Trans-obturator tape (TOT) and Tension-Free Vaginal tape (TVT) are a minimally invasive surgical management for stress urinary incontinence (SUI). The aim of this study is to evaluate the postoperative outcome after Transobturator tape surgery and Tension-Free Vaginal tape.

We performed a retrospective analysis of comparing the postoperative outcome after TOT and TVT surgery. Patients diagnosed with SUI on urodynamic study and underwent operation at our institution from January 2017 through December 2020 were evaluated.
Validated quality-of-life questionnaires were completed preoperatively and postoperatively to assess subjective improvement. Our primary outcome was the occurrence of postoperative complications and recured urinary leakage symptom. Women with less than 1 year of follow-up and those with a prior incontinence surgery were excluded. Continuous variables was compared using the Two sample t-test, while non-continuous variables using the Chi-squared test or Fisher’s exact test.

298 patients who underwent the TOT and TVT were reviewed. At 1 year follow-up there were 262 women available for the analysis: (217 [82.8%] TOT group, 45 [17.2%] TVT group.) There was no difference in weight, BMI, previous hysterectomy history, underlying diseases between 2 groups. Comparison of urodynamic study result also showed that there was no difference in the bladder capacity, maximal urethral closing pressure. Among the urodynamic parameters, VLPP was significantly lower in TOT group. (88.18 ± 27.28 in TOT group, 102.22 ±  29.46 in TVT group (p=0.002)). Operation time was significantly longer in TVT group (29.11 ± 9.65 minutes in TOT group, 38.29 ± 13.65 minutes in TVT group (p=<0.001), and blood loss was significantly different in both groups. (10.46 ±6.14 cc in TOT group, 35.33 ± 48.97 cc in TVT group (p < 0.001)
Patients in both groups reported a significant improvement in their urinary symptoms after surgery. Among the postoperative urinary symptoms, urine leakage can be regarded as symptom of recurred urinary incontinence, and it occurred in 5.1% (n=11) of the TOT group, 2.2% (n=1) of the TVT group with no significant difference. (p=0.406). Also there was no significant difference in rate of complication between groups. (p=0.094)

Considering the lower VLPP in TOT group, we may expect TOT group would have worse outcome, but recurrence and complication rate were similar in both groups. In conclusion, TOT and TVT seem to be both effective treatments.

Considering the longer operation time and the risk of bladder injury and bleeding during the TVT procedure, TOT is seems to be more safe method than TVT with similar effectiveness.
As woman population who have SUI symptom is increasing, the further study will be needed in a larger subgroup of women with long-term follow up period.