Latthe PM et al. (2007) Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG 114: 522–531

Outside-in transobturator tape (TOT) and inside-out tension-free vaginal obturator tape (TVTO) insertion were introduced to reduce the risk of complications associated with tension-free vaginal tape (TVT) for treatment of female urinary stress incontinence. Good initial results led to widespread use before efficacy and safety data were available. In this meta-analysis and review, Latthe et al. assess the respective cure and complication rates.

The investigators searched online for reports published between January 1966 and September 2006. They did further manual searches of bibliographies in identified articles, and of the proceedings of the International Urogynecological Association and International Continence Society from 2004 to 2006. Subjective measures of cure were analyzed, since only some articles used objective measures.

Eleven reports (4 full articles and 7 abstracts) were identified as being suitable for inclusion. A total of 1,261 women aged between 40 and 85 years were included across studies. Six trials compared TOT and five TVTO with TVT. In terms of cure, TVTO was slightly worse than and TOT was equal to TVT. The vaginal erosion rate was significantly higher in the TOT recipients and nonsignificantly lower in the TVTO recipients than among those who received TVT.

Only short-term data were available that did not clearly show notable advantages to using TOT and TVTO. The authors call for the initiation of long-term, well-designed, randomized, controlled trials and, in the interim, prospective collection of outcome data for audit.