Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis
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.
KeywordsSling Stress urinary incontinence Surgery TOT TVT
Autologous fascial sling
Laparoscopic mesh colposuspension
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
Compliance with ethical standards
No funding was received for this study.
Conflicts of interest
- 1.Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. doi: 10.1007/s00192-009-0976-9.CrossRefPubMedGoogle Scholar
- 6.Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol. 2014;65(2):402–27. doi: 10.1016/j.eururo.2013.08.032.CrossRefPubMedGoogle Scholar
- 7.Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010;58(2):218–38. doi: 10.1016/j.eururo.2010.04.022.CrossRefPubMedGoogle Scholar
- 14.Sivaslioglu AA, Unlubilgin E, Aydogmus S, Keskin L, Dolen I. A prospective randomized controlled trial of the transobturator tape and tissue fixation mini-sling in patients with stress urinary incontinence: 5-year results. J Urol. 2012;188(1):194–9. doi: 10.1016/j.juro.2012.02.2564.CrossRefPubMedGoogle Scholar
- 16.Costantini E, Kocjancic E, Lazzeri M, Giannantoni A, Zucchi A, Carbone A, 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. 2016;34(4):585–93. doi: 10.1007/s00345-015-1651-z.CrossRefPubMedGoogle Scholar
- 17.Khan ZA, Nambiar A, Morley R, Chapple CR, Emery SJ, Lucas MG. Long-term follow-up of a multicentre randomised controlled trial comparing tension-free vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women. BJU Int. 2015;115(6):968–77. doi: 10.1111/bju.12851.CrossRefPubMedGoogle Scholar
- 19.Ross S, Tang S, Eliasziw M, Lier D, Girard I, Brennand E, et al. Transobturator tape versus retropubic tension-free vaginal tape for stress urinary incontinence: 5-year safety and effectiveness outcomes following a randomised trial. Int Urogynecol J. 2016;27(6):879–86. doi: 10.1007/s00192-015-2902-7.CrossRefPubMedGoogle Scholar
- 20.Tommaselli GA, D’Afiero A, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Tension-free vaginal tape-obturator and tension-free vaginal tape-Secur for the treatment of stress urinary incontinence: a 5-year follow-up randomized study. Eur J Obstet Gynecol Reprod Biol. 2015;185:151–5. doi: 10.1016/j.ejogrb.2014.12.012.CrossRefPubMedGoogle Scholar
- 24.Asıcıoglu O, Gungorduk K, Besimoglu B, Ertas IE, Yildirim G, Celebi I, et al. A 5-year follow-up study comparing Burch colposuspension and transobturator tape for the surgical treatment of stress urinary incontinence. Int J Gynaecol Obstet. 2014;125(1):73–7. doi: 10.1016/j.ijgo.2013.09.026.CrossRefPubMedGoogle Scholar
- 27.ElSheemy MS, Fathy H, Hussein HA, Elsergany R, Hussein EA. Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study. Int Urogynecol J. 2015;26(10):1533–40. doi: 10.1007/s00192-015-2725-6.CrossRefPubMedGoogle Scholar
- 28.Dmochowski R, Athanasiou S, Reid F, Kraus S, Nitti V, Gomelsky A, et al. Surgery for urinary incontinence in women. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5th ed. Plymouth, UK: Health Publications; 2012.Google Scholar
- 29.Tommaselli GA, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis. Int Urogynecol J. 2015;26(9):1253–68. doi: 10.1007/s00192-015-2645-5.CrossRefPubMedGoogle Scholar
- 30.Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A, et al. Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012;119(2 Pt 1):321–7. doi: 10.1097/AOG.0b013e31823dfc73.CrossRefPubMedGoogle Scholar