Study: Both TOT and TVT are safe, effective

Berlin-Results of an Italian study comparing transobturator suburethral tape (TOT) and tension-free vaginal tape (TVT) show both surgical techniques to be equally efficient at a follow-up of nearly 3 years in women suffering from stress urinary incontinence.

The results demonstrated that both surgical techniques proved to be equally safe and effective in alleviating patients' symptoms, with 86% of those who underwent the TVT procedure (Gynecare/Ethicon, Somerville, NJ) and 88% of those who underwent the TOT procedure (Aris, Coloplast, Minneapolis) were continent at a mean follow-up of 31 months. Minimal complications were observed at 31 months, and researchers reported no difference in postoperative voiding symptoms.

"Postoperative storage symptoms seen in our patients still remain to be the main issue with both techniques, and the underlying mechanism still needs to be investigated."

David Castro Diaz, MD, co-moderator of the session, asked which of the procedures Dr. Costantini prefers based on her experiences following this study.

"I believe TVT is the better choice," she answered. "There are a few cases in which the TOT can be somewhat difficult to perform and difficult to place. In general, I prefer the out-in technique when I perform a sling procedure, but this is simply a question of the personal style of the surgeon."

Dr. Costantini was also asked if she had any case in the study in which the TOT sling needed to be completely removed.

"I only had to remove three TOTs, but this was only due to the erosion of the tape," she said. "In one case, I needed to perform a urethrolysis following a TVT because of voiding symptoms after the procedure. Generally, the problem is the erosion rate and not the voiding symptoms. If you put the tape in the right place, it is very difficult to have any problems with it."