Transobturator Suburethral Tape Procedure Research Articles

BANDA SUBURETRAL CON ABORDAJE TRANSOBTURADOR(TOT), EN EL TRATAMIENTO DE LA INCONTINENCIA URINARIA DE ESFUERZO FEMENINA. NUESTRA EXPERIENCIA

Objetivos: Analizar los factores predisponentes que influyen en la incontinencia urinaria de esfuerzo (IUE). Valorar la eficacia y seguridad de la técnica de banda suburetral con abordaje transobturador (TOT) en el tratamiento de la IUE femenina. Diseño: Estudio observacional retrospectivo. Institución: Servicio de Ginecología y Obstetricia, Xarxa Sanitaria i Social de Santa Tecla. Hospital Vendrell. Red sanitaria publica. Tarragona. Cataluya. Espanya. Participantes: Pacientes con diagnóstico de IUE. Intervenciones: Sesenta pacientes con diagnóstico de IUE fueron tratadas entre octubre 2006 y febrero 2010. Se utilizó tres tipos de malla de casas comerciales diferentes (Aris, Gynecare y Monarc). La técnica de colocación en la mayoría de las pacientes fue out–in con abordaje transobturador, a excepción de Gynecare, cuya colocación fue in–out. Principales medidas de resultados: Curación de la IUE. Resultados: La edad media fue 56 años, el antecedente más frecuente la obesidad, con 50%, seguida de hipertensión arterial 32% e histerectomía 27%. El índice de curación (definida como ausencia absoluta de escape, tanto en la anamnesis como en la exploración física) fue al mes de la cirugía 83%, al año 83% y a seguimiento a más de un año de 70%. Un 12% necesitó corrección de otros defectos del compartimento vaginal. No se presentó alguna complicación intraoperatoria. El tiempo de ingreso hospitalario fue de 0,8 día. En el postoperatorio ocurrieron 10% de retención urinaria, 8% de tenesmo vesical, 8% urgencia de novo, 2% extrusión de malla y 3% dispareunia. Conclusiones: Nuestros resultados son equiparables a los publicados en la literatura. Bajo nuestra experiencia, el TOT se presenta como una técnica segura, con una alta eficacia en el tiempo para el tratamiento de la IUE en pacientes con uretra móvil, y con una tasa baja de complicaciones. Se trata de una técnica con una curva de aprendizaje corta y la posibilidad de realizarla en régimen de cirugía mayor ambulatoria.

Long-term outcome of transobturator suburethral tape procedure for treatment of female stress urinary incontinence.

Objective:The aim is to evaluate the long-term safety and efficacy of transobturator tape (TOT) procedure in the treatment of women with stress urinary incontinence (SUI) by subjective and objective measures.Patients and Methods:A total 48 women with SUI underwent the TOT procedure during the period from December 2005 to February 2008. The follow-up period ranged between 60 and 84 months (mean 71 months). Mean age was 44.21 ± 7.52 (range: 30-58). Preoperative and early postoperative data were retrieved from the patient's medical files. Follow-up evaluation was carried out every 3 months during the 1st year and yearly afterwards by history taking (including incontinence and quality-of-life questionnaire), clinical examination, urine analysis, abdominopelvic ultrasonography, and urodynamic studies when indicated.Results:At 12-month follow-up, the cure, improvement, and failure rates were 39 patients (81.25%), 5 (10.42%) and 4 (8.33%), respectively. The corresponding rates at the last follow-up were 38 (79.15%), 5 (10.42%) and 5 (10.42%) respectively. The postvoid residual urine and peak flow rates did not differ significantly between the preoperative values and at the last follow-up. The complication rates after a mean 71-month included one patient with voiding difficulty and two patients with de novo urgency. No case was recorded with retention of urine or erosion.Conclusions:Transobturator tape procedure appeared to be effective minimally invasive procedure for SUI with low rate of complication and good long-term outcome.

Impact of concomitant anterior vaginal reconstructive surgery on transobturator suburethral tape procedures

To explore the functional and morphological impact of concomitant anterior vaginal reconstructive surgery on outcome of transobturator suburethral tape (TOT) procedures. This was a retrospective review and analysis of data from 196 women who had undergone a TOT procedure with or without concomitant anterior vaginal reconstructive surgery during a 30-month period. Retrieved data included clinical information and ultrasound findings. Ultrasound examinations assessed the tape location and tape tension at rest, on straining and during coughing. Ultrasound parameters representing tape location comprised the sagittal tape-symphysis pubis distance, sagittal tape-symphysis pubis angle and tape percentile (an indication of tape position along the urethra with respect to urethral length); those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end, central point and lower end of the tape and axial urethral central echolucent area at the center of the tape. Of the 196 women, 117 had undergone a TOT procedure without concomitant anterior vaginal surgery (Group 1), 44 had undergone TOT placement with anterior colporrhaphy (Group 2) and 35 had undergone TOT placement with a transobturator vaginal mesh procedure (Group 3). At the 3-month follow-up, functional outcomes as well as resting and dynamic ultrasound findings were similar between women following TOT procedures without (Group 1) and with (Groups 2 and 3) concomitant anterior vaginal surgery. However, a significantly higher rate of urethral encroachment at rest was noted in Group 2. Concomitant anterior vaginal reconstructive surgery neither aggravates the functional outcome nor affects the ultrasound findings of TOT procedures.

