Long-term outcomes of transobturator tension-free vaginal tapes as secondary continence procedures

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To assess the long-term patient-reported outcomes following TO-TVT as a secondary continence procedure in women with recurrent stress urinary incontinence (R-SUI).

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 continence 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). Secondary outcomes included late adverse events and impact on women’s quality of life and sexual function. Statistical analysis was performed using SPSS version 23.

Sixty-three per cent completed the 9-year follow-up. The success based on the PGI-I was 62.1% with no significant 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 secondary continence procedure.

TO-TVT operations are associated with good patient-reported success rates (62%) in women with previous 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.
Original languageEnglish
Pages (from-to)1141-1148
Number of pages8
JournalWorld Journal of Urology
Issue number7
Early online date18 Nov 2016
Publication statusPublished - Jul 2017

Bibliographical note

We thank Dr. Karmakar (Research Fellow— University of Aberdeen) for sending out the questionnaires and collating the responses. We thank Lindsey Grant for performing the independent data entry cross-check. A special gratitude goes to all the participants whose excellent cooperation over the years made this study successful.

The initial phase of this study (up to 3-year follow-up) was funded by the Henry Smith Charity. Dr. Karmakar was funded by IUGA Clinical Fellowship Grant 2014.


  • transobturator tapes
  • mid-urethral slings
  • tension-free vaginal tape
  • urinary incontinence
  • stress urinary incontinence


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