Comparing TVT and TVT-O in women with stress urinary incontinence

This study aimed to compare the effectiveness and complications of bottom-up tension-free vaginal tape (TVT) and inside-out tension-free vaginal tape – obturator (TVT-O) in women with stress urinary incontinence (SUI). This study suggested that TVT and TVT-O had similar effectiveness but TVT was associated with fewer chronic side effects than TVT-O.

SUI is the involuntary leakage of urine due to stress on the bladder like when sneezing, coughing, or laughing. Devices such as vaginal tape are often used to treat SUI if non-surgical treatments are not effective. TVT and TVT-O are two surgical procedures used to treat SUI. Both treatments use vaginal tape (mesh sling). However, they differ in the location of the sling placement.

TVT involves passing the sling from the urethra (the tube that passes urine out from the bladder) through the space between the pubic bone and the bladder. This often causes damage to the bladder. TVT-O involves passing the sling from the urethra to the inner thigh. This aims to avoid damaging the bladder. The effectiveness and safety of TVT compared to TVT-O in women with SUI are still not clear.

This study assessed the results of 22 studies that investigated the effects of TVT of TVT-O on SUI. 

Both TVT and TVT-O reduced the number of incontinence episodes in participants with SUI. However, there was no difference in results between procedures. There was also no difference in the outcomes reported by the patients between the treatment groups. 

12 studies with 1312 patients assessed the complications of surgery. TVT was associated with a significantly lower risk (by 73%) of leg or groin pain than TVT-O. However, TVT was associated with a 4.53 times higher risk of bladder perforation compared to TVT-O. No significant differences were found regarding other surgical complications between groups.

This study suggested that TVT and TVT-O were both similarly effective in women with SUI. However, fewer patients treated with TVT needed re-operation and experienced leg pain than those treated with TVT-O.

This study analyzed multiple published papers. Therefore, the results may be influenced due to multiple different investigators reporting outcomes.