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

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Abstract

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

AFS:

Autologous fascial sling

CS:

Colposuspension

IVS:

Intravaginal slingplasty

LCM:

Laparoscopic mesh colposuspension

OAB:

Overactive bladder

PVS:

Pubovaginal sling

RCTs:

Randomised controlled trials

STM:

Surgeon-tailored polypropylene mesh

SUI:

Stress urinary incontinence

TOT:

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

TOT-OI:

TOT using the out–in technique

TVT:

Transvaginal tape using the retropubic technique

TVT-O:

TOT using the in–out technique

TVT-S:

TVT-Secur

XS:

Xenograft sling

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Authors and Affiliations

  1. Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino—IST, Largo R. Benzi 10, 16132, Genova, Italy

    Umberto Leone Roberti Maggiore

  2. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy

    Umberto Leone Roberti Maggiore

  3. Department of Urology, Tor Vergata University Hospital, Rome, Italy

    Enrico Finazzi Agrò

  4. Department of Women, Mothers and Neonates, Buzzi Children’s Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy

    Marco Soligo

  5. Department of Urology, Careggi University Hospital, Florence, Italy

    Vincenzo Li Marzi

  6. Department of Urogynaecology, Imperial College Healthcare NHS Trust, London, UK

    Alex Digesu

  7. Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy

    Maurizio Serati

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  1. Umberto Leone Roberti Maggiore
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  2. Enrico Finazzi Agrò
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  3. Marco Soligo
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Correspondence to Umberto Leone Roberti Maggiore.

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On behalf of the Publication Committee of the Italian Society of Urodynamics

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Leone Roberti Maggiore, U., Finazzi Agrò, E., Soligo, M. et al. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 28, 1119–1130 (2017). https://doi.org/10.1007/s00192-017-3275-x

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  • DOI: https://doi.org/10.1007/s00192-017-3275-x

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