[en] INTRODUCTION AND HYPOTHESIS: The aim of this study is to compare a modified inside-out transobturator procedure with its original counterpart [inside-out transobturator (TVT-O)] for the treatment of female stress urinary incontinence (SUI). METHODS: A prospective, randomized trial in women suffering from SUI was used. The modified procedure consisted of a shorter tape whilst the scissors or guide no longer perforated the obturator membrane. The primary outcome was the resolution of subjective and objective SUI at 1 year. Secondary outcome measures included adverse events, quality of life measures, and groin pain. RESULTS: One hundred seventy-five patients were randomized. No intraoperative complications were recorded. The SUI cure rate was 91.7% versus 90.7% (original versus modified, respectively; p = 0.824). Incidence and intensity of groin pain was higher in the original TVT-O group on day 0 and 1 (p < 0.05), requiring more analgesics (p = 0.015) but not thereafter. CONCLUSIONS: At 1 year follow-up, the modified inside-out transobturator tape procedure was as efficient and safe as the original technique but associated with less immediate postoperative groin pain.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics) Urology & nephrology
Author, co-author :
De Leval, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Urologie
Thomas, Alexandre ; Centre Hospitalier Universitaire de Liège - CHU > Urologie
Waltregny, David ; Université de Liège - ULiège > Département des sciences cliniques > Urologie - GIGA-R : Labo de recherche sur les métastases
Language :
English
Title :
The original versus a modified inside-out transobturator procedure: 1-year results of a prospective randomized trial.
Publication date :
2011
Journal title :
International Urogynecology Journal
ISSN :
0937-3462
eISSN :
1433-3023
Publisher :
Springer Science & Business Media B.V., Godalming, United Kingdom
E Delorme 2001 Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women Prog Urol 11 1306 1313 1:STN:280:DC%2BD387isFWgsg%3D%3D 11859672 (Pubitemid 33646183)
J de Leval 2003 Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out Eur Urol 44 724 730 10.1016/j.eururo.2003.09.003 14644127 (Pubitemid 37542932)
D Waltregny J de Leval 2009 The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update Int Urogynecol J Pelvic Floor Dysfunct 20 337 348 10.1007/s00192-008-0753-1 18982235
RM Houwert C Renes-Zijl MC Vos HA Vervest 2009 TVT-O versus Monarc after a 2-4-year follow-up: a prospective comparative study Int Urogynecol J Pelvic Floor Dysfunct 20 1327 1333 10.1007/s00192-009-0943-5 19597718
D Waltregny Y Gaspar O Reul W Hamida P Bonnet J de Leval 2008 TVT-O for the treatment of female stress urinary incontinence: results of a prospective study after a 3-year minimum follow-up Eur Urol 53 401 408 10.1016/j.eururo. 2007.08.021 17728052 (Pubitemid 350296579)
RM Houwert JP Roovers PL Venema HW Bruinse MG Dijkgraaf HA Vervest 2010 Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices Am J Obstet Gynecol 202 75 e1 e7 19846055
VW Sung MD Schleinitz CR Rardin RM Ward DL Myers 2007 Comparison of retropubic vs transobturator approach to midurethral slings: a systematic review and meta-analysis Am J Obstet Gynecol 197 3 11 10.1016/j.ajog.2006.09.025 17618742 (Pubitemid 47001828)
PM Latthe P Singh R Foon P Toozs-Hobson 2010 Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials BJU Int 106 1 68 76 10.1111/j.1464-410X.2009.09051.x 19912182
Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2009:CD006375
M Bourrat C Armand P Seffert J Tostain 2003 Complications and medium-term functional results of TVT in stress urinary incontinence Prog Urol 13 1358 1364 15000314 (Pubitemid 40075093)
