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Randomised prospective single-blinded study comparing 'inside-out' versus 'outside-in' transobturator tapes in the management of urodynamic stress incontinence: 1-year outcomes from the E-TOT study.
BJOG. 2010 Jun; 117(7):870-8.BJOG

Abstract

OBJECTIVE

To compare the 'inside-out' versus 'outside-in' routes for transobturator tape insertion for urodynamic stress incontinence, and to identify independent risk factors for failure at 1 year.

DESIGN

Prospective single-blinded randomised trial.

SETTING

Tertiary urogynaecology centre.

POPULATION

A cohort of 341 women undergoing transobturator tape procedures between April 2005 and April 2007.

METHODS

Women were randomised to tension-free vaginal tape-obturator (TVT)-O for the 'inside-out' route (n = 170) and transobturator tape (TOT)-ARIS for the 'outside-in' route (n = 171). Participants completed validated symptom-severity, quality-of-life and sexual-function questionnaires before and after surgery. In addition, they completed the patient global impression of improvement questionnaire (PGI-I) and standard 1-hour pad test postoperatively.

MAIN OUTCOME MEASURES

The primary outcome was the patient-reported success rate reported on the PGI-I scale. Secondary outcomes included objective cure rate and improvement in King's Health Questionnaire scores.

RESULTS

A total of 341 women were recruited: 171 women to the 'outside-in' (TOT-ARIS) group and 170 to the 'inside-out' (TVT-O) group; 299 completed the 1-year follow up. The patient-reported success rate was 80% with no statistically significant differences between the groups ('outside-in' 77.6% versus 'inside-out' 81.2%; OR 1.25; 95% CI 0.71, 2.20; P = 0.54). The objective cure rate was 91% with no statistically significant difference between the groups ('outside-in' 88% versus 'inside-out' 94%; OR 2.21; 95% CI 0.85, 5.75; P = 0.157). Previous incontinence surgery (OR 1.41; 95% CI 1.18, 1.91; P = 0.029) and preoperative urgency incontinence (OR 1.78; 95% CI 1.21, 3.91, P = 0.048) were significant risk factors for failure of transobturator tape at the 1-year follow up.

CONCLUSIONS

There are no significant differences in patient reported and objective cure rates between 'inside-out' and 'outside-in' transobturator tapes. Quality of life and sexual function significantly improved following surgery. Both previous incontinence surgery and preoperative urgency incontinence are associated with significantly lower patient-reported cure rates.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Abdel-Fattah M
Division of Applied Health Science, University of Aberdeen, Aberdeen, UK. m.abdelfattah@abdn.ac.uk
Ramsay I
No affiliation info available
Pringle S
No affiliation info available
Hardwick C
No affiliation info available
Ali H
No affiliation info available
Young D
No affiliation info available
Mostafa A
No affiliation info available

MeSH

FemaleHumansIntraoperative ComplicationsMiddle AgedProspective StudiesQuality of LifeRisk FactorsSexual Dysfunction, PhysiologicalSingle-Blind MethodSuburethral SlingsTreatment OutcomeUrinary Incontinence, Stress

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20394610

Citation

Abdel-Fattah, M, et al. "Randomised Prospective Single-blinded Study Comparing 'inside-out' Versus 'outside-in' Transobturator Tapes in the Management of Urodynamic Stress Incontinence: 1-year Outcomes From the E-TOT Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 117, no. 7, 2010, pp. 870-8.
Abdel-Fattah M, Ramsay I, Pringle S, et al. Randomised prospective single-blinded study comparing 'inside-out' versus 'outside-in' transobturator tapes in the management of urodynamic stress incontinence: 1-year outcomes from the E-TOT study. BJOG. 2010;117(7):870-8.
Abdel-Fattah, M., Ramsay, I., Pringle, S., Hardwick, C., Ali, H., Young, D., & Mostafa, A. (2010). Randomised prospective single-blinded study comparing 'inside-out' versus 'outside-in' transobturator tapes in the management of urodynamic stress incontinence: 1-year outcomes from the E-TOT study. BJOG : an International Journal of Obstetrics and Gynaecology, 117(7), 870-8. https://doi.org/10.1111/j.1471-0528.2010.02544.x
Abdel-Fattah M, et al. Randomised Prospective Single-blinded Study Comparing 'inside-out' Versus 'outside-in' Transobturator Tapes in the Management of Urodynamic Stress Incontinence: 1-year Outcomes From the E-TOT Study. BJOG. 2010;117(7):870-8. PubMed PMID: 20394610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomised prospective single-blinded study comparing 'inside-out' versus 'outside-in' transobturator tapes in the management of urodynamic stress incontinence: 1-year outcomes from the E-TOT study. AU - Abdel-Fattah,M, AU - Ramsay,I, AU - Pringle,S, AU - Hardwick,C, AU - Ali,H, AU - Young,D, AU - Mostafa,A, Y1 - 2010/04/12/ PY - 2010/4/17/entrez PY - 2010/4/17/pubmed PY - 2010/8/18/medline SP - 870 EP - 8 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 117 IS - 7 N2 - OBJECTIVE: To compare the 'inside-out' versus 'outside-in' routes for transobturator tape insertion for urodynamic stress incontinence, and to identify independent risk factors for failure at 1 year. DESIGN: Prospective single-blinded randomised trial. SETTING: Tertiary urogynaecology centre. POPULATION: A cohort of 341 women undergoing transobturator tape procedures between April 2005 and April 2007. METHODS: Women were randomised to tension-free vaginal tape-obturator (TVT)-O for the 'inside-out' route (n = 170) and transobturator tape (TOT)-ARIS for the 'outside-in' route (n = 171). Participants completed validated symptom-severity, quality-of-life and sexual-function questionnaires before and after surgery. In addition, they completed the patient global impression of improvement questionnaire (PGI-I) and standard 1-hour pad test postoperatively. MAIN OUTCOME MEASURES: The primary outcome was the patient-reported success rate reported on the PGI-I scale. Secondary outcomes included objective cure rate and improvement in King's Health Questionnaire scores. RESULTS: A total of 341 women were recruited: 171 women to the 'outside-in' (TOT-ARIS) group and 170 to the 'inside-out' (TVT-O) group; 299 completed the 1-year follow up. The patient-reported success rate was 80% with no statistically significant differences between the groups ('outside-in' 77.6% versus 'inside-out' 81.2%; OR 1.25; 95% CI 0.71, 2.20; P = 0.54). The objective cure rate was 91% with no statistically significant difference between the groups ('outside-in' 88% versus 'inside-out' 94%; OR 2.21; 95% CI 0.85, 5.75; P = 0.157). Previous incontinence surgery (OR 1.41; 95% CI 1.18, 1.91; P = 0.029) and preoperative urgency incontinence (OR 1.78; 95% CI 1.21, 3.91, P = 0.048) were significant risk factors for failure of transobturator tape at the 1-year follow up. CONCLUSIONS: There are no significant differences in patient reported and objective cure rates between 'inside-out' and 'outside-in' transobturator tapes. Quality of life and sexual function significantly improved following surgery. Both previous incontinence surgery and preoperative urgency incontinence are associated with significantly lower patient-reported cure rates. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/20394610/Randomised_prospective_single_blinded_study_comparing_'inside_out'_versus_'outside_in'_transobturator_tapes_in_the_management_of_urodynamic_stress_incontinence:_1_year_outcomes_from_the_E_TOT_study_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓18]

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