Since its introduction, there were scores of articles published suggesting that TVT is effective and safe and similar in effectiveness to colposuspension. Larger, multicenter trials provide the most realistic look at outcomes of a surgical procedure performed by many surgeons with varying experience on a wide array of patients. A report of the 2-year follow-up of 344 women with urodynamic stress incontinence enrolled from 14 centers in a multicenter randomized clinical trial compared TVT and open Burch colposuspension. The objective cure rates (defined as a negative 1-hour pad test) ranged from 63% to 85% for the TVT procedure and 51% to 87% for open colposuspension, depending on how missing data were handled, leading the authors to conclude that “TVT may be better, worse, or the same as open colposuspension in the cure of stress incontinence” (103). Subjectively, only 43% of women in the TVT group and 37% of women in the open colposuspension group reported cure of their stress leakage. Women undergoing the TVT were more likely to have a cystocele after surgery, whereas those undergoing the Burch colposuspension were more likely to have apical prolapse. Two years after the index procedure, seven women (4.8%) in the Burch colposuspension group underwent surgery for pelvic organ prolapse, compared with no women in the TVT group. There was no difference in the number of women that underwent repeat surgery for stress incontinence (1.8% in the TVT group and 3.4% in the Burch group). Women who underwent TVT were less likely to have voiding disorders requiring intermittent self-catheterization than those who underwent colposuspension (0% vs. 2.7%).
Another form of minimally invasive sling is the transobturator tape procedure (also known as a TOT) or transobturator suburethral tape. This modification was designed to reduce complications associated with retropubic needle passage. Inserting the trocar through the obturator space theoretically lessens the risk of bladder, bowel, or vascular injury because the procedure involves passing the polypropylene midurethral sling through the obturator membrane along its ischiorectal fossa path, bypassing the pelvic cavity altogether (104,105). In a multicenter trial, 183 women from seven sites underwent a transobturator tape procedure for stress and mixed urinary incontinence. At 1-year follow-up 80.5% patients were cured (defined as absence of subjective report of stress urine leakage and negative cough stress test). Perioperative complications included one bladder perforation, two urethral perforations, and one lateral vaginal perforation. Tape erosion necessitating removal occurred in five cases (three vaginal and two urethral) (106).