European/ Canadian results favor TOT for ease and safety.(Gynecology)(transobturator tape )

PARIS -- A randomized, multicenter trial and two retrospective studies presented at the annual congress of the European Association of Urology found outcomes were similar whether patients had the transvaginal or transobturator sling procedure for urinary stress incontinence.

The investigators agreed that their results favored the newer transobturator tape (TOT) procedure, as it is simpler than constructing midurethral synthetic slings with transvaginal tape (TVT). "Both are the same in my experience. The TOT is easier, and it is inherently safe," Dr. Graeme H. Urwin of the United Kingdom said in a conclusion echoed by investigators from France and Canada.

"My sense is transobturator is a little easier to carry out, so it gave me a little confidence to recommend this," said Dr. Sender Herschorn, professor of urology at the University of Toronto.

Less clear was whether some patients might present with conditions that would be better treated by TVT or TOT. Dr. Herschorn said he did "not know of any specific indications for one over the other."

The French group is continuing to investigate this question. "There might be some specific indications for the retropubic route, but we don't have enough data to support this yet. We are going to do more work," Dr. Emmanuel David-Montefiore of Hopital Tenon, Paris, said in an interview.

Dr. David-Montefiore reported 3-month data from a multicenter trial in which 88 women with similar demographics and clinical histories were randomized: 42 to a retropubic route (TVT) and 46 to TOT. He said the same tape was used in both groups.

At 3 months, 89.3% of the retropubic cohort and 88.6% of the transobturator group were dry. Satisfaction rates were 90% and 92%. He also reported de novo pollakiuria in 10.7% of the retropubic patients vs. 5.7% of transobturator patients. De novo urgency occurred in 17.9% ...