TOT may manage urgency better than TVT in patients with stress incontinence

Procedures using tension-free vaginal tape (TVT, Gynecare/Ethicon, Somerville, NJ) or trans-obturator tape (TOT, Mentor Corp., Santa Barbara, CA) appear to equally treat the incontinence associated with stress urinary incontinence. TOT, however, may leave patients more comfortable because it is associated with a lower risk of urgency symptoms, Italian researchers say.

Presenter and co-author Elizabetta Costantini, MD, associate professor of urology at the University of Perugia, told Urology Times that these findings highlight the importance of obtaining a better understanding of how effective TVT and TOT procedures are at treating not just stress incontinence but related symptoms, such as urgency.

"We need to decide which is the best technique, if possible," she said, and determine what kind of technical tweaking can be done to improve outcomes.

The investigators randomized patients with stress incontinence to treatment with TVT or TOT. Patients were similar with respect to clinical and demographic details that included age, parity, body mass index, menopausal status, history of hysterectomy, previous continence surgery, and incontinence symptoms.

Dr. Costantini presented initial results in 96 patients involved in the trial, which is ongoing. To date, the patients have been followed for just over 1 year.

Efficacy, in terms of the proportion of patients who were dry, based on both objective and subjective measures, was similar for both groups. What was different was the proportion of patients left with urgency. Patients who underwent TOT were less likely to experience postoperative symptoms of urgency than those who underwent TVT, which can sometimes be more of a problem for patients than the incontinence itself, said co-author Ervin Kocjancic, MD, a urology specialist at Maggiore della Carità Hospital in Novara, Italy.

One patient in each surgical group experienced a bladder injury during surgery. Early and late complications from each procedure were also similar between the two groups and included the occasional case or two of fever, retropubic hematoma, vaginal erosion, vaginal discomfort, foreign body granuloma, wound discomfort, or paraincisional hernia.