Prospective observational study of inside-out versus outside-in transobturator tapes for female stress urinary incontinence at a tertiary care hospital of South Western railway
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253527Keywords:
Trans vaginal technique, Trans obturator technique, Stress urinary incontinence, Inside out, Mid urethral sling, Outside in technique, Patient satisfactionAbstract
Background: To compare outcomes of transobturator tension-free vaginal tape using outside-in and inside-out approaches in women with stress urinary incontinence (SUI), and to identify risk factors for treatment failure.
Methods: A prospective observational study was conducted at Central Hospital, Hubli, from July 2007 to June 2022. A total of 223 women with SUI refractory to conservative management were enrolled; 129 underwent the inside-out (TVT-O) procedure and 94 underwent the outside-in (TOT) procedure. Patients were followed annually for at least 3 years (maximum 10 years). Subjective and objective cure rates, complications, quality of life (QoL), and psychological outcomes were assessed.
Results: At 5 years, subjective cure rates were 87% for TVT-O and 83% for TOT, while objective cure rates were 95.3% and 90%, respectively. Both techniques demonstrated significant improvements in QoL and Beck depression inventory scores. Dyspareunia was higher in the TVT-O group (p=0.02), but other complication rates were comparable. In 75 patients with 10-year follow-up, long-term success was maintained at 97%.
Conclusions: Both TVT-O and TOT techniques are safe and effective for treating female SUI, with durable long-term results. The choice of procedure should be guided by surgeon expertise and patient preference.
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References
Milsom I, Altman D, Lapitan MC, Nelson R, Sillén U, Thom D. Epidemiology of urinary incontinence (ICUD-EAU). Neurourol Urodyn. 2017;36:1816-25.
Reigota RB, Pedro AO, Machado VSS, Costa-Paiva L, Pinto-Neto AM. Prevalence of urinary incontinence and associated factors in women aged 50 years or older. Rev Bras Ginecol Obstet. 2016;38:433-9.
Dufour S, Wu M. Conservative care of urinary incontinence in women. CMAJ. 2012;184:1095-101.
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29:213-40. DOI: https://doi.org/10.1002/nau.20870
Hay-Smith J, Dumoulin C. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2006;CD005654. DOI: https://doi.org/10.1002/14651858.CD005654
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;58:218-38. DOI: https://doi.org/10.1016/j.eururo.2010.04.022
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7:81-5. DOI: https://doi.org/10.1007/BF01902378
Delorme E. Transobturator urethral suspension: Mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11:1306-13.
De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: Transobturator vaginal tape inside-out. Eur Urol. 2003;44:724-30. DOI: https://doi.org/10.1016/j.eururo.2003.09.003
Silva WA. Treatment of stress urinary incontinence with transobturator sling: Surgical technique and results. Int Braz J Urol. 2004;30:207-16.
Latthe PM, Singh P, Foon R, Toozs-Hobson P. Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int. 2010;106:68-76. DOI: https://doi.org/10.1111/j.1464-410X.2009.09051.x
Serati M, Ghezzi F, Cattoni E, Braga A, Torella M, Salvatore S, et al. Tension-free vaginal tape-obturator for treatment of pure urodynamic stress urinary incontinence: Efficacy and adverse effects at 10-year follow-up. Eur Urol. 2017;71:437-44. DOI: https://doi.org/10.1016/j.eururo.2016.08.054
Abdel-Fattah M, Ramsay I, Pringle S. Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study. BJOG. 2006;113:1377-81. DOI: https://doi.org/10.1111/j.1471-0528.2006.01097.x
Huang WC, Yang JM. Effect of transobturator suburethral tape procedure on voiding function: one-year follow-up study. J Urol. 2003;170:2327-30.
Liapis A, Bakas P, Creatsas G. Efficacy of inside-out transobturator vaginal tape (TVT-O) at 3 years follow-up. Eur J Obstet Gynecol Reprod Biol. 2008;136:87-90.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362:2066-76. DOI: https://doi.org/10.1056/NEJMoa0912658
Long CY, Hsu CS, Wu MP, Liu CM, Wang CL, Tsai EM. Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence. Curr Opin Obstet Gynecol. 2009;21:342-7. DOI: https://doi.org/10.1097/GCO.0b013e32832e07bf
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 meta-analysis. Am J Obstet Gynecol. 2014;211:71.e1-27. DOI: https://doi.org/10.1016/j.ajog.2014.01.030
Sung VW, Schleinitz MD, Rardin CR, Ward RM, Myers DL, Clarke AE, et al. Comparison of retropubic vs transobturator approach to midurethral slings: a systematic review and meta-analysis. Am J Obstet Gynecol. 2007;197:3-11. DOI: https://doi.org/10.1016/j.ajog.2006.09.025
Ford AA, Rogerson L, Cody JD, Aluko P, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD006375. DOI: https://doi.org/10.1002/14651858.CD006375.pub4
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