A Comparative Study of Outside-In and Inside-Out Transobturator Tape Procedures for Female Stress Urinary Incontinence: 7-Year Outcomes

Objectives: The aim of this study was to compare the long-term surgical outcomes of the "inside-out" (TVT-O) and "outside-in" (TOT) transobturator tape procedures for treating female stress urinary incontinence (SUI).

Methods: This was a retrospective analysis of women who underwent a transobturator tape procedure and were followed for at least 7 years. Patients' baseline characteristics and urodynamic parameters were compared between the two groups and analyzed to identify factors related to failure of therapy.

Results: A total of 215 patients were followed for > 7 years (TOT, n = 129; TVT-O, n = 86), with a median follow-up period of 7.1 years. No significant differences were observed in the baseline characteristics or urodynamic parameters between the groups, except incontinence type (TOT 33.3% vs. TVT-O 52.3% with mixed urinary incontinence, P < 0.05). The TOT group had significantly higher cure rate, satisfaction with surgery, willingness to undergo the procedure to others, and willingness to receive the same procedure than those of the TVT-O group (87.1 vs. 66.7%, 87.6 vs. 64.0%, 89.1 vs. 77.9%, and 77.5 vs. 57.0%, all P-values < 0.05), respectively. A Univariate analysis identified maximum urethral closure pressure (MUCP) (odds ratio, 0.980; 95% confidence interval, 0.960-1.000; P = 0.046) as a risk factor for surgical failure.

Conclusions: TOT and TVT-O procedures are safe and effective for the treatment of SUI in women over a 7-year follow-up period. The TOT procedure had higher cure rate and satisfaction rates than TVT-O. MUCP may be associated with surgical outcome.