Women who have a transobturator tape (TOT) procedure for urinary incontinence (UI) may have a higher risk of repeat surgery compared with those having a retropubic midurethral tape operation, a nationwide study suggests.

Margrethe Foss Hansen, MD, of the University of Southern Denmark, and colleagues used the Danish National Patient Registry to identify 8,671 women who had UI surgery during the period 1998–2007. Patients who had UI surgery within the prior 2 years were excluded.

Overall, 10% of women had a reoperation within 5 years, according to findings published online in the American Journal of Obstetrics and Gynecology. Three procedures shared the lowest reoperation rate of 6%: pubovaginal sling, retropubic midurethral tape, and Burch colposuspension. Repeat surgery occurred after 9% of TOT procedures and 12% of miscellaneous operations. Expectedly, the highest rate of reoperation was observed with urethral injection therapy (44%).

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After adjusting for patient age, surgery volume, and year, the researchers determined that TOT carried double the risk of reoperation, and urethral injection therapy 12 times the risk, compared with retropubic midurethral tape. In line with previous research, the majority of repeat surgeries occurred in the first 2 years after the initial procedure.

The findings indicate that retropubic midurethral tape procedures are “more efficient” than TOT, according to the investigators. They cautioned that the results do not apply to any specific tension-free vaginal tape or transobturator tape, as many synthetic slings are now available. A majority of patients (67%) received a synthetic midurethral sling.

The researchers acknowledged they were unable to assess risk factors, such as body mass index, severity of UI symptoms, and surgeon skill.


  1. Foss Hansen, M; Lose, Gunnar; Kesmodel, US; Oren Gradel, K; American Journal of Obstetrics and Gynecology; doi: 10.1016/j.ajog.2015.08.069.