Received: 20 September 2016 | Accepted: 21 November 2016 DOI 10.1002/nau.23192 ORIGINAL CLINICAL ARTICLE Long-term outcomes for transobturator tension-free vaginal tapes in women with urodynamic mixed urinary incontinence Mohamed Abdel-Fattah 1 | Gabriel Cao 2 | Alyaa Mostafa 2 1 Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland 2 University of Aberdeen, Aberdeen, Scotland Correspondence Mohamed Abdel-Fattah, MD, FRCOG, Senior Lecturer/Consultant Urogynaecologist, Division of Applied Health Sciences, University of Aberdeen, Second Floor, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB25 2ZD, Scotland. Email: m.abdelfattah@abdn.ac.uk Funding information Henry Smith Charity; IUGA Clinical Fellowship Grant 2014 AIMS: To assess the long-term patient reported outcomes following transobturator tension-free vaginal tapes (TO-TVT) in women with urodynamic mixed urinary incontinence (MUI). METHODS: A secondary analysis of the 9-year follow-up of the E-TOT study: 341 women with predominant stress urinary incontinence symptoms were randomized to undergo either inside-out or outside-in TO-TVT between April 2005 and April 2007. Forty-eight women had preoperative urodynamic MUI and were available for 9-year follow-up. Primary outcome was the patient-reported success rate defined as very/much improved on Patient's Global Impression of Improvement PGI-I. Secondary outcomes included impact on women's quality of life, sexual function, overactive bladder symptoms,and late adverse events. Statistical analysis was performed using SPSS v.23. RESULTS: Forty-eight women completed the 9-year follow-up, with adjusted response rate of 63%. The success based on the PGI-I was 64.6% (n = 31), with a further 14.6% (n = 7) who reported “improved.” There was no significant difference between groups (OR 1.11; 95%CI 0.33, 3.70; P > 0.999). Clinically significant improvement in quality of life was found in 85.3%. Cure of urgency and UUI was reported by 35% and 41%, whereas worsening was reported in 6.5% and 2.3%, respectively. One patient reported chronic groin/leg pain. The small sample size and the sizeable loss to follow-up are limitations in this study. CONCLUSIONS: This is the first study to report the long-term outcomes of TO-TVT in women with urodynamic MUI; TO-TVT is associated with a good and sustained patient-reported success rate in women with MUI up to 9-years follow-up. KEYWORDS mid-urethral slings, stress urinary incontinence, tension-free vaginal tape, transobturator tapes, urinary incontinence 1 | INTRODUCTION The unprecedented growth of the elderly population in the western world highlights the importance of studying the long- term outcomes of the interventions used for treatment of chronic conditions, including urinary incontinence (UI). In 2016, a large epidemiology study in the United States 1 showed prevalence in UI of 19-26% and increasing with age; this was most apparent for urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). Interestingly, the prevalence of stress urinary incontinence (SUI) did not seem to increase with age in this study. UI is associated with a negative impact on a woman's social, physical, and psychological well-being, leading to embarrassment, low self-esteem, and negative effects on the productivity of working women. In extreme cases, patients reported avoiding employment; 60% avoided going away Dr. Hashim Hashim led the peer-review process as the Associate Editor responsible for the paper. Neurourol Urodynam 2016; 9999: 1–7 wileyonlinelibrary.com/journal/nau © 2016 Wiley Periodicals, Inc. | 1