To describe the clinical outcomes in terms of objective and subjective improvement and complications of transobturator cystourethropexy (TVT-O) or retropubic cystourethropexy (TVT) performed for the correction of female stress urinary incontinence (SUI).

Case series study, in female patients over 18 years of age with a diagnosis of SUI by clinical and/or confirmed by urodynamics, taken to stress incontinence correction surgery, with either of the two techniques TVT-O or TVT, in a university hospital in the period of time between January 1, 2017 and December 31, 2021. A review of medical records was performed, patients were classified  into complicated and uncomplicated SUI according to internationally accepted standards, and subsequently the Sandvik test and the Patient Global Impression of Improvement Scale (PGI-I) were applied. A descriptive statistical analysis is presented; nominal variables are described by proportions and absolute frequencies. Continuous variables are described by measures of central tendency appropriate to the distribution (mean and standard deviations for normally distributed continuous variables or median and interquartile ranges for non-normally distributed continuous variables). The distribution of continuous quantitative variables was analyzed using the Shapiro Will test.

261 patients who met the inclusion criteria were included, 90.80% of the patients had complicated urinary incontinence, the median age was 53 years. These patients underwent 70.5% of surgeries for TVT-O tape placement and 29.5% of surgeries for TVT placement, of the total number of patients 86.97% underwent surgical procedures in addition to incontinence surgery. 
Regarding the improvement with the procedure performed for the treatment of urinary incontinence, a total of 229 patients were interviewed, 57 patients in person, applying the Patient Global Impression of Improvement (PGI-I) scale. The objective cure rate was 86.03%, the feeling of being "much better" was 44.54%; 5.6% showed no change and 6.9% of the patients reported deterioration in the severity of incontinence, so follow-up and further evaluation by  the urogynecology group was proposed to propose adjustments to the treatment for this condition.
When the rate of improvement was evaluated according to the procedure performed (Table 1) for the treatment of urinary incontinence, the rate of improvement in the group of patients  undergoing TVT-O was 84.57% (39.51% rated much better) and the rate of improvement in patients undergoing TVT was 89.55% (56.72% rated much better). The deterioration of urinary incontinence after surgery was 9.25% in the group of patients undergoing TVT-O and 5.96% in patients undergoing TVT. 
In terms of the objective cure rate, evaluated according to the Sandvik scale, 45.41% of all patients were found to be incontinence-free . There was an overall improvement rate after surgery of 92.58% (mild improvement 28.38%, moderate improvement 18.78%), while severe incontinence persisted in 4.80% and very severe in 2.6% of the patients. According to the type of surgery performed, the objective cure rate was 49.25% in patients undergoing TVT and 43.83% in those undergoing O-TVT.
In the assessment of improvement by the physician in the postoperative check-ups, improvement was observed in 93.49% of all patients. In this assessment, the improvement rate was 92.93% in the O-TVT group and 94.81% in the TVT group. The overall failure rate was 6.51% of all patients.
The relative frequency of complications was 19.16%. The main complication was urinary tract infection. Most complications occurred in the TVT-O group (70.5%).

In our study the use of TVT-O predominated over TVT, 90% of the intervened patients correspond to the classification of complicated urinary incontinence, according to the European Society of Urology criteria for the Management of SUI.  
According to the recommendations issued by the American Urological Society, the Urodynamics Society and the Society for Female Pelvic Health and Urogenital Reconstruction, we can state that the interventions performed in our service conformed to the recommendations insofar as they refer to the  fact that if concomitant surgical procedures are performed for the management of genital prolapse, either procedure is indicated 
When evaluating the results obtained in our study for the TVT-O type surgical procedure, the rate of successful outcome is similar to the results reported by other groups (1). In the present study a success rate of 86.03% was found, , while these authors reported success rates between 43% and 92%(1).  Furthermore, the ESTHER study (2) showed an effectiveness in the treatment of stress incontinence with TOT of over 65.1%. In relation to the TVT type procedure, effectiveness rates of between 51% and 88% have been reported (1). In our population the success rate was 89.55%, comparable to the result reported in the ESTHER study where it was 89.4% (2).
When evaluating the cure rates, rates of 81.3% and 61.6% have been reported for TVT and TVT-O, respectively (3), whereas in our study we found cure rates of 49.25% in patients undergoing TVT and 43.83% of patients undergoing TVT-O. This difference may be explained in part by the methods selected by the authors, which differ from the interventions chosen in the present study. Prospective studies using similar methods are needed to compare this result .

Our study allows us to know the characteristics of the intervened population and the results obtained with respect to the correction of urinary incontinence. The limitation of this type of study motivates us to propose prospective studies that allow us to adjust the indications in the proposed interventions for the management of stress urinary incontinence

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Leone Roberti Maggiore, U., Finazzi Agrò, E., Soligo, M., Li Marzi, V., Digesu, A., & Serati, M. (2017). Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: A systematic review and meta-analysis. International Urogynecology Journal, 28(8), 1119-1130. https://doi.org/10.1007/s00192-017-3275-x