Transobturator Suburethral Sling Research Articles

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique).

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization. This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness. Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group. This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

Prevalence and risk factors of lower urinary tract symptoms after robotic sacrocolpopexy

Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP). Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05. Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI. Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.

Oral 13 - The Transobturator Sub-urethral Sling: A Safe and Effective Option for all Degrees of Post Prostatectomy Urinary Incontinence

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

Efficacy of a synthetic middle urethral sling in patients with mixed urinary incontinence

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p &lt; 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p &lt; 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence.

Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator Suburethral Sling

The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling.Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence.Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe.Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.

Anatomical premises for the variability of the results of transobturator mid-urethral sling

Introduction. The implantation of a synthetic sub-urethral sling is the main method of surgical correction of stress urinary incontinence (SUI). However, the investigation results of long-term effectiveness indicate the ambiguity of the surgery outcomes. In addition, the problem of pain in the perineum remains relevant for everyday practice. One of the important aspects in this matter may be a variant technique for installing a suburethral sling, including based on the anatomical variability of the small pelvis.Purpose of the study. To identify key anatomical factors that can negatively affect the effectiveness and safety of the environment of suburethral sling surgery for urinary incontinence in women.Materials and methods. The study consisted of 2 parts - anatomical and clinical. In the anatomical part of the study, a suburethral sling was implanted on 20 preparations of a female pelvis with a lower limb and preserved soft tissues. The clinical part of the study involved 50 patients with stress urinary incontinence. These patients underwent installation of a transobturator suburethral sling in two ways using the “inside-out” technique: using the standard “external landmarks” technique and using the proposed anatomical technique developed in the first part of the study. After visualization of the suburethral sling using the original method, the outcomes of the operations were assessed depending on the location of the sling in the patient's tissues.Results. In the anatomical part of the study, the most atraumatic method of suburethral sling implantation was determined by rotating the tool around the lower branch of the pubic bone. In the clinical part of the study, this method demonstrated a higher efficiency of the operation at a follow-up of 1 year, presumably due to the U-shaped angle of the «hammock» for the urethra, which is characteristic of the retropubic sling.Conclusion. Outcomes of operations for SUI depend, among other things, on the method of the suburethral sling implantation.

The association between personal history and the outcomes of transobturator sling surgery.

This study aims to verify the association between risk factors for the onset of SUI and transobturator suburethral sling surgical treatment outcomes. A retrospective study was conducted with 57 patients operated by the Pelvic Floor Surgery Service. Demographic data were compiled from the sample, the body mass index (BMI) was calculated, and the patients were divided according to the response to the surgical treatment. A total of 77.2% of the sample was cured or improved after surgical treatment. Out of the total sample, 75.4% of the women were postmenopausal, and 73.7% denied current or past smoking. The median age was 61 years, the median number of births was 4.0, the median BMI was 28.6 kg/m2, and 50.9% of the sample was classified as pre-obese. BMI, menopausal status, age, smoking, and sexual activity were not factors associated with the surgical outcome. However, parity equal to or greater than 5 was associated with worse postoperative results (p = 0.004). among risk factors associated with the emergence of SUI, only parity greater than 4 showed a negative impact on transobturator sling surgery outcomes.

790 - The transobturator sub-urethral sling: A safe and effective option for all degrees of post prostatectomy urinary incontinence

790 - The transobturator sub-urethral sling: A safe and effective option for all degrees of post prostatectomy urinary incontinence

Place of surgery in the management of post-operative chronic pain after placement of prosthetic material based on a series of 107 cases.

The objective of this study was to evaluate the efficacy of surgical removal of prosthetic material, possibly combined with nerve release, on chronic postoperative pain following placement of prosthetic material. Single-tertiary-centre study on 107 patients managed between November 2004 and April 2016 for removal of prosthetic material responsible for postoperative chronic pain: retropubic suburethral sling (n = 32), transobturator suburethral sling (n = 50), prolapse mesh (n = 16), and hernia mesh (n = 9). The primary endpoint was at least 50% reduction of pain evaluated by a pain numerical rating scale (NRS). The mean interval between the initial operation involving placement of prosthetic material and reoperation for removal of prosthetic material was 41.2 ± 35.4 months. In all cases pain apperaed immediately following prosthetic material placement surgery. Pain presented neuropathic features in almost 30% of cases and was poorly systematized in more than one-half The mean follow-up of the study population was 8.4 ± 10.3 months. The mean pain NRS score for the overall population was seven preoperatively and three at last follow-up. At least 50% reduction of the pain NRS score was observed 67% of cases at last follow-up. During follow-up, 45% of patients experienced relapse of the disorder for which the prosthetic material was initially placed with, in particular, a 62% recurrence rate of urinary incontinence after removal of transobturator suburethral tape. Surgical removal of prosthetic material to treat chronic postoperative pain, achieved global improvement of pain in about two-thirds of cases, but with a risk of recurrence of the initial disorders.

