Tension-free vaginal tape is currently considered the first-line surgical option for stress urinary incontinence, the authors point out, but retropubic tape placement carries some risk of bladder perforation or other complications. “Transobturator mid-urethral tapes aim to lessen these risks by passing the tape through the obturator foramen.”
Dr. Roderick Teo, with the Leicester Royal Infirmary, and colleagues compared the two approaches in 127 women with stress incontinence; 66 were randomized to standard tension-free vaginal tape and 61 were randomized to tension-free vaginal tape-obturator.
Time to resuming normal activity was similar in both groups. At 6 months, the objective cure rate, defined as less than 5 grams urine loss on a 24-hour pad test, was 69.7% for tension-free vaginal tape versus 72.1% with tension-free vaginal tape-obturator, according to the report. Corresponding subjective cure rates were 72.7% vs 67.2%.
While the two techniques were equally effective, more women complained of leg pain after receiving a tension-free vaginal tape-obturator (26.4%) than a tension free vaginal tape (1.7%). Although the pain was transient, the trial was terminated early for this reason. “Nevertheless,” Dr. Teo and colleagues write, “our data will be useful for future meta-analyses and systematic reviews.”
In fact, they suggest that the leg pain problem with the transobturator approach may be peculiar to the inside-out approach used in this study, since studies using outside-in tapes have not reported a higher incidence of leg pain.
Summing up, the team concludes: “Our findings are similar to those in other studies comparing retropubic and transobturator tapes. The 2 procedures have a high cure rate with a low rate of complications.”
Randomized Trial of Tension-Free Vaginal Tape and Tension-Free Vaginal Tape-Obturator for Urodynamic Stress Incontinence in Women
J Urol 2011;185,1350-1355.