Tension-free Transobturator Tape Procedure Research Articles

Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence.

Purpose. The objective was to evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. Methods. This retrospective pilot study consists of 32 stress incontinent women, who underwent TOT procedure and routine sonographic control at day 1 postoperatively and at follow-up visit. TUI was applied on the resulting 4D volumes, thereby delivering 9 axial slices with a 4 mm interslice distance starting at the meatus urethrae internus in caudal direction. The reliability of the approach was tested by two examiners. Postoperative and follow-up ultrasound parameters of uncured and cured patients were analyzed. Results. Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. Conclusions. TUI can be a reliable method for determining the position of the tape. Further studies are needed to evaluate whether the postoperatively determined position can be used as an indicator of future subjective cure.

Efficacy and quality of life after transobturator tension-free vaginal tape procedure for female stress urinary incontinence

Background: Nowadays, tension-free transobturator midurethral sling procedures have been gaining popularity in the surgical management of female stress urinary incontinence (SUI). However, quality of life (QoL) assessment following this new procedure is sparingly reported and requires further investigations for credentialing this intervention as a standard of care for women with SUI. Objective: To evaluate the QoL outcome using King’s Health Questionnaires (KHQ) scale following tension-free transobturator tape procedure. Materials and Methods: We evaluated 31 women with genuine SUI in a tertiary medical teaching hospital for QoL before and after the surgery using KHQ. The responses were analyzed for internal consistency, criterion validity, and improvements in various domains in relation to QoL, which could have been affected by their urinary symptoms. Results: Cronbach’s a statistics indicated good correlation between various items of the KHQ scale before and after surgery (0.88 vs 0.81). The criterion validity of the scale against Sandvik Short Format (SSF) indicated a good agreement between these two scales before intervention and during follow-up (Spearman’s rank correlation coefficient: 0.872 vs. 0.638). When it came to various domains of KHQ scale, there were significant improvements in all items (p < 0.0001) except General Health Perception (p = 0.69). There was no procedure-related morbidity. Conclusion: The results of this study indicate that KHQ can be effectively used for assessing QoL after TOT procedures. This procedure is also safe and effective for continence treatment.

Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure

To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30° on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.

Tension-free transobturator tape procedure for stress urinary incontinence

Recent data on the tension-free transobturator tape procedure for the treatment of female stress urinary incontinence are reviewed. Although long-term data are not available, the effectiveness and safety of the tension-free transobturator tape procedure as reported during the past 5 years are very promising and this procedure is becoming a popular surgical treatment for female stress urinary incontinence. The continence rates obtained have been similar to those obtained using the retropubic tension-free vaginal tape on short-term follow-up. Clinical data as well as studies on cadaveric dissections suggest that complication rates can be decreased significantly with the transobturator approach. In the original tension-free transobturator tape procedure, the tape is inserted through the obturator foramen from the outside-to-inside direction (skin incision to vaginal incision). The inside-to-outside approach with passage of the tape from the vaginal incision to the obturator foramen has also been described. The tension-free transobturator tape procedure provides a useful alternative to the retropubic tension-free vaginal tape approach while maintaining the principles of tension-free midurethral support. By avoiding the intrapelvic and retropubic passage, complications can be decreased. The effectiveness of this approach is similar to that of tension-free vaginal tape on short-term follow-up.