Transvaginal tape or transobturator tape - what to opt for cure of female stress urinary incontinence

Abstract

Background: Urinary incontinence is a very disturbing condition that affects quality of life. Stress urinary incontinence (SUI) is defined as the involuntary loss of urine associated with the sensation of urgency and is usually associated with exertion, sneezing or coughing. About 30-50% of women suffers from this condition and is conventionally treated with pelvic floor exercises, bladder drill, duloxetine and anticholinergic drugs with unsatisfactory results. Retro pubic and transobturator sub urethral slings such as TOT and TVT are the gold standard surgical treatment for women with USI. Methods: This is a prospective study conducted between May 2007 to March 2010 in RLJH hospital, Kolar in department of surgery under the guidance of urologist. Patients diagnosed with stress urinary incontinence were randomized by double blind technique, to the retropubic route (TVT) or the transobturator route (TOT) group. A total of 71 patients TVT = 36 and TOT = 35 patients were posted for respective operative procedures. The institutional ethical committee approved the study, and all women gave their written and informed consent after receiving full information about the study. Inclusion criteria were patients diagnosed with stress urinary incontinence and those who had recurrence after previous anti-incontinence surgery. Patients with mixed incontinence were excluded from our study. Results: The demographic data and pre and post-operative clinical parameters of all patients studied showed no significant differences between the two groups. Mean follow up was 30 months (24-48). Mean operative time was 36 (20-45) minutes in TVT and 20 (12-25) minutes in TOT. The post-operative urinary retention was seen in 13.8% (n = 5) in the TVT group and 2.8% (n = 1) in the TOT group. We had suprapubic haematoma 5.5% (n = 2) in the TVT group. Bladder perforation occurred in two cases of TVT. Two patients with previous failed incontinence surgery also did well in our study. Conclusions: Transobturator tape procedure has less complication, good postoperative outcome in terms of cure of stress urinary incontinence and improved quality of life and patient’s satisfaction. This technique is easy to learn and can be performed by general surgeons as day care surgery. This procedure has an advantage of easy performance in those patients who have a failed previous incontinence surgery.