P Debodinance 2007 Trans-obturator urethral sling for the surgical correction of female stress urinary incontinence: outside-in (Monarc®) versus inside-out (TVT-O®). Are the two ways reassuring? Eur J Obstet Gynecol Reprod Biol 133 232 238 10.1016/j.ejogrb.2006.05.015 16793194 (Pubitemid 47079074)
K Tamussino E Hanzal D Kölle A Tammaa O Preyer W Umek, et al. 2007 Transobturator tapes for stress urinary incontinence: results of the Austrian registry Am J Obstet Gynecol 197 634 e1 e5
A Liapis P Bakas G Creatsas 2008 Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study Int Urogynecol J Pelvic Floor Dysfunct 19 185 190 1:STN:280:DC%2BD1c%2FgvFWjuw%3D%3D 10.1007/s00192-007-0432-7 17668144
I But M Faganelj 2008 Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study Int Urogynecol J Pelvic Floor Dysfunct 19 857 861 10.1007/s00192-007-0544-0 18188489 (Pubitemid 351597567)
KS Lee MS Choo YS Lee JY Han JY Kim BJ Jung DH Han 2008 Prospective comparison of the 'inside-out' and 'outside-in' transobturator-tape procedures for the treatment of female stress urinary incontinence Int Urogynecol J Pelvic Floor Dysfunct 19 577 582 10.1007/s00192-007-0487-5 17940717 (Pubitemid 351356451)
F Araco G Gravante R Sorge J Overton D De Vita F Sesti E Piccione 2008 TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence Int Urogynecol J Pelvic Floor Dysfunct 19 917 926 1:STN:280:DC%2BD1czjs1Kitw%3D%3D 10.1007/s00192-007-0554-y 18217177 (Pubitemid 351772622)
KS Lee DH Han YS Choi SH Yum SH Song CK Doo MS Choo 2007 A prospective trial comparing tension-free vaginal tape and transobturator vaginal tape inside-out for the surgical treatment of female stress urinary incontinence: 1-year followup J Urol 177 214 218 10.1016/j.juro.2006.08.063 17162048 (Pubitemid 44879472)
E Laurikainen A Valpas A Kivela, et al. 2007 Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial Obstet Gynecol 109 4 11 10.1097/01.AOG.0000249607.82768.a1 17197581 (Pubitemid 46035504)
M Abdel-fattah I Ramsay S Pringle C Hardwick H Ali 2010 Evaluation of transobturator tapes (E-TOT) study: randomised prospective single-blinded study comparing inside-out vs. outside-in transobturator tapes in management of urodynamic stress incontinence: short-term outcomes Eur J Obstet Gynecol Reprod Biol 149 106 111 10.1016/j.ejogrb.2009.11.023 20036048
L Krofta J Feyereisl M Otcenásek P Velebil E Kasí ková M Krcmár 2010 TVT and TVT-O for surgical treatment of primary stress urinary incontinence: prospective randomized trial Int Urogynecol J Pelvic Floor Dysfunct 21 141 148 10.1007/s00192-009-1027-2 19907913
P Hinoul HA Vervest P Venema J Den Boon A Milani JP Roovers 2009 TVT obturator system versus TVT secur: a randomized controlled trial, short term results Int Urogynecol J 20 S213 10.1007/s00192-008-0751-3
M Basu J Duckett 2010 A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence BJOG 117 6 730 735 1:STN:280:DC%2BC3c3ksV2ksA%3D%3D 10.1111/j.1471-0528.2010.02513.x 20175874
P Marquis G Amarenco C Sapède F Josserand C McCarthy M Zerbib, et al. 1997 Elaboration and validation of a specific quality of life questionnaire for urination urgency in women Prog Urol 7 56 63 1:STN:280:DyaK2s3jtFCrsw%3D%3D 9116740
D Waltregny O Reul B Mathantu Y Gaspar P Bonnet J de Leval 2006 Inside out transobturator vaginal tape for the treatment of female stress urinary incontinence: interim results of a prospective study after a 1-year minimum followup J Urol 175 2191 2195 10.1016/S0022-5347(06)00277-1 16697838 (Pubitemid 43668575)
Villet R (1995) Les prolapsus génitaux. In: Villet R, Buzelin JM, Lazorthes F (eds) Les troubles de la statique pelvipérinéale de la femme. Vigot, Paris, pp 119-140
BM Ridgeway BE Arias MD Barber 2008 Variation of the obturator foramen and pubic arch of the female bony pelvis Am J Obstet Gynecol 198 546 e1 e4 18355775
