Long-Term Outcomes and Recurrence Rates of TVT versus TVTO in Female Stress Urinary Incontinence: A Systematic Review of Studies with ≥5-Year Follow-Up.

Abstract

Introduction and hypothesis: Midurethral slings (MUS), including retropubic (tension-free vaginal tape [TVT]) and transobturator tape (TVTO) approaches, are commonly used surgical treatments for female stress urinary incontinence (SUI). Although both techniques have demonstrated high short-term success rates, long-term durability and recurrence remain critical concerns. This systematic review was aimed at comparing long-term outcomes of TVT and TVTO based on studies with a minimum of 5 years of follow-up.

Methods: A systematic search of PubMed and Embase was conducted for studies published between 2000 and 2024. Eligible studies included those reporting long-term clinical outcomes, recurrence rates, and complications following TVT or TVTO procedures with ≥5 years of follow-up. Data extraction included cure or improvement rates, recurrence, adverse events, and reoperation rates. Study selection followed PRISMA guidelines.

Results: Both TVT and TVTO showed sustained effectiveness in treating female SUI over long-term follow-up. However, recurrence appeared more common following TVTO, particularly beyond 10 years. TVT was associated with higher long-term durability, whereas TVTO demonstrated a slightly lower rate of pain and erosion-related complications. Reintervention rates varied across studies, and inconsistency in outcome definitions limited direct comparison in some cases.

Conclusions: Both TVT and TVTO remain effective options for the surgical management of female SUI. TVT may offer greater long-term durability and lower recurrence, whereas TVTO may be associated with a more favorable short-term complications profile. These findings highlight the importance of individualized surgical planning and underscore the need for standardized long-term outcome reporting in future research.