Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis

Introduction and hypotheses: One of the most relevant topics in the field of pelvic floor dysfunction treatment is the long-term efficacy of surgical procedures, in particular, the use of prosthesis. Hence, a systematic review and meta-analysis was conducted to evaluate the long-term effectiveness and safety of midurethral sling (MUS) procedures for stress urinary incontinence (SUI), as reported in randomised controlled trials (RCTs) and non-randomised studies. Methods: This systematic review is based on material searched and obtained via PubMed/Medline, Scopus, and the Cochrane Library between January 2000 and October 2016. Peer-reviewed, English-language journal articles evaluating the long-term (\ue2\u89\ua55\uc2 years) efficacy and safety of MUS in women affected by SUI were included. Results: A total of 5,592 articles were found after the search, and excluding duplicate publications, 1,998 articles were available for the review process. Among these studies, 11 RCTs (0.6%) and 5 non-RCTs (0.3%) could be included in the qualitative and quantitative synthesis. Objective and subjective cumulative cure rates for retropubic technique (TVT) and transobturator tape (TOT; both out\ue2\u80\u93in and in\ue2\u80\u93out) were 61.6% (95% CI: 58.5\ue2\u80\u9364.8%) and 76.5% (95% CI: 73.8\ue2\u80\u9379.2%), and 64.4% (95% CI: 61.4\ue2\u80\u9367.4%) and 81.3% (95% CI: 78.9\ue2\u80\u9383.7%) respectively. When considering TOT using the out\ue2\u80\u93in technique (TOT-OI) and TOT using the in\ue2\u80\u93out technique (TVT-O) the objective and subjective cumulative cure rates were 57.2% (95% CI: 53.7\ue2\u80\u9360.7%) and 81.6% (95% CI: 78.8\ue2\u80\u9384.4%), and 68.8% (95% CI: 64.9\ue2\u80\u9372.7%) and 81.3% (95% CI: 77.9\ue2\u80\u9384.7%) respectively. Furthermore, this article demonstrates that both TVT and TOT are associated with similar long-term objectives (OR: 0.87 [95% CI: 0.49\ue2\u80\u931.53], I2 = 67%, p = 0.62) and subjective (OR: 0.84 [95% CI: 0.46\ue2\u80\u931.55], I2 = 68%, p = 0.58) cure rates. Similarly, no significant difference has been observed between TTOT-OI and TVT-O) in objective (OR: 3.03 [95% CI: 0.97\ue2\u80\u939.51], I2 = 76%, p = 0.06) and subjective (OR: 1.85 [95% CI: 0.40\ue2\u80\u938.48], I2 = 88%, p = 0.43) cure rates. In addition, this study also shows that there was no significant difference in the complication rates for all comparisons: TVT versus TOT (OR: 0.83 [95% CI: 0.54\ue2\u80\u931.28], I2 = 0%, p = 0.40), TOT-OI versus TVT-O (OR: 0.77 [95% CI: 0.17\ue2\u80\u933.46], I2 = 86%, p = 0.73). Conclusions: Independent of the technique adopted, findings from this systematic review and meta-analysis suggest that the treatment of SUI with MUS might be similarly effective and safe at long-term follow-up