Tension-free Vaginal Tape (TVT) Versus Transobturator Tape

(TOT) for Treatment of Female Stress Urinary Incontinence: A

Comparative Study
Ashraf H Abd El Lateef, Ahmed G Abd El Raoof, Shehata H Farghal, Sayed M El
Eweedy, Ahmed F Abd El Raheem, Hosam F Abd El Raheem.
Department of Urology, Faculty of medicine, Al Azhar University.

Objective: to prospectively compare between tension-free vaginal tape (TVT) and trans-
obturator tape (TOT) procedures in treatment of female SUI as regards; safety and
efficacy by subjective and objective measures.
Patients and methods: 40 consecutive women with stress urinary incontinence (SUI)
were randomly assigned to TVT group (20) or TOT group (20) during the period from
April 2005 to December 2006. The follow up period was one year. Mean age was
44.7±6.7 (range 30-50) for TOT group and 45.7±10.24 (range 22-67) for TVT group. All
patients were assessed before surgery by history, clinical examination, urine analysis,
abdomino-pelvic ultrasonography, ascending cystourethrography and urodynamic
examination. Postoperative evaluation carried out at 2 weeks, 3, 6 and 12 months
postoperatively.
Results: All patients were operated upon under spinal anesthesia with the mean ± SD
operative time significantly shorter in TOT vs TVT (22.7 ± 9.6 min for TOT vs 29.5± 8.7
min for TVT, p= 0.025). No intra-operative bleeding requiring blood transfusion was
observed in both groups. Bladder injury occurred in 3 patients (15%) of the TVT group (2
of them had past history of previous pelvic surgery) and non of the TOT group. There
were 2 patients with urethral injury, one in each group (both had past history of anterior
colporhaphy). There were 2 minor lateral wall vaginal tears in the TOT group without
any sequelae. There was no significant difference between TVT and TOT in the rates of
cure ( 85% and 80%), improvement (5% and 10%) and failure (10% and 10%)
respectively. Preoperative urge incontinence resolved in 71.4% of the TVT group and
75% of the TOT in patients suffering from mixed SUI (7 patients in the TVT group and 9
patients in the TOT group). There were no cases reporded with postoperative urinary
retention. Three patients (15%) of the TVT group and non of the TOT group developed
transient postoperative voiding outflow obstruction. The mean uroflowmetry Q max did
not show any significant changes during the follow-up period in both groups. De-novo
urgency occurred in 2 patients of the TVT group (in one it was transient and the other
developed detrusor instability) and one patient (5%) of the TOT group (which was
transient). There were 3 (15%) patients in each group complaining from transient
postoperative pain and transient UTI.
Conclusions: Both techniques appear to be equally effective in treatment of SUI.
However TOT had a shorter operative time and lower rate of intraoperative and
postoperative complications.