Trans-Obturator Tape Versus Trans-Vaginal Tape for Stress Urinary Incontinence in Women

• How effective is TOT compared to TVT in terms of objective cure at 12 months postoperatively? [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Objective evidence of SUI will be obtained using a standardised pad test undertaken at 12 months following surgery. The pad test will be carried out using a modification of the International Continence Society (ICS) recommendations. Women will be considered 'cured' if the pad weight gain is less than 1g over the test period. This is the definition of cure used by Ward and will allow comparison with that trial.
  
  
• Vaginal erosion or other serious adverse outcomes of surgery over 5 years postoperatively [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]
  

• How effective is TOT compared to TVT in terms of subjective cure 12 months postoperatively? [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Incontinence-specific quality of life at 6 weeks and 12 months postoperatively? [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Satisfaction with surgery at 12 months postoperatively? [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Return to usual activities and usual sex life after surgery? [ Time Frame: 6 weeks and 1 year ] [ Designated as safety issue: No ]
  
• The prevalence of voiding dysfunction at 12 months postoperatively? [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Surgical complications, both short term and long term? [ Time Frame: 6 weeks and 1 year ] [ Designated as safety issue: Yes ]
  
• Utility and cost? (an economic evaluation) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  
• Subjective effectiveness at 5 years postoperatively [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  
• Incontinence-specific quality of life at 5 years postoperatively [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  UDI-6, IIQ-7, PISQ-12
  
  
• Health care utilization over 5 years postoperatively [ Time Frame: 5 year ] [ Designated as safety issue: No ]
  
• Cost effectiveness over 5 years postoperatively [ Time Frame: 5 year ] [ Designated as safety issue: No ]
  
• Objective effectiveness at 5 years postoperatively [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Pad test leakage of <1g over period of test
  
  

This study is a randomized trial in which women with stress incontinence will be allocated to receive either TOT or TVT procedures. Women who elect surgical management of their type II stress incontinence are eligible to participate in the trial. Baseline data, including a patient questionnaire, will be collected. Hospital outcomes, including length of stay and surgical complications will be documented from hospital charts. All women attend a 6-week follow-up visit as standard of care: a structured data collection form will be used by surgeons to collect information and another patient questionnaire will be administered. At 12 months postoperatively women will attend the clinic for objective measurement of incontinence, a full exam and to complete a questionnaire. The main outcome is effectiveness of the procedure determined using a 1-hour pad test. Secondary research questions include:

How effective is TOT compared to TVT in terms of:

Subjective cure at 12 months postoperatively? Incontinence-specific quality of life at 6 weeks and 12 months postoperatively? Satisfaction with surgery at 12 months postoperatively? Return to usual activities and usual sex life after surgery? The prevalence of voiding dysfunction at 12 months postoperatively? Surgical complications, both short term and long term? Utility and cost? (an economic evaluation) The study will be carried out according to the ICH Good Clinical Practice Guidelines.

At 5 years postoperatively women will attend the clinic for a further follow-up. The primary research question of the 5-year follow-up is:

Safety - What is the incidence of vaginal erosion or other serious adverse outcomes of surgery among women who had a surgical procedure for stress urinary incontinence utilizing a TOT device, versus a TVT device, over the 5 years following surgery?

Secondary questions are as follows:

Effectiveness - What are the objective and subjective outcomes of TOT compared with TVT at 5 years following surgery for SUI? Health economics - What are the disease-specific rates of health service utilization related to repeat surgical intervention, as well as surgery and other treatment related to adverse events for women who had a TOT procedure, versus those who had a TVT procedure, over the 5 years after surgery? Using economic modelling and cost utility analysis, is TOT cost-effective compared with TVT over the 5 years after surgery?

Other question:

Do women with tape found to be palpable in the vagina at 12 months postoperatively, go on to develop vaginal erosion by 5 years following surgery?