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.

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.