Cure chirurgicale de l'incontinence urinaire d'effort de la femme par bandelette transobturatrice (de dehors en dedans). Étude de 70 cas

Abstract

To evaluate the feasibility, the efficacy and the innocuousness of suburethral transobturator support using multifilament polypropylene transobturator tape (TOT) inside out for stress urinary incontinence in women. The study concerns 70 patients representing our team's first experience of this technique. The inclusion criterion was persistent SUI despite perineal rehabilitation. There were no exclusion criteria. Among the 70 patients, 22 (31%) presented with associated genital prolapse. Mean parity was 2.6 (extremes ranging from 0 to 6). Thirty-five patients were menopaused (50%), of whom 12 (34%) were under hormone replacement therapy. We retained five judgement criteria to evaluate this surgical act: duration of surgery and hospitalisation, per- and postoperative complications and functional results on SUI (via a telephone questionnaire). The rate of positive results (healing or improvement) was 84% with a mean follow-up of 14.5 months. The rate of peroperative complications was very low: 1.4% (only one case of bladder injury). The mean duration of surgery was 23 minutes. The mean duration of hospitalisation in the case of isolated TOT was 1.25 days. The transobturator approach is a feasible, safe and efficient short-term surgical technique. Results inferior to those observed in the literature are probably due to the learning curve in a university hospital unit. None of the preoperative data (age, parity, body mass index, history of SUI treatment or hysterectomy, hormonal status, associated prolapse, mean urethral closure pressure, clinical vesical hyperactivity syndrome) appears to influence results; however, the study strength is poor due to the small study population.