Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery

Abstract

To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications. Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire. The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P=.001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P=.998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P=.664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P=.028 and P=.032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P=.043, P=.048,P=.034, and P=.039, respectively). The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.