Lower likelihood of additional surgery with tension-free vaginal tape vs. transobturator tape

Key Points

Toronto-Tension-free vaginal tape (TVT) results in a lower likelihood of further stress incontinence surgery than transobturator tape (TOT) in the treatment of women with urodynamic stress incontinence and intrinsic sphincter deficiency, according to long-term data.

Australian researchers presented 3-year follow-up data from a prospective, randomized, controlled trial at the 2010 joint meeting of the International Continence Society and the International Urogynecological Association.

Half of the 164 women enrolled in the study were randomized to the TVT Retropubic System (Ethicon Inc., Somerville, NJ), and the other half were randomized to the Monarc transobturator sling (American Medical Systems, Minnetonka, MN), with the primary endpoint being failure of the sling procedure and the need for repeat surgery. In addition, investigators performed subjective assessments of quality of life, explained principal investigator Lore Schierlitz, MD, a consultant urogynecologist at Mercy Hospital for Women in Melbourne.

She noted that the trial aimed to be as inclusive as possible in its eligibility criteria by taking into account women who had intrinsic sphincter deficiency.

"In the majority of trials, they are excluded or there is a very small number included in the trial, so you cannot make any comment on how that subgroup behaves," Dr. Schierlitz noted. "They usually have the most severe stress incontinence. This is why we wanted to look at this group specifically and exclusively."

Short-, long-term outcomes better with TVT

At a mean follow-up of 37 months, investigators found 15 of 82 cases (18.3%) required repeat sling procedures in the TOT arm of the study compared with one of 82 cases (1.2%) in the TVT arm, a statistically significant difference (p<.001).

"The findings support that TVT was much better in the short term and long term compared to the transobturator Monarc tape," Dr. Schierlitz said in an interview following her presentation, noting she and colleagues published 6-month data in Obstetrics and Gynecology (2008; 112:1253-61).

Dr. Schierlitz said the study data suggest that retropubic TVT should be the first choice in the surgical treatment of stress urinary incontinence, noting the study's subjects will continue to be followed.

"Generally, there would be few reasons why it would be prohibitive to use a TVT, but there are always women who have previous surgery or scarring or a personal preference [to not have a TVT]," she said.

Side effects associated with the TVT include perforation, and side effects associated with the TOT sling include groin pain and complications due to the way the tape is placed, she said.