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Korean Journal of Obstetrics & Gynecology 2008;51(6):650-658.
Published online June 1, 2008.
A comparative study of two transobturator tape procedures: 'Outside-in' (TOT) and 'inside-out' (TVT-O) for surgical treatment of female stress urinary incontinence.
Young Sang Kim, Jin Ho Cho, Sung Woon Chang, Hyun Chul Kim, Chung No Lee, Ji Eun Shin
Department of Obstetrics and Gynecology, College of Medicine, Pochon CHA University, Seongnam, Korea. obgyn@dreamwiz.com
To compare the outcomes of the 'outside-in' (TOT) and 'inside-out' (TVT-O) transobturator tape procedures for surgical treatment of female urinary incontinence. METHODS: We enrolled 320 stress urinary incontinence women who could be followed-up and they underwent the TOT procedure (N=184) and TVT-O procedure (N=136) from January 1, 2003 to June 30, 2006. The preoperative evaluation included a history taking, physical examination, residual urine check, pad test, Q-tip test and urodynamic test. And we investigated the patients' characteristics, success rates, operation times, concomitant surgeries, hospital days, hemoglobin changes and complications. RESULTS: There were no statistically significant differences in patients' characteristics and urodynamic tests except the intrinsic sphincter deficiency rate (ISD: 5.6% vs. 30.6%, p=0.000). The success rates were similar in both groups (98.4% vs. 97.8%). Most common complication of TOT group is operation site erosion (2.1%), and TVT-O group is thigh or vaginal pain (3.6%). There were noted other complications, such as postoperative urinary retention, de novo urgency and urinary tract infection. Total complication rates of both groups were not statistically different (7.6% vs. 9.5%, p=0.415). There were no statistic differences in the postoperative complication rates of between only TOT group and TOT with colporrhaphy group (p=0.371), also between only TVT-O group and TVT-O with colporrhaphy group (p=0.692). There were no correlation with ISD and postoperative complications in TOT (p=0.373) and TVT-O group (p=0.082). CONCLUSIONS: The two procedures of transobturator tape procedure for female stress urinary incontinence appear to be equally effective and safe. However, long-term follow-up, surgeons' learning course, skill and experience for transobturator tape procedures should be evaluated at further studies.
Key Words: Stress urinary incontinence, Transobturator tape procedure, TOT, TVT-O

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