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 Maggiore
  • Enrico Finazzi Agrò
  • Marco Soligo
  • Vincenzo Li Marzi
  • Alex Digesu
  • Maurizio Serati
Review Article

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.

Keywords

Sling Stress urinary incontinence Surgery TOT TVT 

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

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflicts of interest

None.

Supplementary material

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

References

  1. 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
  2. 2.
    Fatton B, de Tayrac R, Costa P. Stress urinary incontinence and LUTS in women--effects on sexual function. Nat Rev Urol. 2014;11(10):565–78. doi: 10.1038/nrurol.2014.205.PubMedGoogle Scholar
  3. 3.
    Lim R, Liong ML, Leong WS, Khan NA, Yuen KH. Effect of stress urinary incontinence on the sexual function of couples and the quality of life of patients. J Urol. 2016;196(1):153–8. doi: 10.1016/j.juro.2016.01.090.CrossRefPubMedGoogle Scholar
  4. 4.
    Chong EC, Khan AA, Anger JT. The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep. 2011;12(5):358–62. doi: 10.1007/s11934-011-0209-x.CrossRefPubMedGoogle Scholar
  5. 5.
    Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(1):71.e1–71.e27. doi: 10.1016/j.ajog.2014.01.030.CrossRefGoogle Scholar
  6. 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. 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
  8. 8.
    Serati M, Ghezzi F, Cattoni E, Braga A, Siesto G, Torella M, et al. Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10-year follow-up. Eur Urol. 2012;61(5):939–46. doi: 10.1016/j.eururo.2012.01.038.CrossRefPubMedGoogle Scholar
  9. 9.
    Serati M, Bauer R, Cornu JN, Cattoni E, Braga A, Siesto G, et al. TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up. Eur Urol. 2013;63(5):872–8. doi: 10.1016/j.eururo.2012.12.022.CrossRefPubMedGoogle Scholar
  10. 10.
    Serati M, Sorice P, Bogani G, Braga A, Cantaluppi S, Uccella S, et al. TVT for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 13-year follow-up. Neurourol Urodyn. 2015. doi: 10.1002/nau.22914.Google Scholar
  11. 11.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12. doi: 10.1016/j.jclinepi.2009.06.005.CrossRefPubMedGoogle Scholar
  12. 12.
    Ward KL, Hilton P. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG. 2008;115(2):226–33. doi: 10.1111/j.1471-0528.2007.01548.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Angioli R, Plotti F, Muzii L, Montera R, Panici PB, Zullo MA. Tension-free vaginal tape versus transobturator suburethral tape: five-year follow-up results of a prospective, randomised trial. Eur Urol. 2010;58(5):671–7. doi: 10.1016/j.eururo.2010.08.004.CrossRefPubMedGoogle Scholar
  14. 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
  15. 15.
    Laurikainen E, Valpas A, Aukee P, Kivela A, Rinne K, Takala T, et al. Five-year results of a randomized trial comparing retropubic and transobturator midurethral slings for stress incontinence. Eur Urol. 2014;65(6):1109–14. doi: 10.1016/j.eururo.2014.01.031.CrossRefPubMedGoogle Scholar
  16. 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. 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
  18. 18.
    Kenton K, Stoddard AM, Zyczynski H, Albo M, Rickey L, Norton P, et al. 5-year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol. 2015;193(1):203–10. doi: 10.1016/j.juro.2014.08.089.CrossRefPubMedGoogle Scholar
  19. 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. 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
  21. 21.
    Valpas A, Ala-Nissila S, Tomas E, Nilsson CG. TVT versus laparoscopic mesh colposuspension: 5-year follow-up results of a randomized clinical trial. Int Urogynecol J. 2015;26(1):57–63. doi: 10.1007/s00192-014-2454-2.CrossRefPubMedGoogle Scholar
  22. 22.
    Zhang Z, Zhu L, Xu T, Lang J. Retropubic tension-free vaginal tape and inside-out transobturator tape: a long-term randomized trial. Int Urogynecol J. 2016;27(1):103–11. doi: 10.1007/s00192-015-2798-2.CrossRefPubMedGoogle Scholar
  23. 23.
    Prien-Larsen JC, Hemmingsen L. Long-term outcomes of TVT and IVS operations for treatment of female stress urinary incontinence: monofilament vs. multifilament polypropylene tape. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(6):703–9. doi: 10.1007/s00192-009-0844-7.CrossRefPubMedGoogle Scholar
  24. 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
  25. 25.
    Cheung RY, Chan SS, Yiu KW, Chung TK. Inside-out versus outside-in transobturator tension-free vaginal tape: a 5-year prospective comparative study. Int J Urol. 2014;21(1):74–80. doi: 10.1111/iju.12196.CrossRefPubMedGoogle Scholar
  26. 26.
    Chun JY, Song M, Yoo DS, Han JY, Hong B, Choo MS. A comparative study of outside-in and inside-out transobturator tape procedures for female stress urinary incontinence: 7-year outcomes. Lower Urinary Tract Symptoms. 2014;6(3):145–50. doi: 10.1111/luts.12052.CrossRefPubMedGoogle Scholar
  27. 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. 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. 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. 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

Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  • Umberto Leone Roberti Maggiore
    • 1
    • 2
  • 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

Personalised recommendations