Effects of lumbar lordosis and pelvic inlet orientation on the outcome of the transobturator tape sling operation in women

Abstract

To determine the association between changes in lumbar lordosis (LL) and/or pelvic inlet (PI) orientation and the outcome of a transobturator tape (TOT) sling procedure. The study population consisted of 70 patients who underwent the TOT sling procedure for stress urinary incontinence, and were evaluated by a stress test at the sixth month after the surgery. The women were defined as continent on the absence of both subjective complaint of leakage and objective leakage as a result of the test. Cases that failed, even though improvement may have been observed, were considered incontinent. With the use of a standardized protocol, lateral lumbosacral spine/pelvic X-rays were taken with the participants standing in their usual upright posture with hands kept at chest level. From these X-rays, the angle of LL and PI were measured. Of the 70 cases, 42 were continent and 28 were incontinent according to the evaluation done during the sixth month after the TOT procedure. There were no significant differences with respect to age, body mass index, gravidity, vaginal parity, pelvic organ prolapse and comorbid diseases between the continent and incontinent groups. The mean angle of PI in the continent group (34°, range 20-50) was significantly lower than in the incontinent group (37°, range 28-60) (p = 0.012). There was no significant difference in the median angle of LL (32°, range 15-50 in continent group, 34.5°, range 21-56 in incontinent group, p = 0.13) between the two groups. Women with continence after the TOT sling procedure have lower angle of PI than women with incontinence.