1. No difference in urinary continence after surgery between retropubic and transobtoratoric transvaginal sling operations when correcting for predisposing factors Background: Several RCTs report similar treatment results when comparing the two transobturatoric intravaginal tape operations TVT-O and TOT with the original retropubic TVT. Recently reports on the superiority of TVT have been published. How come? M&M: Data from the Swedish National Quality Register on Incontinence Surgery comprising the good 4500 patients included by the end of 2009 were analyzed by groups mentioned below. By the univariate analyses Chi-square test was used. Significance level was p < 0.05. Low risk group: No predisposing factors defined below Risk group: One ore more of the classic predisposing factors preoperative urge incontinence, BMI > 30, history of pelvic floor surgery or hysterectomy and age > 75 years High risk group: All predisposing factors mentioned above M&M: Data from the Swedish National Quality Register on Incontinence Surgery comprising the good 4500 patients included by the end of 2009 were analyzed by groups mentioned below. By the univariate analyses Chi-square test was used. Significance level was p < 0.05. Low risk group: No predisposing factors defined below Risk group: One ore more of the classic predisposing factors preoperative urge incontinence, BMI > 30, history of pelvic floor surgery or hysterectomy and age > 75 years High risk group: All predisposing factors mentioned above Treatment results – Unselected data TVT superior (p<0.002) to both TVT-O and TOT at two months and one year follow-up Treatment results – Unselected data TVT superior (p<0.002) to both TVT-O and TOT at two months and one year follow-up Operation type Urinary leakage 8 w Total Continent Once a week Leakage daily TVT74,4%14,0%11,6%1254 TVT-O71,5%14,7%13,8%523 TOT70,8%13,7%15,6%315 mean73,1%14,1%12,8%2092 Operation type Urinary leakage 1 y Total Continent Once a week Leakage daily TVT70,5%17,1%12,4%1254 TVT-O60,6%21,4%18,0%523 TOT65,7%16,5%17,8%315 mean67,3%18,1%14,6%2092 Treatment results are impaired (p<0.002) by preoperative urge incontinence Urge incontinence preop Postop continence 8 w 1 y Never86,6%83,5% Almost never86,1%79,6% 1-3 times a month 80,5%75,2% 1-3 times a week 70,6%61,5% Daily58,9%55,3% mean72,5%67,2% patients included 32821943 Predisposing factors – Distribution Both urge incontinence and obese are overrepresented in the transobturatoric groups (p< 0.01) Predisposing factors – Distribution Both urge incontinence and obese are overrepresented in the transobturatoric groups (p< 0.01) Urge Incontinence preop Operation type (almost) never > once a weekTotal TVT *43.0%57.0%2299 TVT-O 37.9%62.1%1008 TOT 40.2%59.8%605 mean 41.3%58.7%4012 BMI Operation type<3030-35>35Total TVT79,9%15,7%4,4%2364 TVT-O74,7%18,5%6,8%976 TOT77,4%17,0%5,6%593 mean78,3%16,6%5,2%3933 Predisposing factors – Treatment results Hysterectomy is no riskfactor, but age > 75 yy is (p=0.005) Previous hysterectomy in low risk group previous hysterectomy Urinary leakage after 8 weeks Total Continent Once a week leackage daily No87,8%8,9%3,2%831 Yes86,7%7,6%5,7%105 Age-related results in low risk group Age (years)% postop continent <3591.7 35-4590.7 45-5587.5 55-6586.6 65-7587.9 >75*70.4 Riskgroup does matter when it comes to results No difference between the 3 transvaginal methods in the low risk group - but 4 out of 5 patients in clinical practice have some risk factor! Conclusion: Results from RCTs will not predict the outcome in patients with predisposing factors Treatment results - low risk Urinary leakage after 8 weeks Total Operation type Continent Once a week Leakage daily TVT88,5%8,8%2,7%524 TVT-O85,2%10,4%4,4%183 TOT88,7%7,3%4,0%124 mean87,8%8,9%3,2%831 treatment results- high risk group Operation type Urinary leakage after 8 weeks Total Continent Once a week Leakage daily TVT48,4%22,0%29,7%91 TVT-O51,2%20,9%27,9%43 TOT68,4%5,3%26,3%19 mean51,6%19,6%28,8%153 A Kjaeldgaard, F Taheri-Johansson, M Ankardal Dept. Gynecol Obstet, Karolinska and Sahlgrenska University Hospitals and Värnamo County Hospital, Sweden