Our experiences in Trans-Obturator Tape surgery after performing 150 cases

Abstract

Nearly 30% of adult European women suffers from urinary incontinence. The recently introduced Trans-Obturator Tape (TOT) implant provides a new surgical technique for the treatment of stress incontinence. Preoperative work-up included detailed history taking, stress-test and Q-tip test, general and gynaecological physical examination and completion of the QUID questionnaire. Equivocal cases were further investigated with urodynamic assessment. TOT implantation was performed on 150 patients. Clinical efficacy of the treatment was evaluated with the QUID questionnaire. Mean age of the patients was 50.8 years (SD = 8.64). 69 patients (46%) had genuine stress incontinence, 33 patients (22%) had urge incontinence, 48 patients (32%) had mixed type incontinence with dominant stress component. Mean length of follow-up was 16 months (4-26 months). Preoperative severity score of stress incontinence was 11.78 on average, while that of urge component was 6.63. On average, it took 25 minutes to complete the operation. Four out of the 150 operations were complicated by adverse event. Twelve patients required prolonged catheterisation exceeding 24 hours with a maximum of 5 days. The mean length of hospital stay was 4.76 days (SD = 0.8). Evaluation of postoperative questionnaires resulted in a mean severity score of 2.22 for the stress component and 2.59 for the urge component. In a patient satisfaction survey 46 patients reported the treatment as excellent (47.4%), 39 as good (40.2%), 7 as satisfactory (7.2%), 3 as suboptimal (3.1%) and 2 patients reported the procedure as ineffective (2.1%). The procedure is an effective, quick, minimally invasive method of treating urinary incontinence. The operation requires short hospital stay and carries a low morbidity.