Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings.

Introduction And Hypothesis: The purpose of this study is to compare retropubic tension-free vaginal tape (TVT) with transobturator out-in TOT and in-out TVT-O for female stress urinary incontinence. Uroflow rate was primary; continence rates, quality of life (QoL) and complication pattern were secondary endpoints.

Methods: A prospective randomised trial with 2:1:1 randomisation at two Swiss teaching hospitals. Patients were followed up at 12 months.

Results: Eighty TVT, 40 transobturator tape (TOT) and 40 TVT-O were randomised. At 12 months, there was no difference in Qmax among the groups. Continence was comparable (≥ 89%). QoL was improved significantly in all groups (P < 0.05). Five vaginal tape exposures occurred (one TVT, four TOT, zero TVT-O; P = 0.028). Two percent (1/52) of sexually active patients after TVT, 17% (5/29) after TOT, but 0% (0/25) after TVT-O reported de novo female sexual dysfunction (P = 0.011). We considered this clinically important enough to stop enrolment.

Conclusions: There was no difference for Qmax at 12 months between TVT, TOT and TVT-O. Female sexual dysfunction and tape exposure may be higher with a transobturator tape.