Caruso S et al. (2007) Clitoral blood flow changes after surgery for stress urinary incontinence: pilot study on TVT versus TOT procedures. Urology 70: 554–557

Tension-free midurethral sling procedures are now the preferred treatment for stress urinary incontinence (SUI) in women, as they are highly effective yet minimally invasive; however, risks associated with tension-free vaginal tape (TVT) include injury to the bladder, bowel and blood vessels. The transobturator (TOT) approach decreases the risk of complications, but whether it helps to preserve sexual function is unknown.

In a prospective, open clinical study, Caruso et al. monitored vascular function in the area around the urethra and clitoris in women with SUI before and after TVT or TOT. Translabial color Doppler ultrasonography was performed in 42 women undergoing TVT surgery, and in 63 women undergoing TOT. Blood flow in the clitoral arteries was measured before the procedure and 6 months later.

After treatment, women in the TVT group had a significantly lower mean pulsatility index and mean peak systolic velocity, and a significantly higher mean resistance index than before treatment, indicating a reduced and less-efficient blood flow after surgery. In the TOT group, however, values were similar before and after the procedure. TOT procedures were shorter than TVT because cystoscopy was not required, and no complications were reported (versus two bladder perforations in the TVT group). Objective cure rates were high in both the TOT and TVT groups (95.0% and 88.2%, respectively).

The authors conclude that the TOT procedure might be preferable to TVT in women with SUI because, as well as providing good cure rates for stress urinary incontinence, it conserves clitoral blood flow after treatment.