A Comparative Study of Outside-In and Inside-Out Transobturator Tape Procedures for Female Stress Urinary Incontinence: 5-Year Outcomes

Background: In the surgical treatment of female urodynamic stress incontinence (USI), the transobturator approach for tension-free suburethral vaginal tapes has witnessed a significant increase in its utilization over the course of the past seven years. This method, which avoids the blind entrance into the retropubic region but employs the same suburethral hammock principle as the retropubic TVTTM [2], was first published by Delorme [1] in the year 2001. The retropubic TVTTM [2] is a technique developed by the same researcher. It considerably lowers the likelihood of visceral injury occurring.. Aim and Objectives: Comparing the 'inside-out' (TVT-O) and 'outside-in' (TOT) transobturator tape surgeries for the treatment of female stress urinary incontinence (SUI) over the course of a five-year period is an important step in the study process. Patients and Methods: This retrospective cohort study was done at outpatients’ urogynecological clinic - Obstetrics and Gynecology Department, Ahmed Maher Teaching Hospital from February 2022 until February 2023. During this study, 116 women were enrolled, after consenting each of them and divided into two equal groups, 58 in each group. Results: success rate, women's satisfaction, recommendation to other cases with SUI and readiness to undergo the same procedure if same symptoms recur were statistically significant better among TOT outside-in cases compared with TVT-O inside-out ones. Conclusion: TOT & TVT-O are effective and safe in treating female stress urinary incontinence. However, our study concluded that outside-in (TOT) transobturator tape procedure is favorable than inside-out (TVT-O) one with higher success rate and women's satisfaction.