TOT and TVT Comparable
Transobturator tape (TOT) is a safe and effective as tension-free vaginal tape (TVT) in surgery for stress urinary incontinence.
Researchers compared the two approaches in 148 women, of whom 75 were randomized to TOT and 73 to TVT. The two procedures had similar rates of intra- and postoperative complications.
At a mean follow-up of 31 months, the overall objective cure (dry) was 77.3% for TOT and 71.4% for TVT, a nonsignificant difference between the groups, the investigators reported in European Urology (2007;52:1481-1491). When the researchers combined patients who were dry and “wet but improved,” the proportions rose to 90% and 90.6%, respectively. Postoperative storage symptoms persisted in 24% and 44% of the TOT and TVT groups, respectively.
The authors noted that operating times were slightly shorter with TOT than TVT (20 vs. 30 minutes), but the length of the postoperative stay was similar (1.3 vs. 1.5 days, respectively). The study population had a 4% incidence of mesh erosion. The mean patient Visual Analogue Scale score was 9. The scale had a range of 0 to 10, with 10 the maximum satisfaction reported and 0 the lowest.
“One main issue with both techniques remains postoperative storage symptoms, whose underlying mechanism still needs in-depth investigation,” the authors wrote. “The other outstanding problem is mesh erosion, and optimal tape material and construction still need to be identified.”