Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis

Introduction and hypotheses

One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies.

Methods

This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (≥5 years) efficacy and safety of MUS in women affected by SUI were included.

Results

A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out–in and in–out) were 61.6% (95% CI: 58.5–64.8%) and 76.5% (95% CI: 73.8–79.2%), and 64.4% (95% CI: 61.4–67.4%) and 81.3% (95% CI: 78.9–83.7%) respectively. When considering TOT using the out–in technique (TOT-OI) and TOT using the in–out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7–60.7%) and 81.6% (95% CI: 78.8–84.4%), and 68.8% (95% CI: 64.9–72.7%) and 81.3% (95% CI: 77.9–84.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 95% CI: 0.49–1.53], I ²?=?67%, p?=?0.62) and subjective (OR: 0.84 95% CI: 0.46–1.55], I ²?=?68%, p?=?0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 95% CI: 0.97–9.51], I ²?=?76%, p?=?0.06) and subjective (OR: 1.85 95% CI: 0.40–8.48], I ²?=?88%, p?=?0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 95% CI: 0.54–1.28], I ²?=?0%, p?=?0.40), TOT-OI versus TVT-O (OR: 0.77 95% CI: 0.17–3.46], I ²?=?86%, p?=?0.73).

Conclusions

Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up.