International Urogynecology Journal

, Volume 28, Issue 8, pp 1119–1130 | Cite as

Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis

  • Umberto Leone Roberti MaggioreEmail author
  • Enrico Finazzi Agrò
  • Marco Soligo
  • Vincenzo Li Marzi
  • Alex Digesu
  • Maurizio Serati
Review Article


Introduction and hypotheses

One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies.


This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5 years) efficacy and safety of MUS in women affected by SUI were included.


A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out–in and in–out) were 61.6% (95% CI: 58.5–64.8%) and 76.5% (95% CI: 73.8–79.2%), and 64.4% (95% CI: 61.4–67.4%) and 81.3% (95% CI: 78.9–83.7%) respectively. When considering TOT using the out–in technique (TOT-OI) and TOT using the in–out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7–60.7%) and 81.6% (95% CI: 78.8–84.4%), and 68.8% (95% CI: 64.9–72.7%) and 81.3% (95% CI: 77.9–84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49–1.53], I 2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46–1.55], I 2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97–9.51], I 2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40–8.48], I 2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54–1.28], I 2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17–3.46], I 2 = 86%, p = 0.73).


Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.


Sling Stress urinary incontinence Surgery TOT TVT 



Autologous fascial sling




Intravaginal slingplasty


Laparoscopic mesh colposuspension


Overactive bladder


Pubovaginal sling


Randomised controlled trials


Surgeon-tailored polypropylene mesh


Stress urinary incontinence


Transobturator tape (both out–in and in–out)


TOT using the out–in technique


Transvaginal tape using the retropubic technique


TOT using the in–out technique




Xenograft sling


Compliance with ethical standards


No funding was received for this study.

Conflicts of interest


Supplementary material

192_2017_3275_MOESM1_ESM.docx (1.3 mb)
ESM 1 (DOCX 1282 kb)


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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  • Umberto Leone Roberti Maggiore
    • 1
    • 2
    Email author
  • Enrico Finazzi Agrò
    • 3
  • Marco Soligo
    • 4
  • Vincenzo Li Marzi
    • 5
  • Alex Digesu
    • 6
  • Maurizio Serati
    • 7
  1. 1.Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino—ISTGenovaItaly
  2. 2.Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of GenovaGenovaItaly
  3. 3.Department of UrologyTor Vergata University HospitalRomeItaly
  4. 4.Department of Women, Mothers and Neonates, Buzzi Children’s Hospital, ASST Fatebenefratelli SaccoUniversity of MilanMilanItaly
  5. 5.Department of UrologyCareggi University HospitalFlorenceItaly
  6. 6.Department of UrogynaecologyImperial College Healthcare NHS TrustLondonUK
  7. 7.Department of Obstetrics and Gynecology, Del Ponte HospitalUniversity of InsubriaVareseItaly

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