Abstract
BackroundThe transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.MethodsIt was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®). Follow-up information was available for 225 (96.6%) women.ResultsThere were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001).ConclusionLate post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
Highlights
Urinary incontinence is a major public health problem
transobturator tape (TOT) was the only procedure in 129 patients and was associated with another surgical intervention in 104 women (11 total laparoscopic hysterectomies, 33 vaginal hysterectomies, 58 vaginal anterior repairs, 53 vaginal posterior repairs, vaginal vault suspensions to the sacrospinous ligament according to Richter, and other procedures such as conisation, laparoscopy and hysteroscopy)
The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% confidence intervals (CIs) 0.05-0.38, P < 0.001)
Summary
Urinary incontinence is a major public health problem. In Europe, it is estimated to affect up to one third of women older than the age of 18 years. BMC Women's Health 2009, 9:28 http://www.biomedcentral.com/1472-6874/9/28 and has revolutionized the surgical treatment of female stress urinary incontinence (SUI) due to its simplicity, efficiency and minimal invasiveness [2]. One category of complications is associated with the blind passage of the tape through the retropubic space causing bladder or bowel perforation, or vascular injuries. In a quest to find a minimally invasive sling associated with even less morbidity than the TVT, the transobturator tape (TOT) was created [4] and a modified procedure (TVT-O) was reported by de Leval [5]. Few articles reported high erosion rates [9,10], ischio rectal abcess [11,12] as well as other complications. Data concerning safety are rare, follow-up is often less than two years, and risk factors for erosions are poorly described [13]
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