To present the long-term results of Trans-obturator Tape (TOT) with identical technique and material by a single surgeon in the treatment of stress type urinary incontinence (SUI) in women.

After Institutional Review Board Approval, demographical and clinical data of all women who underwent TOT by the same surgeon (TT) using the same technique and material (Boston Scientific Obtryx II Trans obturator Mid-urethral sling system®) as the primary or secondary treatment for SUI between 2006 and 2023 and had at least 12 months of follow-up been retrospectively evaluated. All patients underwent preoperative evaluation with International Continence Society standardized cough stress test (ICS CST) and invasive urodynamic studies (UDS). 
The current urological status of the patients was queried via telephone conversation. All interviews were conducted by the same urologist. Patients who couldn’t be reached by telephone were excluded. Successful treatment was defined as not using pads and indicating the absence of SUI in the 6th question of the International Consultation on Incontinence – Short Form (ICIQ-SF) questionnaire. Patient satisfaction was defined as reporting current urinary incontinence status as “improved” and answering “Yes” to the question “Would you recommend this procedure to a friend with similar complaints?” Information related to intervention(s) performed due to TOT-related complications were also documented. Furthermore, newly emerged symptoms such as difficult urination, and urgency were recorded. The treatment success and patient satisfaction rates were compared between patients with follow-up periods above versus below ten years. Group I comprise patients with follow-up durations ranging from 12 to 120 months, while Group II consists of patients with follow-up durations of 121 months and above.

A total of 42 females with a median age of 53 years (34-69) were included. TOT was performed as the primary treatment in 39 patients, while 3 patients had a history of previous SUI surgery. Preoperatively, all patients had a positive ICS CST with UDS demonstrating SUI. The median follow-up period was 125 (12-204) months. Group I had a median follow-up duration of 69.5 months, while Group II had a median duration of 154 months. In all patients, treatment success and patient satisfaction rates were recorded as 83.3% (35/42), and 92.8% (39/42), respectively. Results are stratified based on follow-up duration in Figure 1. Most of the cohort (90.4%, 38/42) did not undergo additional intervention due to TOT-related complication. Seven (16.6%) patients reported de novo urgency and 1 (2.3%) patient reported persistent difficulty in urination during the follow-up period. In total, 4 patients underwent secondary procedures due to TOT-related complications. Two patients underwent tape-cut procedure, while 1 patient required TOT revision, and another patient underwent TOT revision and tape-cut at the same session.

Our study has demonstrated significantly higher rates of treatment success and patient satisfaction over a median follow-up period of 125 months, which is one of the longest durations reported in the literature. This outperforms previous studies such as Kenton et al., who reported a patient satisfaction rate of 85% and a treatment success rate of 43% at 5 years following midurethral sling surgery [1]. Another study with a longer follow-up of 145 months reported objective and subjective cure rates of 78.9% and 62.6%, respectively [2]. Importantly, our research also revealed comparable rates of treatment success and patient satisfaction regardless of the duration of follow-up, whether above or below 10 years.
Furthermore, the rate of complications necessitating re-operations in our study was 9.5% which stood much lower compared to the rates approaching 18% in the literature [3]. We attribute this favorable and durable outcome to several factors including the standardized preoperative patient evaluation pathway, experience of a single surgeon, and consistent use of the same materials and techniques throughout the study period.

Overall, our findings suggest that TOT is a safe and effective treatment option for SUI in female patients with high rates of success and patient satisfaction persisting in the long run. Standardization and consistency in perioperative management and surgical technique could be the key to achieve durable outcomes. Further validation of our results with comparative studies involving larger and more diverse patient cohorts is needed.

Kenton, K., et al., 5-year longitudinal followup after retropubic and transobturator mid urethral slings. J Urol, 2015. 193(1): p. 203-10.
Natale, F., et al., Transobturator Tape: Over 10 Years Follow-up. Urology, 2019. 129: p. 48-53.
Brazzelli, M., et al., Surgical treatments for women with stress urinary incontinence: the ESTER systematic review and economic evaluation. Health Technol Assess, 2019. 23(14): p. 1-306.