TVT‐O vs TVT‐S for female stress urinary incontinence: A systematic review and meta‐analysis

Abstract

Background Tension‐free vaginal tape obturator (TVT‐O) and tension‐free vaginal tape secur (TVT‐S) are common surgeries for the treatment of stress urinary incontinence (SUI), several randomised controlled trials (RCTs) have compared the effects of TVT‐O and TVT‐S, yet the results remained inconsistent. Therefore, we attempted to conduct this systematic review and meta‐analysis to analyse the role of TVT‐O and TVT‐S in patients with SUI. Methods We searched PubMed databases from inception date to Jan 15, 2020 for RCTs that compared TVT‐O and TVT‐S in SUI patients. Two authors independently screened and extracted data from the published articles. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (95% CI) were calculated for each outcome by fixed‐ or random‐effects model. Results Seven RCTs with a total of 755 patients were identified, with 373 patients for TVT‐O and 382 patients for TVT‐S. TVT‐O preceded TVT‐S in the objective cure at 12 months (OR = 1.72, 95% CI 1.21‐2.45), subjective cure (OR = 1.98, 95% CI 1.08‐3.62); but TVT‐S have more advantage in the incidence of postoperative thigh pain (OR = 18.94, 95% CI 7.01‐51.15); no significant differences on the duration of operative procedure (OR = −1.09, 95% CI −2.37‐0.18), urinary retention (OR = 0.77, 95% CI 0.36‐1.62) and urinary infection (OR = 1.80, 95% CI 0.63‐5.13) were found. Conclusions TVT‐O should be preferred for patients with SUI even though with higher risks of postoperative thigh pain when compared with TVT‐S, more related studies are needed to identify the role of TVT‐O and TVT‐S for the treatment of SUI.

Long-Term Effectiveness and Complications of Mid-Urethral Slings: Clinical Case

“…Other common TOT and TVT-O complications include urgency symptoms, feeling of incomplete urination, nocturia, and overly frequent urination, however, most of these complications resolve themselves during the first 6 months after surgery. Haematoma, infection and groin pain were also observed as complications after transobturator sling surgery (1,13).…”

“…After TVT sling erosion or extrusion was also observed more frequently. All of these methods significantly improve the quality of women's sexual life, with the main reason being a less frequent or complete absence of urinary leakage during intercourse (1,14,15). One of the clinical trials that were carried out in 2015 and in which 597 patients were a part of didn't observe any significant differences in the effectiveness between retropubic and transobturator approaches.…”

“…Under regular conditions, these women don't feel any symptoms, however, when the intraabdominal pressure increases, women cannot voluntarily contain their urine. Intraabdominal pressure can increase for various reasons, such as coughing, sneezing, laughing, while lifting heavy objects, or simply changing their body position (1,2). Treatment of stress urinary incontinence begins with conservative measures.…”