Comparative evaluation of TVT and TOT results in female urinary incontinence
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Mirosław Salomon, Maciej Szczębara, Krzysztof Pliszek, Agata Witosińska, Andrzej Kupilas, Magda Duda, Zofia Salska, Wiesław Duda, Mieczysław Fryczkowski

Oddział Urologii, Szpital im. E. Michałowskiego w Katowicach
Katedra i Klinika Urologii w Zabrzu Śląskiego Uniwersytetu Medycznego
Oddział Urologii, Szpital Wojewódzki w Bielsku-Białej

summary

Introduction.

Urinary incontinence is one of the most frequent medical issues facing women. The turning-point in the cure of urinary incontinence was the TVT technique introduced by Ulmstedt in 1996 and its modifications introduced by Delorn and Leval in 2001 and 2003 called TOT technique. The techniques’ advantages are: a positive final effect, ease of the intervention and a minimal number of post surgical complications.

Objective.

The paper is to evaluate the efficiency of TVT and TOT interventions by women with urinary incontinence due to increases in intra-abdominal pressure and the frequency of mid-surgical and post-surgical complications.

Material and methods.

The research involves 446 patients who, from 5.10.2000 to 20.03.2007, underwent TVT procedures due to urinary incontinence and 234 patients who, from 11.08.2003 to 28.02.2008, underwent TOT procedures.

The patients were qualified for the procedures on the basis of an interview and a complex URD exam including a cough trial, pad test, cystoscopy, cystometry and in some cases profilometry and dynamic emiction cystography. The results of the procedure was evaluated on the basis of survey, a subjective intervention assessment and additional exams, including: a cough trial, pad test, ultrasonographic post urination evaluation, URD exam.

Results.

It has been ascertained that TVT and TOT procedures are highly efficient in cases of urinary incontinence due to increases in intra-abdominal pressure. In both methods the results were comparable. 94% of the patients examined evaluated the result of the procedures as good or very good. The mid-surgical complications – bleeding, in both procedures, and a bladder damage during TVT procedures did not cause long term consequences. In one case, after the TVT procedure, arterial damage and an internal hip-vein occurred, for which a cure in a General and Vessels Surgery was necessary. In one case, 30 days after the TVT procedure a large haematoma in the bladder area was observed, which needs to be relieved by surgical intervention. After the TOT procedures, however, no serious complications were observed.

Conclusions.

1. The research has demonstrated a very high efficiency of both TVT and TOT procedures in the cure of urinary incontinence due to increases in intraabdominal pressure in cases where correct diagnoses were attained and the procedures were carried out in a correct manner. 2. The technique of the TOT procedure is, however, easier and involves a lower risk of mid- and post-surgical complications.