Which type of vaginal sling procedure is better for intrinsic sphincter deficiency?

This study compared two vaginal sling procedures for intrinsic sphincter deficiency. Researchers reported that the tension-free vaginal tape (TVT) was more effective than the transobturator tape (TOT) in reducing stress incontinence due to intrinsic sphincter deficiency.

Stress urinary incontinence is often caused by weakness of the urethra (urine tract). This is known as intrinsic sphincter deficiency. Vaginal sling procedures are often recommended to help control stress urinary incontinence. Tension-free vaginal tape (TVT) surgery 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 uses a smaller incision to place the mesh tape. TVT and TOT are generally associated with comparable success rates in treating stress incontinence. However, more studies are needed to determine the relative effectiveness of TOT in cases of intrinsic sphincter deficiency.

The aim of this study was to compare TVT and TOT in treating stress incontinence due to intrinsic sphincter deficiency. The records of 157 women with intrinsic sphincter deficiency were analyzed. All women underwent a vaginal sling procedure for stress urinary incontinence. 105 women received treatment with the TVT procedure. 52 women underwent the TOT procedure.

95.2% of women were fully continent (self-reported absence of urine leakage) 12 months after the TVT procedure. This was significantly higher compared to 82.7% of women in the TOT group. Overall, the risk of treatment failure in women who underwent TOT was about 4 times higher than women who underwent TVT. Having very severe stress urinary incontinence before surgery was also a risk factor.  

Researchers concluded that TVT is more effective than TOT in treating stress urinary incontinence in women with intrinsic sphincter deficiency. 

This study did not randomly assign women to treatment groups. Larger randomized trials are needed to confirm these results.