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Long-term efficacy of the trans-obturator and retropubic mid-urethral slings for stress urinary incontinence: update from a randomized clinical trial

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Abstract

Purpose

To report the extended long-term results of the use of tension-free vaginal tape(TVT) and trans-obturator tape (TOT) for the treatment of female stress urinary incontinence (SUI).

Methods

A prospective, multicentre randomized clinical trial comparing the use of TVT and TOT was used to evaluate 87 patients. The inclusion criteria were stress or mixed UI associated with urethral hyper mobility (the stress component was clinically predominant), while the exclusion criteria were previous anti-incontinence surgery and/or pelvic organ prolapse. The objective cure criteria were a negative provocative stress test and a negative 1-h pad test, with no further treatment for SUI. The subjective cure criteria were a 3-day voiding diary, quality-of-life questionnaires (UDI6–IIQ7), and patient satisfaction on a scale from 0 to 10.

Results

Eighty-seven patients were evaluated (47 TOT and 40 TVT) at a median follow-up of 100 months. Subjective and objective cure rates were 59.6 and 70.2 % in the TOT group and 75 and 87.5 % in the TVT group. The mid-to-long-term trend was a decreasing continence rate in patients who underwent TOT, compared with a stable rate for TVT. The Kaplan–Meier survival curve showed that continence rate decreased for up to 25 months after surgery, with stabilization thereafter for the TVT group while continuing to drop in the TOT group, with no inter-group difference.

Conclusion

The patients in both groups were highly satisfied at long-term follow-up. The overall continence rate worsened for both groups within 25 months. While the results tend to stabilize in the TVT group, a further decline in the TOT was observed.

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Authors and Affiliations

  1. Department of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

    Elisabetta Costantini, Massimo Lazzeri, Antonella Giannantoni, Alessandro Zucchi & Massimo Porena

  2. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    Ervin Kocjancic

  3. Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, 04100, Latina, Italy

    Antonio Carbone, Giovanni Palleschi & Antonio Luigi Pastore

  4. Department of Internal Medicine, University of Perugia, Perugia, Italy

    Vittorio Bini

Authors
  1. Elisabetta Costantini
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  2. Ervin Kocjancic
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  3. Massimo Lazzeri
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  4. Antonella Giannantoni
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  5. Alessandro Zucchi
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  6. Antonio Carbone
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  7. Vittorio Bini
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  8. Giovanni Palleschi
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  9. Antonio Luigi Pastore
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  10. Massimo Porena
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Corresponding author

Correspondence to Antonio Luigi Pastore.

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Conflict of interest

All authors certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Authors contributions

Protocol/project development: Costantini, Zucchi, Lazzeri, Giannantoni, and Porena; data collection or management: Costantini, Kocjancic, and Zucchi’ data analysis: pastore, Giannantoni, Carbone, Bini, and Palleschi; manuscript writing/editing: Costantini, Kocjancic, Lazzeri, Giannantoni, Zucchi, Carbone, Bini, Palleschi, Pastore, and Porena.

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Costantini, E., Kocjancic, E., Lazzeri, M. et al. Long-term efficacy of the trans-obturator and retropubic mid-urethral slings for stress urinary incontinence: update from a randomized clinical trial. World J Urol 34, 585–593 (2016). https://doi.org/10.1007/s00345-015-1651-z

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  • DOI: https://doi.org/10.1007/s00345-015-1651-z

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