1 3 World J Urol DOI 10.1007/s00345-016-1969-1 ORIGINAL ARTICLE Long-term outcomes of transobturator tension-free vaginal tapes as secondary continence procedures Mohamed Abdel-Fattah 1 · Gabriel Cao 2 · Alyaa Mostafa 1 Received: 23 September 2016 / Accepted: 4 November 2016 © Springer-Verlag Berlin Heidelberg 2016 Conclusions TO-TVT operations are associated with good patient-reported success rates (62%) in women with previ- ous failed continence surgery with up to 9-years follow-up. There is a non-significant trend towards better outcomes with the inside-out TO-TVT. Keywords Transobturator tapes · Mid-urethral slings · Tension-free vaginal tape · Urinary incontinence · Stress urinary incontinence Introduction In the UK, the lifetime risk of women undergoing sur- gery for stress urinary incontinence (SUI) is 3.6% [1]. The reoperation rate for recurrent SUI (R-SUI) varies between studies (8.8–17%) [2, 3]. The median time to undergo repeat continence surgery for R-SUI in the UK is 2.8 years [4]. Management of R-SUI can be challenging being depend- ent on multiple factors such as the type of the index proce- dure, time to failure and patients’ factors such as BMI, co- morbidities and patient’s attitude towards further surgery. Surgeons and institution factors are also important such as the availability of surgical expertise and specific investiga- tions [video urodynamics (VUD), urethral pressure profile (UPP)]. The Society of Obstetricians and Gynaecologists of Canada recommends the use of conservative manage- ment, such as pelvic floor muscle training (PFMT), as a first-line treatment in women with R-SUI [5]. There is no consensus on the best surgical management of R-SUI, and a number of options have been suggested including midure- thral tension-free vaginal slings (MUS) including retropu- bic tension-free vaginal tape (RP-TVT) and transobturator tension-free vaginal tape (TO-TVT) and more traditional Abstract Purpose To assess the long-term patient-reported out- comes following TO-TVT as a secondary continence pro- cedure in women with recurrent stress urinary incontinence (R-SUI). Methods A secondary analysis of the 9-year follow-up of the E-TOT study was performed: 341 women with predominant SUI symptoms were randomised to undergo either Inside-out or Outside-in TO-TVT between April 2005 and April 2007. Forty-six women had R-SUI following previously failed con- tinence surgery at time of randomisation and are the basis of this analysis as a one single cohort. Primary outcome was the patient-reported success rate defined as very/much improved on Patient’s Global Impression of Improvement (PGI-I). Sec- ondary outcomes included late adverse events and impact on women’s quality of life and sexual function. Statistical analy- sis was performed using SPSS version 23. Results Sixty-three per cent completed the 9-year follow- up. The success based on the PGI-I was 62.1% with no sig- nificant difference between groups (OR 5.33; 95% CI 1.03, 27.76; p = 0.094). Clinically significant improvement in QoL was found in 84.2%. Adverse events included vaginal erosions (n = 3) and groin pain (n = 2). The small sample size is a limitation in this study; nevertheless, this is one of the largest cohorts reported for women with R-SUI and the first to report the long-term outcomes of TO-TVT as a sec- ondary continence procedure. * Mohamed Abdel-Fattah m.abdelfattah@abdn.ac.uk 1 Division of Applied Health Sciences, University of Aberdeen, Second Floor, Aberdeen Maternity Hospital, Foresterhill, AB25 2ZD Aberdeen, UK 2 University of Aberdeen, Aberdeen, UK