Sexual function in women following transvaginal mesh procedures for the treatment of pelvic organ prolapse

Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women's sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP). A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery. At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains. Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.

MRI anatomical study of the outside‐in transobturator suburethral tape procedure

This study aims to clarify the relationship between the outside-in transobturator suburethral tape and the anatomical structures at the blind passage of the obturator foramen, and to detail the tape position, shape, and the factors on which they are dependent. MRI scans were performed on 30 patients operated on with a dermal porcine collagen suburethral tape, indicated for urodynamically proven stress incontinence. The lateral bladder wall was the closest structure to the tape at the passage of the obturator foramen, whereas vascular injuries appeared to be minimal using the outside-in technique. The distance from tape to bladder neck was correlated with the distance from tape to pubococcygeal line (PCL) (p=0.001), and with urethral length (p=0.049). From the obturator foramen to its passage under the urethra, the tape was U-shaped with a cranio-caudal and antero-posterior orientation. The cranio-caudal tape shape was correlated with the distance between the tape and the PCL (p=0.002), and to the patient's anatomical characteristics: distance between the bladder neck and the pubis (p=0.01), and the urethral length (p=0.01). The antero-posterior shape was correlated with the urethral length (p=0.02). The lateral bladder wall is the structure most at risk during the outside-in transobturator suburethral tape procedure. The distance from tape to bladder neck is dependent on the vertical position of the tape. The tape shape is dependent on both tape position under the urethra and the patient's anatomical characteristics.

Female Sexual Function after Surgery for Stress Urinary Incontinence: Transobturator Suburethral Tape vs. Tension-Free Vaginal Tape Obturator

The transobturator suburethral tape (TOT) and tension-free vaginal tape obturator (TVT-O) procedures are relatively new incontinence treatment procedures. Studies on the influence on sexual function as a result of these procedures are limited. The influence of TOT or TVT-O for the surgical treatment of stress urinary incontinence (SUI) on female sexual function. We evaluated 77 sexually active patients after TVT-O (N = 34, mean age 53.2 years) and TOT (OB-TAPE, Porges) (N = 44, mean age 52.0 years) placement for SUI based on the responses to a mailed questionnaire 3 months after the operation. Difference in postoperative sexual complaints related to the TVT-O (inside-out) and TOT (outside-in) procedure. Postoperative TOT and TVT-O: There was almost no difference in frequency of sexual intercourse and an improvement of the continence during intercourse; continence was reported in 33 patients (42.3%) before and 67 patients (78.4%) after operation. The appreciation of sexual intercourse was improved in 15 patients (19.2%) and worsened in eight patients (10.3%). Postoperative TVT-O vs. TOT: No difference was seen in lost of lubrication, clitoral tumescence reduction, and clitoral sensibility reduction between both procedures. Pain because of vaginal narrowing was seen significantly more in the TOT procedure group. Overall, in this study, the technique of TOT gave rise to more sexual dysfunction than TVT-O. However, because of the successful outcome on incontinence, both procedures had, overall, a positive effect on sexual function. The cause of significant more pain during intercourse as a result of vaginal narrowing in the TOT procedure requires further investigation. Like other studies, this study demonstrated that incontinence surgery can have a positive and negative outcome on sexual function. It is important to put this issue in the informed consent.

Trans‐obturator suburethral tape for female stress incontinence: a cohort of 254 women with 1‐year to 2‐year follow‐up

A clinical cohort study of 254 women undergoing trans-obturator surgery for stress urinary incontinence was conducted to assess the efficacy of the trans-obturator suburethral tape (TOT) after a follow-up of 1 year (251 evaluable patients) and 2 years (62 patients). Seventy-five patients had previous gynaecologic surgery. Overall cure and improvement rates were 82% at 6 and 12 months, and 90% at 24 months. The most favourable results were obtained in patients with occult incontinence and urethral hypermobility. The relative risk (RR) for failure in patients with a history of gynaecologic surgery was 3.3 (95% CI: 1.1-14.7). There were 8 cases of bladder perforation (3.1%) during the learning phase with the TOT procedure, 20 of urinary retention (7.9%) - in 1 patient the tape was released after 12 days of insertion - and 3 of tape erosion (1.2%). Results are encouraging but should be substantiated on a larger series over a longer follow-up.

Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up

To report the results obtained with the transobturator sub-urethral tape (TOT) for the surgical treatment of stress urinary incontinence (SUI) after 1 year follow-up. Ninety-three patients diagnosed with SUI or mixed urinary incontinence (MUI) underwent a TOT procedure associated to prolapse surgery, if necessary. Pre-operative quality of life (QoL) was assessed with the Urogenital Distress Inventory Short Form (UDI-6)/Incontinence Impact Questionnaire Short Form (IIQ-7) questionnaires. Surgical and early complications were monitored. A stress test and an urodynamic test if urge incontinence de novo appeared were performed at 1 year follow-up. UDI-6/IIQ-7 questionnaires and SUI symptoms were recorded. Patients' characteristics, pre-operative quality of life and urodynamic evaluation were similar in the TOT and in the pelvic floor surgery group. From the sample, 15% had post-operative retention and 10% had vaginal erosion. The global rate of objective cure was 97% in both groups. The scores of the QoL questionnaires were worse by 9% and 10% with the procedure, respectively. Patients with urodynamic (MUI) or persistence of SUI symptoms (10%) did not reach a significant improvement, although patients with urge incontinence de novo (10%) did. The TOT procedure is safe and effective. Results showed that the association to pelvic floor surgical techniques did not diminish 1 year later. The stress test outcome assessment can overestimate the results, compared to the QoL assessment. In our report, the MUI did not improve with this surgical approach. Our results highlight the necessary employment of both the objective testing and the patient's opinion of her symptoms during daily life.

Obturator Hematoma After the Transobturator Suburethral Tape Procedure

Herein we report a case of obturator hematoma formation which occurred during our 25th case involving the transobturator suburethral tape procedure with the inside-to-out approach. A case of an obturator hematoma forming after a transobturator suburethral tape procedure is reported. The patient did not become infected and was managed conservatively. The hematoma spontaneously resorbed after 11 weeks and the patient was cured of her incontinence. The transobturator approach for suburethral tape placement may be associated with vascular complications.

Voiding Dysfunction Following Removal of Eroded Synthetic Mid Urethral Slings

Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion. Retrospective review identified 19 patients with genitourinary erosion of polypropylene mesh slings. Comprehensive urological evaluation was performed in all patients, and perioperative and postoperative data were analyzed. Voiding dysfunction was defined as refractory storage symptoms, emptying symptoms and pelvic pain. All subsequent medical and surgical interventions were recorded. In 19 patients a total of 11 vaginal, 7 intravesical and 5 urethral erosions occurred. Mean patient age was 52 years (range 32 to 69) and average followup was 8.4 months (range 3 to 34). Average time from symptom onset to sling removal was 10.1 months (range 1.5 to 38). Of the 19 patients 14 (74%) presented with multiple symptoms. Symptoms varied, including refractory pain, recurrent infections and bladder storage/emptying dysfunction. Urodynamic studies were abnormal preoperatively and postoperatively in 9 of 13 (69%) and 4 of 6 patients (67%), respectively. Following surgery lower urinary tract symptoms resolved completely in only 4 of the 19 patients (21%). Stress incontinence recurred in 8 of the 19 patients (42%). Five patients underwent simultaneous pubovaginal sling, of whom none had recurrent stress urinary incontinence. Only 9 patients (47%) considered themselves dry with no pads following surgery. Four patients required further surgery for refractory voiding symptoms. Voiding dysfunction is not an uncommon finding after sling excision in the setting of genitourinary erosion. It may cause additional patient morbidity.

Abscess of the thigh and psoas muscle after transobturator suburethral sling procedure

In October 2002, a 43-year-old female patient, para 2, underwent tubal sterilization by means of posterior colpotomy and a transobturator suburethral tape procedure (Uratape (Mentor Porges, Le Ples...

Objective and Subjective Cure Rates after Trans-Obturator Tape (OBTAPE®) Treatment of Female Urinary Incontinence

Objective(s)To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE®, Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. MethodsBetween January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE® in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. ResultsMean follow-up was 17.2±4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2±2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. ConclusionsOur results suggest that the OBTAPE® is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

DIAGNOSIS, MANAGEMENT AND PROGNOSIS OF VAGINAL EROSION AFTER TRANSOBTURATOR SUBURETHRAL TAPE PROCEDURE USING A NONWOVEN THERMALLY BONDED POLYPROPYLENE MESH

We studied the diagnosis, management and prognosis of vaginal mesh erosion using a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure for the surgical treatment of stress urinary incontinence in women. A total of 65 patients diagnosed with stress urinary incontinence underwent a transobturator suburethral tape procedure with a fusion welded, nonwoven, nonknitted polypropylene mesh, with or without a central silicone coated section, at our institution. All women were followed and if vaginal erosion was diagnosed, cystoscopy and vaginoscopy were performed, the mesh was partially or completely removed and, if necessary, posterior cough test and urodynamic study were performed. Of the 65 patients 9 (13.8%) were diagnosed with vaginal erosion at the vaginal incision during a relatively long postoperative period (mean 290 days). All presented with vaginal discharge and 1 had a severe complication (obturator abscess). Complete mesh removal was necessary in 8 patients and only 2 (22%) had recurrent stress urinary incontinence. A 13.8% rate of vaginal mesh erosion using a nonwoven thermally bonded polypropylene mesh was reported. This complication was probably due to the characteristics of the mesh and not to the transobturator approach. Complete removal of the tape is recommended and the continence status prognosis is good (78%).