Efficacy and outcomes of transobturator tension-free vaginal tape with or without concomitant pelvic floor repair surgery for urinary stress incontinence: five-year follow-up

Abstract

Objectives:To compare the 5-year subjective and objective outcomes of transobturator tensionfree vaginal tape alone versus the same procedure with concomitant pelvic floor repair surgery for pelvic organ prolapse in women with urinary stress incontinence.Design: Prospective cohort study. Setting:Urogynaecology unit at a university hospital in Hong Kong. Patients:Of 218 women, 96 (44%) received transobturator tension-free vaginal tape alone and 122 (56%) received transobturator tension-free vaginal tape with concomitant pelvic floor repair surgery from September 2004 to December 2009. The women were followed up annually for up to 5 years after the operation. Main outcome measures:The 5-year subjective and objective cure rates were assessed. Subjective cure was defined as no urine loss during physical activity and objective cure was defined as no urine leakage on coughing during urodynamic study. Results:Overall, 88 women receiving transobturator tension-free vaginal tape alone and 101 women receiving transobturator tension-free vaginal tape with concomitant pelvic floor repair surgery were followed up for 5 years after operation. The

Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery

“…In a Hong Kong study, the incidences of postoperative tape erosion, voiding problem, and inguinal pain were 1, 2.3, and 1.1%, respectively, in women who underwent the TOT procedure [17]. The incidences of postoperative urgency, dyspareunia, pelvic pain, and voiding dysfunction were 46, 21, 4, and 4%, respectively, in this study.…”

“…Later, Athanasiou indicated 7-year overall subjective and objective cure rates of 83.5 and 81.5%, respectively, in 124 women who were subjected to the TOT procedure [24]. Law et al [17] found 5-year subjective and objective cure rates of 70.5 and 94.1%, respectively, in 96 women who underwent the TOT procedure. Angioli et al [25] showed that only 62% of the women who underwent the TOT procedure were satisfied.…”

“…The overall 5-year incidence of de novo detrusor overactivity was 6.4% in a study [25], whereas an overall 7-year incidence was found to be 7% in another study [24]. Law et al [17] specified first-year and 5-year incidences of de novo detrusor overactivity as 5.4 and 9% respectively. The incidence of de novo detrusor activity was 33.3% each for the first and second postoperative year in this study.…”

“…The third-year objective cure rates were 83 and 85% in the only TOT procedure and concomitant TOT procedure and vaginal surgery groups respectively. Later, Law et al [17] assessed 96 women who had only TOT and 122 women who had concurrent TOT and pelvic floor repair surgery. The 5-year subjective cure rates were 70.5 and 94.1%, while 5-year objective cure rates were 80.3 and 85.7% for the TOT group and concurrent TOT and pelvic floor repair group respectively.…”

“…However, there is scanty data about the efficacy and safety of this combined surgical approach in women with stress urinary incontinence [17-19]. …”