Five years on: Two vaginal sling procedures compared

This long-term study compared two surgical techniques used to treat stress urinary incontinence in women. Researchers concluded that the transobturator tape (TOT) surgery is, overall, as safe and effective as the current standard-of-care.

Vaginal sling procedures are the most common type of surgery used to help control stress urinary incontinence (SUI). Tension-free vaginal tape surgery (TVT) is the current standard-of-care. It is a minimally invasive procedure that involves the placement of a thin mesh tape to lift the urethra to its normal position. The transobturator tape (TOT) procedure is a similar technique that has been under the focus of investigation as a possible alternative. This study directly compared the long-term effectiveness and safety of TVT and TOT.

176 women with stress incontinence were randomly assigned to receive either TVT or TOT surgery. Surgery outcomes were compared and followed-up on for five years.

No differences were noted in treatment effectivity between the two procedures. Women in both groups reported few or no urinary symptoms at 5-year follow-up (less than 1% of women reported persistent symptoms). Equal improvements in quality of life and sexual function were reported in both groups.

The rate of complications after surgery (including mesh or tape exposure, failure of surgery, urine retention or substantial pain) were similar for women undergoing TVT (28% of women) and TOT (22% of women). However, vaginal examination found that the vaginal tape was palpable (touchable) in about half of the women (49%) undergoing TOT, when compared to only 22% of women in the TVT group. This was nearly always identified within the first year of treatment. 

The researchers concluded that TVT and TOT were similar in terms of long-term effectiveness and safety. However, women undergoing TOT have an increased risk of tape exposure, which could lead to further complications.