Clinical and Ultrasonographic Comparison of Tension-Free Vaginal Tape and Transobturator Tape Procedure for the Treatment of Stress Urinary Incontinence

Study ObjectiveThe purpose of this study was to compare tension-free vaginal tape (TVT) and the TVT-obturator (TVTO) procedures.DesignMulticenter retrospective cohort study (Canadian Task Force classification II-2).SettingTertiary teaching hospitals.PatientsWe reviewed 82 women with urodynamically proven stress incontinence undergoing either TVT (n = 53) or TVTO (n = 29) without concomitant surgery.InterventionTVT and TVTO procedure.Measurements and Main ResultsAll subjects underwent urinalyses, 1-hour pad testing, perineal ultrasonography, and urodynamic studies, as well as validated questionnaires before and 1 year after surgery. Mean operative time was significantly shorter in the TVTO group (16.8 ± 10.7 minutes vs 28.6 ± 6.9min, p <.01; unpaired t-test). The subjective and objective cure rates were comparable for the TVT and TVTO groups (p = .085 vs .19, respectively; Fisher's exact test). At rest or during Valsalva, the middle of the TVTO tape localized more distally than that of TVT on ultrasound scanning (p <.01; unpaired t-test). A higher rate of urethral kinking during straining was noted in the TVT group compared with the TVTO group after surgery (87% vs 25%, p <.01; χ2 test). After TVT, maximum urethral closure pressure increased significantly (83.6 ± 24.6 cm H2O vs 69.2 ± 25.9 cm H2O, p <.05), but this was not the case in the TVTO group (67.8 ± 15.0 cm H2O vs 63.2 ± 12.3 cm H2O, p >.05; paired t test).ConclusionWith comparable subjective and objective cure rates, TVTO has the advantages over TVT with shorter operative time. However, the TVTO tape is at a less acute angle and localizes to a more distal part of the urethra, resulting in a lower rate of urethral kinking and less urethral compression.