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| |  Tension-Free Vaginal Tape Produces Better Outcomes Compared With Transobturator Tapes for Urinary Stress Incontinence: Presented at ICS By Sandra Ripley Distelhorst SAN FRANCISCO -- October 3, 2009 -- Better objective and subjective outcomes are obtained after tension-free vaginal tape (TVT) compared with the transobturator vaginal tapes (TVT-O) and transobturator tape (TOT) in the treatment of urinary stress incontinence in women, researchers reported here at the 39th Annual Meeting of the International Continence Society (ICS). The results of a multicentre prospective cohort study that included 27 gynaecological departments in Norway were presented by Sigurd Kulseng-Hanssen, MD, Department of Obstetrics and Gynecology, Asker and Baerum Hospital, Oslo, Norway, on October 1. According to Dr. Kulseng-Hanssen, the study showed not only the better outcome with TVT, but also how registry data can be used to identify areas for improvement in patient care. “Departments who have poorer outcome with the TVT-O or TOT operations than with the TVT operations should consider improving their technique, or reintroducing the TVT operation,” Dr. Kulseng-Hanssen advises. A total of 5,942 patients were recruited for the study. Inclusion criteria included patients who had stress incontinence surgery with TVT, TVT-O, or TOT performed between January 2004 and January 2008 and who completed postoperative follow-up. Patients were excluded from the final analysis if they underwent concurrent vaginal prolapse surgery or did not complete the 9-month follow-up. The choice of surgical approach was left to the performing surgeon. Study analyses included 4,285 women who had a TVT, 732 women who had a TVT-O, and 366 women who had a TOT performed. No significant difference in mean age was found between groups. Small significant differences were found in BMI and numbers of months to follow-up, but these were not considered of clinical importance. Preoperative and postoperative evaluation included a validated Stress and Urge Incontinence Questionnaire, a 24-hour Pad Test, and a Standardised Stress Test. Perioperative complications were recorded by the surgeons. At follow-up, there were significant differences in all outcome values between the TVT and TVT-O groups. No leakage during stress test was 87% for the TVT group versus 80% for the TVT-O group (P = .001). No leakage during 24-hour pad test postoperatively was 87% for TVT group and 82% for the TVT-O group (P = .011). Low urge index was 88% for TVT versus 84% for TVT-O (P = .003). Satisfaction with surgery was higher for TVT group (83%) versus TVT-O group (75%) or TOT group (77%). Perforation of the bladder was higher in TVT (3.5%) than TVT-O (0.8%) or TOT (0.5%), as were haematomas (1.2% for TVT, 0.5% for TVT-O, and 0% for TOT). According to Dr. Kulseng-Hanssen, in the hands of surgeons from 27 different hospitals, a significant better subjective and objective outcome is obtained with the TVT than with the TVT-O operation. However, patients who had TVT-O and TOT operations were less likely to suffer from perioperative complications. [Presentation title: Result From a National Incontinence Registry: TVT Is a Better Surgical Procedure for Treating Stress Incontinence, Compared to TVT-O and TOT. Abstract 3]
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