Long-term outcomes of the TOT vaginal sling procedure

This study investigated the long-term safety and effectiveness of the transobturator tape (TOT) vaginal sling procedure. Researchers reported good cure rates at 10 years with a low rate of long-term complications.

Vaginal sling procedures are the most common type of surgery used to help control stress urinary incontinence. The transobturator tape (TOT; also sometimes known as TVT-O) approach is a minimally invasive vaginal sling procedure. It is a widely adopted approach that involves the placement of a narrow mesh tape underneath the urethra (urine tract). This helps lift the urethra to its normal position and close more tightly. Since women are likely to live with vaginal slings for many years, long-term studies are needed to address their safety and effectiveness.

This study included 124 women with stress urinary incontinence treated with the TOT procedure. Physical examinations and questionnaires measured long-term treatment outcomes 10 years after the procedure. 63% of women completed follow-up questionnaires. 49% of women were available for physical examinations at 10 years.

69% of women were considered fully continent at the physical examination. 22% of women did not achieve continence at the follow-up examination. Self-reported continence at 10 years was 64%. 9% of women had undergone another surgery due to persistent stress urinary incontinence.

5% of women were found to have tape exposure during examination. However, these were considered mild and did not require surgical treatment. The erosion rate (moving of mesh tape through vaginal wall) was 7%. Occasional groin pain occurred in 13% of women. 4 of the 16 sexually active women (25%) reported painful intercourse. 

Researchers concluded that the TOT procedure is a relatively efficient long-term treatment for stress urinary incontinence.

Many women were lost at follow-up. Larger long-term studies are needed to confirm these results.