Outcome of TVTO and Altis® in the Management of Urinary Stress Incontinence

Objectives: This study aimed to compare the effectiveness and complications of TVT-O and Altis® (Coloplast) procedures while examining the influence of various factors on treatment outcomes.

Methods: This is a retrospective study, conducted from February 2020 to 2024, analyzed patients undergoing surgery for stress incontinence, either TVT-O or Altis® procedures. Excluded were those lacking postoperative follow-up. Electronic health records provided demographic data, including age, BMI, menopausal status, parity, chronic illnesses,previous surgeries, incontinence type, complications, and follow-up details. Institutional Review Boards approved the study, adhering to good clinical practice guidelines.

Results: The study involved 184 female respondents aged above 20 years, with the majority (37%) falling in the 40-50 age range, followed by 50-60-year-olds at 26.6%. The sample primarily comprised obese individuals (53.3%), with the majority being Arab (96.2%) and non-smokers (96.7%). Pre-menopausal, menopausal, peri-menopausal, and menopausal hysterectomy subjects accounted for 37.5%, 36.4%, 19%, and 7.1%, respectively. Parity ranged from 0 to over 6 children, with a significant majority (49.5%) reporting parity of more than 6. Common chronic diseases included asthma (15.2%), constipation (25%), hypertension (23.4%), and diabetes (28.8%). A notable portion of participants (29.3%) did not report any chronic diseases.The most prevalent incontinence types were pure stress (75%) and mixed UI with predominant stress (25%).
In terms of surgical procedures, 66.8% underwent TVTO while 33.2% underwent Altis surgery. Complications within 72 hours were reported by 4.89% of respondents, with UTI (10 %), dysuria (10%), leg and back pain (50%), and numbness (20%) being the main issues. Long-term complications were reported by 11.41% of subjects, mainly comprising DENOVO urgency (52.38 %), DENOVO voiding dysfunction (23.81 %) and defective healing (23.81%).
Comparing Altis and TVTO, patient dissatisfaction rates were low and statistically insignificant. Complication rates within 72 hours were relatively similar between the two groups. High BMI was associated with increased complications, while menopause status significantly influenced both short-term and long-term complications. Non-Arabs were more susceptible to short-term complications, while Arabic ethnicity was associated with both short-term and long-term complications. Smoking did not significantly influence complication rates.
Complications within 72 hours and long-term were reported, with no significant differences between Altis and TVTO groups. Dissatisfaction rates were low and statistically insignificant for both methods. Short-term complication rates did not significantly differ between interventions, nor did long-term complications. Factors such as BMI, menopause status, and ethnicity influenced complication rates, while smoking had no significant impact.

Conclusions: Both TVTO and Altis® procedures offer effective treatment options for stress urinary incontinence (SUI), showing similar efficacy and outcomes. The study highlights their clinical equivalence, emphasizing the importance of personalized interventions for SUI patients and contributing to treatment optimization.