SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE: A REVIEW OF LONG-TERM (≥5 YEARS) OUTCOMES COMPARING TENSION-FREE VAGINAL TAPE (TVT) AND TRANSOBTURATOR TAPE (TOT)

Background: Stress urinary incontinence (SUI) is a common condition where mid-urethral slings (MUS) are the standard surgical treatment. While the retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) have proven short-term efficacy, a synthesis of their long-term (≥5 years) comparative performance is needed to guide clinical practice. Aim: This narrative review aims to synthesize and critically evaluate evidence from studies with a follow-up of five years or longer, comparing the long-term efficacy and safety of TVT versus TOT for the surgical management of female SUI. Results: Long-term data indicate high and durable subjective satisfaction for both procedures. However, a consistent trend favors the TVT in objective efficacy, evidenced by a significantly lower reoperation rate for recurrent SUI, particularly in high-risk populations such as women with intrinsic sphincter deficiency (ISD). The established short-term complication profiles—a higher risk of bladder injury and voiding dysfunction for TVT versus a higher risk of groin pain for TOT—persist long-term. Very long-term evidence confirms that mesh exposure, while infrequent, is a lifelong risk. Conclusion: The choice between TVT and TOT is a nuanced clinical decision involving a trade-off between the superior long-term durability of TVT and the enhanced initial safety of TOT. For patients with a high risk of recurrence, particularly those with ISD, the TVT appears to be the evidence-based procedure of choice. For all other patients, the decision must be individualized through a comprehensive shared decision-making process.