Urinary incontinence is one of the most common diseases in women, leading to reduced quality of life in pre- and postmenopausal periods, and sometimes in women of childbearing age. Currently, a large number of surgical techniques for the treatment of stress urinary incontinence have been developed, but none of them is universal. The most popular method to eliminate stress urinary incontinence is suburethral urethropexy with TVT synthetic tape. In the world there is already a lot of experience in its use, which has shown that this technique has not only advantages, but also certain contraindications and complications. In recent years, there has been a renewed tendency to use the patient's own vaginal tissues in surgeries for urinary incontinence. The aim of the present study was to improve the results of surgical treatment of patients with stress urinary incontinence by comparing the effectiveness and safety of two surgical techniques - using a synthetic implant (TVT-Obturator®) and autologous tissues (urethrovesicopexy by vaginal flap).

This is a multicenter prospective in combination with retrospective randomized study, including 105 women with stress urinary incontinence, clinically and instrumentally determined. Two groups were formed: Group 1 - 52 (49.5%) patients who underwent TVT-Obturator® surgery. Group 2 - 53 (50.5%) patients who underwent urethrovesicopexy with vaginal flap. The main stages of the urethrovesicopexy with vaginal flap are: excision of the vaginal mucosal flap, twisting it into a roll-sling, fixation to the periosteum of the pubic bones, anterior colporrhaphy. Follow-up from 1 to 5 years after surgery. The following parameters were examined: Intraoperative - length of operation, blood loss, complications (injury of adjacent organs). Early postoperative (1 to 5 days) - duration and intensity of pain syndrome, temperature response, residual urine volume >50 ml, urinary disorders, lack of effect from surgery; Remote (1 to 5 years or more) - lack of effect from surgery, relapse of urinary incontinence, obstructive urination, erosion in the implant area, urgent incontinence. Multivariable analyses were used to assess statistical significance where possible.

The technique with the use of the patient's own tissues is characterized by a longer operation time and a greater volume of blood loss (15,8±3,2min in Group 1 and 36,4±6,1 min in Group 2). 
In the early postoperative period, a more pronounced temperature reaction and pain syndrome, as well as more frequent urinary retention are inherent to the TVT-Obturator. After 5 years, the operation was ineffective in 9.6% of the first group and 11.3% of the second group. One patient developed vaginal mucosal erosion after using a synthetic implant.

Urethropexy using a synthetic implant compared to the operation with a vaginal flap is statistically significantly faster (p˂0.01), technically easier and accompanied by less blood loss (p˂0.001). There were fewer complications during surgery and in the early postoperative period in the group of patients who used the technique using their own tissues (p˂0.05). The main complications of TVT-Obturator® operations are associated with urinary retention in the early postoperative period (17.3%) and rejection of the synthetic loop and vaginal mucosal defects (1.9%). Both operations were comparable in effectiveness.