TOT sling adjustment: is it worth it?

Abstract

Introduction: Since its introduction, the TOT sling rapidly became a safe and effective option for the treatment of stress urinary incontinence (SUI) in women. The development of the adjustable TOT sling enabled the tape to be repositioned, in cases with suboptimum results (persistent SUI).
 Objectives: To analyze the overall results of our case series, in terms of functional success and postoperative complications, as well as the relation between sling adjustment and the development of postoperative urinary obstruction, mesh erosion, pelvic pain, and dissatisfaction with the tape’s silicone columns.
 Materials and Methods: A comparative, retrospective analysis was carried out on patients that underwent adjustable TOT sling placement, within the time frame of 2006 and 2016, assessing a subgroup of patients that had sling repositioning as a second procedure. The variables analyzed were sling adjustment, mesh erosion, complication related to the tape’s silicone columns, development of postoperative urinary obstruction, and functional success of the surgery. 
 Results: Seventy patients that underwent adjustable TOT sling placement were selected (SUI cured in 84.3%; postoperative obstruction in 22.8%). Slings were repositioned in 11 (15.7%) patients due to adverse functional results, raising the SUI cure rate to 92,8% and the post-adjustment obstruction rate to 28.5%.
 There was a significant association between sling adjustment and the development of pelvic pain (36% vs 10%, p=0.02) and no significant differences between groups, regarding the development of postoperative urinary obstruction (p=0.23), erosion into the vagina (p=0.78), erosion into the bladder (p=0.39), and dissatisfaction with the tape’s silicone columns (p=0.9).
 Conclusion: The possibility of increasing the functional success of a first surgery, within a few minutes and with local anesthesia, together with the fact that there were no significant differences in the majority of the complications analyzed, make tape adjustment a useful complement in the treatment of SUI, which is not possible with conventional slings.