TVT and TOT compared in American studies.(Gynecology)

TUCSON, ARIZ. -- Three studies presented at the annual meeting of the Society of Gynecologic Surgeons have begun to unravel the advantages and disadvantages of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in patients with stress or mixed urinary incontinence.

The introduction of TVT sling procedures in the mid-1990s rapidly took hold worldwide as a simple, minimally invasive alternative to open or laparoscopic Burch colposuspension. They are now the most widely performed procedures in the United States for stress urinary incontinence.

The more recent entry into this arena of hammocklike procedures using TOT avoided the retropubic space and therefore offered a theoretical safety advantage over TVT procedures. Bladder perforation has been reported in as many as 6%-9% of TVT cases; bowel and vascular injuries are very rare but do occur, explained Dr. Matthew Barber of the Cleveland Clinic.

Few studies have directly compared the two approaches in terms of safety and efficacy, or to identify the best candidates for each procedure. The SGS meeting featured comparisons of the following:

* Perioperative complications and adverse events. Dr. Barbar and associates reviewed safety in 205 patients who underwent a TOT and 213 who underwent a TVT procedure at the Cleveland Clinic between January 2003 and August 2005. Concurrent surgical procedures were performed in 72% of all subjects, but neither the number nor type of procedures differed between the two groups.

The most significant difference in perioperative complications was bladder injury, which occurred in 5.1% of women undergoing TVT and no patient undergoing TOT.

Voiding dysfunction was present in 8.9% of women following TVT surgery and 2.9% of women following TOT procedures. Anticholinergic medications were required beyond 6 weeks postsurgery in 14% of women in the TVT group and 6.3% of those in the TOT group.