Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures.

OBJECTIVES: To sequentially compare the postoperative urodynamic changes in patients with urodynamic stress incontinence (USI) who underwent tension-free vaginal tape (TVT) or transobturator tape (Monarc TOT) procedure.

METHODS: Between January 2001 and December 2005, 50 consecutive patients with USI who underwent TVT (n = 24) or TOT (n = 26) procedures were studied, and postoperative urodynamic changes were sequentially compared by one-way ANOVA test with Bonferroni's correction.

RESULTS: There were no significant between-group postoperative changes in urodynamic parameters of uroflowmetry, filling and voiding cystometry. However, the TVT group had a higher objective cure rate (100% vs. 69.2%, P = 0.004) by pad test, urethral closure pressure area [40.4 cm(2) H(2)O, 95% confidence interval (CI) = 22.3-58.5 cm(2) H(2)O vs. 3.9 cm(2) H(2)O, 95% CI = -10.9 to 18.7 cm(2) H(2)O, P = 0.036], and continence area (34.4 cm(2) H(2)O, 95% CI = 16.1-52.7 cm(2) H(2)O vs. -3.5 cm(2) H(2)O, 95% CI = -16.7 to 9.8 cm(2) H(2)O, P = 0.001) at 12 months than those of the TOT group.

CONCLUSIONS: This study demonstrated that tension-free vaginal tape and transobturator tape procedures had no significant difference of impact on bladder voiding and storage functions. However, this study demonstrated that TVT procedure resulted in a higher cure rate with a significantly increased urethral closure pressure area and continence area than did TOT procedure 12 months postoperatively. Thus, TVT procedure might be a better therapeutic choice to achieve continence than TOT.