TVT or TVT-O? – A systematic review and meta-analysis comparing efficacy, complications and re-operations

Elers, Jimmi; Bing, Mette Hornum; Birkefoss, Kirsten; Rohde, Jeanett Friis; Ussing, Anja; Glavind, Karin

doi:10.1016/j.ejogrb.2020.12.005

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…Postoperative pain and lower urinary tract infection were not different between the two groups, which agrees with the outcomes of Elers et al [ 14 ]. Only a few studies have looked into the correlation between comorbidities and perioperative complications within the MUS procedure.…”

Section: Discussionsupporting

confidence: 91%

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women

Schütze¹,

Behre²,

Heitmeir³

et al. 2023

Cureus

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Background and objectiveThe first-line surgical treatment for female stress urinary incontinence (SUI) involves midurethral slings (MUS), including the transobturator tape (TOT) and the retropubic tension-free vaginal tape (TVT). However, whether offering these procedures to older and comorbid women could lead to increased complications is a question that needs to be seriously addressed. In this retrospective cohort study, we aimed to compare the two procedures and evaluate the impact of age, BMI, and comorbidities on complications. Materials and methodsA total of 873 procedures (306 TVTs/567 TOTs) performed between 2007 and 2017 were compared and correlated with regard to age, BMI, and comorbidities. Intraoperative complications included bleeding >50 ml, bladder injury, and anesthesia-associated complications. Postoperative complications included postvoid residual volume, pain, hematoma, lower urinary tract infection, revision for loosening tape, and bladder infections. The comorbidities were evaluated based on the American Society of Anesthesiologists (ASA) and Charlson scores. ResultsA total of 873 MUS were conducted during the study period: 306 TVTs and 567 TOTs. Groupwise comparison between these procedures showed that women in the TOT group were older (p<0.001) with a higher BMI (p<0.001) and a higher ASA score (p<0.001) compared to the TVT group. Nevertheless, significantly more intraoperative complications, especially bladder injuries, were recorded in the TVT group. Postoperative complications occurred in 19.4% of the entire cohort, especially increased post-void residual volume. Postoperative hematoma and tape loosening were significantly more frequent in the TOT group. Age, BMI, and comorbidities showed no significant impact on intraoperative complications; however, the TOT procedure was associated with significantly fewer intraoperative complications [p=0.001, odds ratio (OR): 0.281]. ConclusionsOverall, both procedures were associated with a low number of perioperative complications. The TOT technique had a lower incidence of intraoperative complications. It must be highlighted that age and comorbidities had no influence on either the intra-or postoperative complication rates. Hence, we recommend that TOT is employed to treat SUI in older, more obese, and comorbid women.

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Section: Discussionsupporting

confidence: 91%

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women

Schütze¹,

Behre²,

Heitmeir³

et al. 2023

Cureus

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“…The methodology used in the Danish Health Authority guideline development has previously been described [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. In short, the methodology is based on the recommendations for conducting systematic reviews and meta-analyses from the Cochrane Handbook for systematic reviews [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Cochrane Reviews in Clinical Guideline Development—A Survey of 585 Recommendations

Korfitsen

Mikkelsen

Ussing

et al. 2022

IJERPH

Self Cite

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The Danish Health Authority develops clinical practice guidelines to support clinical decision-making based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and prioritizes using Cochrane reviews. The objective of this study was to explore the usefulness of Cochrane reviews as a source of evidence in the development of clinical recommendations. Evidence-based recommendations in guidelines published by the Danish Health Authority between 2014 and 2021 were reviewed. For each recommendation, it was noted if and how Cochrane reviews were utilized. In total, 374 evidence-based recommendations and 211 expert consensus recommendations were published between 2014 and 2021. Of the 374 evidence-based recommendations, 106 included evidence from Cochrane reviews. In 28 recommendations, all critical and important outcomes included evidence from Cochrane reviews. In 36 recommendations, a minimum of all critical outcomes included evidence from Cochrane reviews, but not all important outcomes. In 33 recommendations, some but not all critical outcomes included evidence from Cochrane reviews. Finally, in nine recommendations, some of the important outcomes included evidence from Cochrane reviews. In almost one-third of the evidence-based recommendations, Cochrane reviews were used to inform clinical recommendations. This evaluation should inform future evaluations of Cochrane review uptake in clinical practice guidelines concerning outcomes important for clinical decision-making.

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“…7 Infection, chronic pain, and erosions are the main complications reported for MUS and are likely to be associated with the synthetic material used. [8][9][10] In light of these findings, biological mesh materials have been proposed for SUI and pelvic prolapsus management to reduce these adverse events. 11 Biological materials, such as autologous fascial slings, have been proven efficient and safe in the management of SUI.…”

Section: Introductionmentioning

confidence: 99%

“…Although the clinical efficacy of MUS has long been demonstrated, recent warnings from scientific societies and regulatory agencies in various countries led to the recall of some mesh products used in pelvic organ prolapsus surgery 7 . Infection, chronic pain, and erosions are the main complications reported for MUS and are likely to be associated with the synthetic material used 8–10 …”

Section: Introductionmentioning

confidence: 99%

Exploratory safety study of an umbilical cord derived urethral sling in bilateral pudendal nerves injury‐induced urinary incontinence in female rats

Pinar¹,

Grossetete

Barnouin

et al. 2022

Neurourology and Urodynamics

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Purpose Mid‐urethral slings are the standard treatment for women with refractory stress urinary incontinence (SUI) but are at risk of infection or erosion due to host−prothesis interaction. In this proof‐of‐concept study, we aimed at evaluating umbilical vessel sling (UVS) in incontinent female rats. Material and Methods UVS was extracted from human umbilical cord lining and was placed on female rats who underwent bilateral pelvic nerve injury (PNI) to reproduce SUI (Group 3, N = 10). Two control groups were also studied: rats with no PNI (Group 1, N = 4) and rats with PNI but no UVS (Group 2, N = 10). Micturition calendar was frequently recorded using a metabolic cage, and leak point pressure (LPP) test was performed on Day 28. After the LPP test, rats were euthanized, and bladder/urethra were collected for histopathological analysis. Results Overall, 24 rats were included, of whom 10 had both PNI and UVS placement. Compared with Group 2, Group 3 had increased maximal LPP but the difference did not reach significance (respectively 21.8 ± 2.1 mmHg vs. 28.4 ± 4.1 mmHg, p = 0.2). Micturition frequencies were similar between the groups. Total voided volume was higher in Group 3 at the end of the study compared with Group 2 (12.5 ± 1.1 ml vs. 9.4 ± 0.6 ml, respectively, p < 0.05). Histopathological findings evidenced a good local tolerance and a moderate to high tissue integration of the UVS. Conclusions Biological sling derived from human umbilical vessel could be safely placed with a slight improvement of LPP in a population of rats who had bilateral PNI without major modification of micturition calendar. UVS could be a promising biomaterial in the management of SUI in women. Clinical studies are needed.

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TVT or TVT-O? – A systematic review and meta-analysis comparing efficacy, complications and re-operations

Cited by 10 publications

References 34 publications

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women

The Transobturator Tape Versus Retropubic Tension-Free Vaginal Tape in the Treatment of Comorbid and Elderly Women With Stress Urinary Incontinence: A Retrospective Analysis of Over 800 Women

Usefulness of Cochrane Reviews in Clinical Guideline Development—A Survey of 585 Recommendations

Exploratory safety study of an umbilical cord derived urethral sling in bilateral pudendal nerves injury‐induced urinary incontinence in female rats

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