Inside-out versus outside-in transobturator tension-free vaginal tape: A 5-year prospective comparative study

Objective To compare the 1‐year and 5‐year outcomes of transobturator tension‐free vaginal tape with outside‐in and inside‐out approaches in women with urinary stress incontinence, and to identify risk factors for treatment failure at 5 years. Method A prospective observational study was carried out for women with urinary stress incontinence who underwent transobturator tension‐free vaginal tape from September 2004 to March 2008 in a tertiary urogynecology center. Women (n = 213) had either an outside‐in (n = 124) or inside‐out (n = 89) procedure. They were followed up annually until 5 years after the operation. Subjective cure was defined as women not experiencing any urine loss on physical activity. Objective cure was defined as no urine leak at cough during a standard urodynamic study. Results At a mean follow up of 59.2 months, the subjective cure rates were 81.7% and 84.1%; the objective cure rate were 82.6% and 82.5% for the outside‐in and inside‐out approach, respectively. There was no statistically significant difference between the procedures. De novo overactive bladder syndrome (10.6% in outside‐in and 14.6% in inside‐out approach; P = 0.40) and de novo detrusor overactivity (5.8% in outside‐in and 15% in inside‐out approach; P = 0.11) was also comparable between the two groups. Complications at the fifth year were low and not significantly different among both methods. Conclusion The outside‐in approach and inside‐out approach are both safe and effective in treating women with urinary stress incontinence up to 5 years.