinary incontinence (SUI), focusing on patient satisfaction and overactive bladder (OAB) symptoms.

This prospective, single-surgeon cohort study included women with SUI who underwent TVT or TOT at a single center (July 2021-October 2022). Follow-up was conducted at 26-41 months through chart review and patient interviews. Satisfaction was rated on a 0-100% global scale (≥75% = satisfied). Outcomes and complications followed International Continence Society criteria. Continuous variables were compared with the Mann-Whitney U-test and categorical variables with Fisher's exact test. Sensitivity analysis addressed the effects of loss to follow-up. Statistical significance was set at P < 0.05.

Fifty-three women (25 TVT, 28 TOT) completed follow-up. Satisfaction (≥75%) was reported by 88.0% of TVT and 89.3% of TOT patients (P ≈ 1.00). Sensitivity analyses assuming all lost patients were satisfied or unsatisfied did not alter statistical significance (P ≈ 1.00 and P = 0.54, respectively). Among women with pre-existing overactive bladder, improvement in symptoms occurred in 78.3% (18/23) of TVT and 61.1% (11/18) of TOT patients (P = 0.47). One bladder perforation occurred in the TVT group; other complications were infrequent and similar between groups.

Both TVT and TOT provided high satisfaction and improvement in OAB symptoms at 26-41 months, with low complication rates. These findings suggest that both procedures remain safe and effective in the medium term, reinforcing their established role in the surgical management of SUI.