Transobturator Suburethral Tapes in the Management of Urinary Incontinence: Success, Safety and Impact on Sexual Life

Abstract

The tension-free vaginal tape (TVT) procedure has, in the past decade, become the most popular treatment for urodynamic stress incontinence (USI). A variant of the TVT operation is the transobturator tension-free vaginal tape (TOT) procedure, of which there are 2 forms: Obtape (the outside-in technique) and TVT-0 (the inside-out technique). This retrospective study compared the efficacy and safety of the 2 TOT procedures and their effects, if any, on patients' sexual lives. Participants were 94 women with USI or mixed incontinence who had the TVT-0 operation at a tertiary referral center in Scotland in the years 2002-2005 and 182 others having the Obtape procedure. The mean age was 49 years, and mean parity was 2. The 2 groups did not differ significantly with regard to body mass index, urodynamic diagnosis, or previous incontinence surgery. Evaluative instruments included the urinary domain of the Birmingham Bowel and Urinary Symptoms Questionnaire, the International Consultation on Incontinence Questionnaire Short Form, the Sexual Impact Questionnaire, and a visual analogue scale to estimate patient satisfaction. After a median follow-up interval of 28 months, the success rates-as estimated subjectively and based on no or only occasional episodes of incontinence-were 86% in patients with USI and 52% in those with mixed incontinence (P < 0.001). Urgency became worse postoperatively in 8% of patients. Rates of bladder and urethral injury were less than 1%, and there were no significant differences in intraoperative or early postoperative complications between the 2 surgical groups. Late postoperative complications were significantly more frequent in the Obtape group and included de novo urgency and vaginal erosions. No substantial change was found in the frequency of intercourse and pleasure or pain during penetration. Coital incontinence declined significantly after surgery. Only 13% of women described sexual intercourse as being worse or much worse after surgery. About 8% of patients experienced vaginal dryness that caused discomfort. The TOT operation is an effective and relatively safe treatment for USI. The vast majority of women in this study reported improvement or no change in their sexual lives. Overall complication rates were similarly frequent with the inside-out and outside-in procedures, but there were significantly more tape-related complications after use of the Obtape (outside-in) technique.