Inside-out versus outside-in transobturator tension-free vaginal tape: A 5-year prospective comparative study

Authors

  • Rachel Yau Kar Cheung,

    Corresponding author
    1. Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
    • Correspondence: Rachel Yau Kar Cheung M.B.Ch.B., M.R.C.O.G., F.H.K.A.M.(O&G), F.H.K.C.O.G., Department of Obstetrics and Gynaecology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China. Email: rachelcheung@cuhk.edu.hk

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  • Symphorosa Shing Chee Chan,

    1. Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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  • Ka Wah Yiu,

    1. Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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  • Tony Kwok Hung Chung

    1. Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Abstract

Objective

To compare the 1-year and 5-year outcomes of transobturator tension-free vaginal tape with outside-in and inside-out approaches in women with urinary stress incontinence, and to identify risk factors for treatment failure at 5 years.

Method

A prospective observational study was carried out for women with urinary stress incontinence who underwent transobturator tension-free vaginal tape from September 2004 to March 2008 in a tertiary urogynecology center. Women (n = 213) had either an outside-in (n = 124) or inside-out (n = 89) procedure. They were followed up annually until 5 years after the operation. Subjective cure was defined as women not experiencing any urine loss on physical activity. Objective cure was defined as no urine leak at cough during a standard urodynamic study.

Results

At a mean follow up of 59.2 months, the subjective cure rates were 81.7% and 84.1%; the objective cure rate were 82.6% and 82.5% for the outside-in and inside-out approach, respectively. There was no statistically significant difference between the procedures. De novo overactive bladder syndrome (10.6% in outside-in and 14.6% in inside-out approach; P = 0.40) and de novo detrusor overactivity (5.8% in outside-in and 15% in inside-out approach; P = 0.11) was also comparable between the two groups. Complications at the fifth year were low and not significantly different among both methods.

Conclusion

The outside-in approach and inside-out approach are both safe and effective in treating women with urinary stress incontinence up to 5 years.

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