TOT, TVT results similar: TOT may manage urgency better

Montreal-Procedures using tension-free vaginal tape (TVT, Gynecare/Ethicon, Somerville, NJ) or the recently introduced trans-obturator tape (TOT, Mentor Corp., Santa Barbara, CA) appear to provide equal outcomes in the treatment of stress urinary incontinence. However, TOT may leave a subset of patients more comfortable because it is associated with a lower risk of urgency symptoms, according to a prospective, multicenter, randomized Italian study presented at the International Continence Society here.

"One of the key points of this study is demonstrating that the results are comparable, but you possibly have less risk of injury [with TOT] because you are not entering into the retropubic space."

Operating time was shorter in the TOT group, but overall operative complication rates were similar for both TOT and TVT. One patient in each surgical group experienced a bladder injury during surgery. Two patients in the TOT group had vaginal erosions requiring tape removal. One patient in the TVT group had pain due to foreign body granuloma that required removal of the suprapubic TVT mesh edges, and one in the TVT group experienced a surgical wound hernia.

Both ex novo storage and voiding symptoms were statistically similar in both groups, although there was a nonsignificant higher prevalence of ex novo storage symptoms in the TVT group (10.2% vs. 2.1%).