When selecting a procedure to treat stress urinary incontinence, both cure rate and complications should be taken into account. This study estimated the surgical therapeutic index (STI) of the tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures, and compared both with the previously obtained results for Burch colposuspension. The STI was defined as the median percent cure rate divided by the median percent complication rate. Participating were 121 women with stress urinary incontinence who underwent TVT (n = 61) or TOT (n = 60) in the years 2000–2005 and were followed up for at least 12 months. None of the women had detrusor overactivity, urinary tract infection, intrinsic sphincter deficiency, or more than stage II pelvic organ collapse.
The 2 groups did not differ significantly in patient characteristics or the results of preoperative urodynamic studies. After 1, 3, 6, and 12 months of follow-up, the STI of TOT was higher than that of either TVT or Burch colposuspension. Cure rates at 1 month postoperatively were 100% for both TVT and TOT, and at 12 months were 88.5% and 88.2%, respectively. Cure rates were not significantly different when adjusted for previous incontinence surgery by multiple logistic regression analysis. Overall complication rates did not differ significantly between the TVT and TOT groups. There also were no differences in voiding difficulty postoperatively. One patient in the TVT group had an intraoperative bladder injury.
The TOT procedure appears to be more suitable than TVT for women who have stress urinary incontinence with urethral hypermobility.