A Comparative Study of Outside-In and Inside-Out Transobturator Tape Procedures for Stress Urinary Incontinence

Abstract

Aims: This study compared the clinical outcome of patients undergoing outside-in transobturator tape (TOT) or inside-out transobturator tape (TVT-O) procedures for female stress urinary incontinence (SUI). Methods: The study examined the medical records of 615 patients who underwent TOT (376 patients) or TVT-O (239 patients) for SUI, and compared patient characteristics, operation time, duration of hospital stay, cure rates, and complication rates, by conducting a 1-year follow-up survey. Results: The TOT and TVT-O groups were found to be similar in terms of operation time, duration of hospital stay, surgical outcome (both before and after adjustment for age, parity, menopause, and previous pelvic surgery, cure rate (87.8% for TOT and 85.3% for TVT-O) and complication rate (14.4% for TOT, 15.5% for TVT-O). The complication rates after operations did not differ significantly between the two groups. Complications over the 1-year follow-up included urinary retention, de novo urgency, leg pain, vaginal mesh erosion, and hematoma, and all resolved following appropriate treatment. Conclusions: The TOT and TVT-O procedures appeared to be equally clinically effective and safe when used to treat female SUI.

Retropubic and Transobturator Slings: Still Useful or Should All Patients Be Treated with Mini-slings?

“…The different "inside-out" and "outside-in" TOT methods were found to have equal clinical efficacy and safety, with cure rates between 85.3% and 87.8% [17]. Randomized control trials comparing TOT to retropubic slings supported the new method [18][19][20][21][22].…”

Female Stress Urinary Incontinence Treatment by Forming an Uretro-Vesical Angle with or without Mesh

“…In order to minimize retropubic space injury, TOT has been used to place the sling both with outside-in and inside-out approachesas proposed by Delorm [10] [18] and by Leval [2]. Many retrospective studies have shown that the difference between inside-out TOT and outside-in TOT approaches was insignificant [19]. The authors concluded that both of these approaches were equally safe and clinically effective.…”

Safety considerations for synthetic sling surgery

“…9,261 In addition, the qualifiers persistent or de novo 261 were often used. De novo OAB, indicating the occurrence of OAB after sling surgery, was reported in 0-48% of patients in various studies (REFS 17,18,20,26,39,(46)(47)(48)(50)(51)(52)(53)55,(57)(58)(59)61,62,66,67,70,(73)(74)(75)(76)(77)79,83,87,88,91,92,96,97,99,140,152,153,155,157,159,161,163,164,(166)(167)(168)(170)(171)…”

“…Compression from the sling is by far the most common cause of urethral obstruction, and at least one case of urethral stricture accompanied by urethral erosion has been reported. 9 The incidence of urethral obstruction requiring surgical intervention ranges from 0% to 8.9% in patients fitted with RP slings and from 0% to 21.3% for those with TOT slings (REFS 17,18,20,21,23,26,30,(46)(47)(48)(50)(51)(52)(53)(54)(55)(56)58,59,(61)(62)(63)(64)(66)(67)(68)(69)71,74,77,(80)(81)(82)(83)(86)(87)(88)(89)(90)(91)(92)(97)(98)(99)148,159,163,166,…”

“…9,110,143 In studies of effectiveness and safety, pain was mostly divided into perioperative pain and pain lasting more than 6 weeks. Perioperative pain has been reported in up to 33% of patients, 252 occurring more frequently after implantation of TOT slings than RP slings, 331 and chronic pain (of any definition) has been reported in 0-31% of patients (REFS 17,18,20,30,39,47,48,53,58,59,(61)(62)(63)66,69,70,73,76,79,82,(89)(90)(91)95,98,99,140,152,155,159,164,167,168,(171)(172)(173)(174)177,(180)(181)(182)185,208,…”