To TVT or TVT-O, does it even matter?
The March, 2014 edition of twitter-based international urology journal club discussion experienced a change of scenery as incontinence took center stage. The discussion focused on the five-year results of a randomised controlled trial (RCT) comparing retropubic versus transobturator midurethral slings for stress incontinence. The platinum priority article by Laurikainen et al. was made available open access thanks to European Urology. Special mention is also given to senior corresponding author Carl Nilsson, whose contributions were relayed via the #urojc guest account.
The prospectively registered, independent RCT was conducted across several Finnish centers. The study reported that at five-year follow up there was no difference in cure rate between the two procedures and that patient satisfaction was high. Initial discussion comments focused on the impressive length of follow up. Furthermore, the study reported that 94.8% of women (254 of 268) returned for five-year follow up.
The question of whether or not urodynamics should form part of the pre-operative workup of urinary incontinence was also raised. The study reported that urodynamics to investigate urgency incontinence was not performed.
The study defined a negative 24hr pad test as being <8g leakage/day. An interesting point was raised as to how this compares with the definition used post radical prostatectomy.
A limitation in the study’s methodology was highlighted.
At this point it became obvious that the usual heavyweight #urojc contributors were missing. Even the ‘King of Twitter’ was unusually silent.
The thirst for knowledge was also evident amongst practicing urologists.
To further shed light on the differences in complications between the two procedures, we were directed to the study’s shorter-term results. While higher complication rate following transobturator sling was statistically significant, it was not regarded as clinically significant.
We were also directed to an excellent review of the surgical management of female stress urinary incontinence.
While the results of the study show no difference between retropubic versus transobturator midurethral slings, the generalisability of this data across various populations was questioned. The mean age and BMI of patients in the study was 53 and 26 respectively.
Surgeon expertise in vaginal/prolapse surgery was an important issue especially in light of litigation.
A few take home messages
While this month’s #urojc discussion did not have the usual level of participation it was nonetheless a valuable conversation concerning two common sling procedures for the management of stress incontinence. Best tweet prize was an iPad app subscription thanks to BJU International which goes to Helen Nicholson (@DrHLN) for above tweet. We look forward to the next installment of #urojc in April.
Isaac Thangasamy is a second year Urology Trainee currently working at the Royal Brisbane and Women’s Hospital, Brisbane, Australia. He is passionate about education and social media. Follow him on Twitter @iThangasamy