Comparison of tension-free vaginal tape and transobturator tape procedure for the treatment of stress urinary incontinence Cheng-Yu Long a,b , Chun-Shuo Hsu c , Ming-Ping Wu d , Cheng-Min Liu a , Tsu-Nai Wang e and Eing-Mei Tsai a,f Introduction Stress urinary incontinence (SUI) is defined as the invo- luntary leakage of urine on effort, exertion, or coughing [1]. These symptoms are rarely life-threatening but always cause a negative impact on quality of life, such as physical, psychological, and social well being of the affected women. Surgery is the most effective treatment for SUI. There are over 100 types of anti-incontinence surgeries invented by Kelley’s placation reported in 1914 [2]. In the last decade, midurethral synthetic sling has become the most popular procedure for female SUI. The two main categories are tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures. Tension-free vaginal tape In 1995, Petros and Ulmsten [3] introduced a new, minimally invasive surgery for the treatment of female SUI, namely the TVT procedure. On the basis of the integral theory, continence can be achieved by placing a vaginal tape underneath the midurethra without tension to reinforce the weakened pubourethral ligament [3]. It has become one of the most popular procedures for female SUI because of its excellent results [3,4]. The 11-year follow-up with durable cure rate (81%) has been published [4]. However, the common use of the TVT has been associated with various operative complications, including bladder perforation, major blood vessel injuries [5], and postoperative voiding difficulties [6]. Transobturator tape In an attempt to reduce the morbidity of retropubic needle passage, an alternative approach with a transob- turator route of prolene tape (UraTape, Porges-Mentor, Lisses, France) (TOT) has been developed by Delorme [7] in 2001. More recently, de Leval [8] designed a TOT a Graduate Institute of Medicine, College of Medicine, b Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, c Department of Obstetrics and Gynecology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, d Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, e Department of Public Health, College of Health Science and f Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Correspondence to Dr Chun-Shuo Hsu, Department of Obstetrics and Gynecology, Buddhist Dalin Tzu Chi General Hospital, 482 Shan-Ming Rd., Hsiao-Kang Dist. 812, Kaohsiung, Taiwan Tel: +886 7 803 6783ext3450; fax: +886 7 806 5068; e-mail: K83263@kmhk.kmu.edu.tw Current Opinion in Obstetrics and Gynecology 2009, 21:342–347 Purpose of review The aim of this review was to assess the recent evidence on the effectiveness and complications of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures for female stress urinary incontinence between January 2008 and March 2009. Recent findings A meta-analysis of recent studies revealed that the short-term objective cure rate was borderline worse in the TOT group compared with TVT [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.37 – 1.00; P ¼ 0.05]. Bladder perforation (OR 12.23; 95% CI 2.86–52.34) was significantly more common, whereas groin/thigh pain was significantly less in the TVT group (OR 0.32; 95% CI 0.11–0.92; P ¼ 0.022). Postoperative urinary retention was slightly more in women undergoing TVT than those undergoing TOT (OR 1.6; 95% CI 0.90–3.12; P ¼ 0.06). The rates of vaginal erosion (OR 0.34; 95% CI 0.09–1.33), de-novo urgency (OR 1.21; 95% CI 0.52–2.79) and urinary tract infection (OR 0.88; 95% CI 0.56–1.38) were comparable in both procedures. In addition, TVT appeared to be more obstructive than TOT, as evidenced by ultrasonographic and urodynamic findings. Changes in sexual function need further investigation because this issue has not been well studied for either sling procedure. Summary TOT has the advantages over TVT with shorter operative time and a relatively lower complication rate. For women with intrinsic sphincter deficiency, however, TVT appears to be a better option because it is more obstructive. Keywords stress urinary incontinence, tension-free vaginal tape, transobturator tape Curr Opin Obstet Gynecol 21:342–347 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 1040-872X