Long‐Term Outcomes and Risk Factors for Failure After Transobturator Tape Surgery in Women With Stress Urinary Incontinence

AIM: To evaluate the long-term outcomes of transobturator tape (TOT) surgery in women with stress urinary incontinence (SUI), identify predictors of surgical failure, and assess failure-free survival using Kaplan-Meier analysis. MATERIALS AND METHODS: This retrospective study included 136 women who underwent TOT surgery for SUI at a tertiary referral center. Demographic, clinical, and urodynamic characteristics were reviewed. Functional outcomes were assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Patients were classified into success and failure groups according to the presence of recurrent SUI during follow-up. Independent predictors of failure were evaluated using multivariable logistic regression analysis. Long-term durability was assessed using Kaplan-Meier survival analysis. RESULTS: The mean age was 52.2 ± 15.6 years, and the mean follow-up duration was 71.5 ± 23.9 months. Overall surgical success was achieved in 101 patients (74.3%), while 35 patients (25.7%) experienced failure. Mean ICIQ-SF scores significantly improved from 16.4 ± 2.6 preoperatively to 5.5 ± 6.0 at final follow-up (p < 0.001). Patients with failure were older and had higher body mass index, parity, prevalence of diabetes mellitus, hypertension, mixed urinary incontinence, previous pelvic surgery, and hysterectomy history. They also demonstrated significantly lower abdominal leak point pressure (ALPP) and maximum urinary flow rate values (all p < 0.05). Preoperative detrusor overactivity (DO) was also significantly more frequent among patients with failure than among those with successful outcomes (57.1% vs. 12.9%, p < 0.001). Multivariable logistic regression identified parity (OR 1.89, 95% CI 1.01-3.53, p = 0.046), preoperative ICIQ-SF score (OR 1.63, 95% CI 1.06-2.49, p = 0.026), and ALPP (OR 0.93, 95% CI 0.88-0.98, p = 0.008) as independent predictors of failure. In an additional exploratory multivariable model incorporating BMI, Qmax, and preoperative DO, ALPP (OR 0.90, 95% CI 0.84-0.97, p = 0.004) and preoperative ICIQ-SF score (OR 1.89, 95% CI 1.17-3.04, p = 0.009) remained independently associated with failure, whereas BMI, Qmax, and preoperative DO were not independently associated with failure. Kaplan-Meier analysis demonstrated a failure-free survival rate of 74.3%, with most recurrences occurring within the first 18 months after surgery. Mean failure-free survival was 102.4 months (95% CI 92.8-112.0). CONCLUSIONS: TOT surgery provides durable long-term continence outcomes and significant symptom improvement in women with SUI. Higher parity, greater baseline symptom severity, and lower ALPP are independent predictors of surgical failure. Although lower Qmax and preoperative DO were associated with failure in univariable analyses, neither remained independently associated with failure in the exploratory multivariable model, whereas ALPP and preoperative ICIQ-SF remained independently associated with failure. Most recurrences occur during the early postoperative period, emphasizing the importance of careful patient selection and follow-up.