TOT and TVT as surgical methods of treatment of stress urinary incontinence in women - meta-analysis

Abstract

Introduction: Urinary incontinence can affect up to 50% of women in the world. The most common is stress incontinence, which consists in involuntary, uncontrolled urination when the pressure in the abdominal cavity increases. Among the most commonly used methods of treating stress urinary incontinence there are treatments using a synthetic tape - TOT and TVT. In this work, both methods were compared in terms of e.g. their effectiveness, the presence of complications, the safety of both procedures and the method of performing both procedures.

Material and methods: The work was based on the articles published in PubMed, medical books and websites.

Results: Both TOT and TVT in the treatment of stress urinary incontinence are highly effective. Both short-term and long-term treatment results of both methods are very good and very similar. In the case of TOT, the subjective cure <1 year is 62-98%, where with TVT - 71-97%. Subjective long-term cure (>5 years) was 43-92% with TOT and 51-88% with TVT. The incidence of complications after TOT is significantly lower, but there is a higher probability of having to perform a repeat procedure to treat stress urinary incontinence. TVT has a lower risk of reoperation in >5 years (1.1%) but has a higher risk of chronic perineal pain.

Conclusions: The placement of a tension-free TVT or TOT tape should be the surgery of choice for women with simple stress urinary incontinence. However, there is a higher risk of chronic perineal pain 12 months after having a tape placed behind the symphysis. The technique of passing the tapes through the obturator holes is associated with a lower risk of bladder injury and less discomfort during bladder emptying compared to the TVT technique. After TOT surgery both pain in the inner thighs and inguinal area and vaginal damage are more common than after TVT.