TOT Preferred Over TVT for Urinary Incontinence

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Tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for urinary incontinence in women provide similar results with respect to continence and patient quality of life, but TOT procedures are associated with fewer complications, according to investigators.

Because the TOT procedure does not involve entering the retropubic space, thus reducing the risk of bladder, bowel, or major vessel trauma, the researchers noted, the TOT procedure, if indicated, is their first choice.

Vahudin Zugor, MD, PhD, of the Department of Urology at St. Antonius Hospital in Gronau, Germany, and colleagues studied 208 women with urodynamically proven urinary incontinence, of whom 100 and 108 underwent TVT and TOT procedures, respectively.

The patients had a median age of 63.4 years and the median follow-up period was 48 months. Prior to surgery, 75.7% had stress urinary incontinence (SUI) and 24.3% had mixed incontinence (SUI and urge incontinence), with predominant SUI. The objective cure rate was 81% with TVT and 77.7% with TOT, Dr. Zugor's group reported in International Urology and Nephrology (2010; published online ahead of print).

The subjective cure rates were 83% and 78.8% in the TVT and TOT groups, respectively. The differences in cures were not statistically significant. Quality of life improved in 80% of patients, with similar proportions in both groups. The rate of perioperative complications (hematoma, perforation of the bladder, bleeding)  was 13% in the TVT group compared with 4.6% in the TOT group; the rate of postoperative complications (pain, tape erosion, post-void residual volume greater than 100 mL) was 12% in the TVT group and 8.8% in the TOT group.

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