A Pilot Comparative Study between Transobturator Tape (TOT) Versus Vaginal Polypropylene Mesh in Management of Patients with Stress Urinary Incontinence in Egyptian Women

Abstract

Aim of work: To assess the efficiency of vaginal polypropylene mesh as a cheaper alternative to Obtape. Patients and methods: Forty qualified patients were subjected to history, examination and investigations including urodynamic studies and the patients were divided into two groups each containing twenty patients. Group 1 underwent the procedure using OB TAPE LG (Mentor Corporation- USA) and Group 2 did the procedure using a polypropylene mesh (Ethicon). Follow-up was done atone and six months post-operatively by clinical exam and by urodynamics (after 6 months only). Results: Age, parity, duration of disease, mode of delivery, menopausal status, associated anterior vaginal wall repair and pre-operative urodynamics were similar in both groups. Success rate was 95% in the mesh group and 90% in the OBTAPE LG (Mentor Corporation- USA) and mean operative time was 18.5 minutes for the mesh and 17.5 minutes for the OBTAPE LG (Mentor Corporation-USA). After 6 months follow-up complications did not differ greatly between the two groups except for mesh erosion which was three cases with Obtape and none with the mesh. Post-operative urodynamics showed significant improvement in cystometric capacity in mesh (P<0.001) and ob Tape (P=0.05), maximum urethral closure pressure in mesh (P=0.01) and obtape (P=0.03), maximum urethral closure pressure at stress in mesh (P=0.04) and obtape (P=0.007) and pressure transmission in mesh (P=0.01) and obtape (P=0.05). Conclusion: Transobturator approach is a safe minimally invasive surgical technique. The use of vaginal mesh for this operation can provide a cheaper alternative for poorly resourced hospital settings. Further studies are needed to properly assess the efficiency of vaginal mesh for this surgical technique.