907 Evaluation of sexual function and quality of life in women treated for stress urinary incontinence: Tension-free transobturator suburethral tape vs single incision sling

907 Evaluation of sexual function and quality of life in women treated for stress urinary incontinence: Tension-free transobturator suburethral tape vs single incision sling

Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques

ObjectiveThe treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Materials and methodsComparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was p≤.005. ResultsThe two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favor of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. ConclusionWe need to perform more high-quality, prospective and randomized studies with larger number of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

Tratamiento de la incontinencia urinaria de esfuerzo femenina mediante cintillas suburetrales: estudio retrospectivo comparativo observacional de 2 técnicas quirúrgicas

ObjectiveThe treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Material and methodsComparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. ResultsThe two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. ConclusionWe need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair

The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.

Laparoscopic Repair for Recurrent Lateral Enterocele and Rectocele

It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse. We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse.

Comparison of two inside‐out transobturator suburethral sling techniques for stress incontinence: Early postoperative thigh pain and 3‐year outcomes

Inside-out tension-free vaginal tape obturators for the cure of female stress incontinence can cause postoperative thigh pain. The aim of the present study was to analyze and compare the mid-term outcomes of two tension-free vaginal tape obturator procedures. Patients diagnosed with urinary stress incontinence were enrolled to undergo a tension-free vaginal tape obturator sub-mid urethral tape operation either by de-Leval's method or by Flam's modification. Peri- and postoperative data were collected by uninvolved researchers and analyzed. Follow up was 36 months. Overall, 161 patients were included in the study. Cure and complication rates were similar between the two treatment groups. Postoperative thigh pain was significantly more frequent and lasted longer in the de-Leval group compared with the Flam group (31.9% vs 10.0%, respectively). Urinary urgency was more frequent in the de-Leval patients (20.3% vs 2.8%). Our findings suggest that both tension-free vaginal tape obturator procedures are effective with few adverse effects. The Flam method provides shorter and decreased levels of postoperative thigh pain, as well as reduced long-term postoperative urinary urgency.

Vaginal Extrusion of Transobturator Tape 6 Years after Procedure: How Long Should Be the Follow-Up Period after Vaginal Sling Surgeries?

A 77-year-old lady presented to the gynaecology outpatient clinic with vaginal extrusion (3C/T3/S1) six years after a transobturator suburethral sling procedure (TOT). The entire tape was spontaneously extruded vaginally and the vaginal erosion healed with conservative management. Midurethral tapes, currently the standard of care in the management of urodynamic stress incontinence (USI), are associated with a risk of erosion and extrusion of the synthetic material. The present case highlights the importance of the long-term followup after any sling procedure as erosion and/or extrusion may arise at any time following the procedure.

Is transobturator suburethral sling effective for treating female urodynamic stress incontinence with low maximal urethral closure pressure?

Objective To assess retrospectively the efficacy and safety of MONARC (American Medical Systems) transobturator suburethral slings in the treatment of female urodynamic stress incontinence with and without low maximal urethral closure pressure (MUCP). Materials and Methods Seventy-three women with urodynamic stress incontinence, fitted with the transobturator suburethral sling at a medical center in central Taiwan, participated in the study. Objective postoperative evaluations, including a 1-hour pad test, cough stress test, uroflowmetry, and residual urine volume, were conducted 6 months after operation. Subjective outcomes were evaluated by telephone interview. Charts were reviewed for perioperative complications, urinary retention, and requirements for postoperative medication for symptoms of urgency. The mean follow-up was 48 months. Results Objective cure rate was 80.8% (dry pad test and negative stress test), 82.4% for MUCP less than 30 cmH 2O, and 80.4% for MUCP greater than 30 cmH 2O ( p = 1.000). Mean pad weight gain changed from 25.8 g preoperatively to 1.8 g postoperatively ( p < 0.05). There was no significant change in urinary flow rate or residual volume. Subjectively, 98.6% of subjects experienced complete improvement; only one patient found no improvement. Very few perioperative complications occurred. Immediate postoperative difficulty in voiding occurred in 6.8% of patients. Postoperative de novo urgency was 2.7%. Conclusions The MONARC transobturator suburethral sling is a safe and highly effective treatment for stress urinary incontinence even in women with low MUCP at a mean follow-up of 48 months. Evaluation of the outcomes after a longer follow-up period is necessary.

MP-04.05: Transobturator suburethral tape (TOT) vs single incision sling system (TVT-Secur System, TVT-S): comparison of efficacy for mixed urinary incontinence

MP-04.05: Transobturator suburethral tape (TOT) vs single incision sling system (TVT-Secur System, TVT-S): comparison of efficacy for mixed urinary incontinence

Vaginal mesh grafts and the Food and Drug Administration

Vaginal mesh grafts and the Food and Drug Administration