Transobturator Tape For Stress Urinary Incontinence Research Articles

Translabial ultrasound: a non-invasive technique for assessing \u201ctechnical errors\u201d after TOT failure

Introduction and hypothesisThe aims of this study were to evaluate by transperineal ultrasound if there were ultrasound-detectable changes over time in the dynamic behavior of the sling in patients who underwent transobturator tape (TOT), and to evaluate if dynamic translabial ultrasonography recognized factors that may be associated with failed surgery.MethodsThis was a single-center prospective study. We included women who underwent “out-in” TOT for stress urinary incontinence (SUI). A dynamic translabial ultrasound was performed 6 months post-surgery and again at the last visit. The objective cure for SUI was defined as the absence of urine leakage during the stress test. We evaluated the bladder neck mobility at rest and during Valsalva; the position of the mesh along the urethra; the concordance of urethral movement with the sling during Valsalva; the symmetry of the lateral arms of the sling during straining; and the presence or absence of bladder neck funneling.ResultsFrom December 2012 to February 2016, 80 consecutive patients were included. Six months after surgery, incontinent women compared with continent women had the sling in a proximal or distal position, that moved discordantly with the urethra (p < 0.0001), with asymmetry arm and bladder neck funneling (p < 0.0001). Continent patients had a significant improvement of urethrocele grade both at rest (p = 0.036) and during Valsalva (p = 0.045).ConclusionsTechnical and positioning errors can lead to the failure of anti-incontinence surgical treatment. Translabial ultrasound allows the correct positioning of the sling to be evaluated and any errors that need to be analyzed in order to then solve the failure.

The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape.

Introduction: Stress urinary incontinence (SUI) has an incidence of 15–80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. Aims: To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. Materials and methods: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student’s t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p < 0.05. Results: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. Conclusions: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.

Cinta suburetral versus cinta transobsturatriz en el tratamiento de la incontinencia urinaria de esfuerzo femenina

Introducción. Entre los tratamientos quirúrgicos de la incontinencia urinaria de esfuerzo se emplea la técnica de la cinta transobturatriz (TOT, por sus siglas en inglés) desde el 2006 hasta la actualidad. Se presenta un estudio con la aplicación de la cinta uretral (UTP, por sus siglas en inglés) como mejor alternativa al no usar la aguja del TOT. Objetivo. Demostrar las ventajas de la aplicación de la cinta suburetral versus la cinta transobturatriz en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo. Métodos. Estudio observacional, comparativo con la técnica no invasiva empleando cinta suburetral versus la técnica de la cinta transobturatriz. Resultados. Se evaluó 50 pacientes intervenidas con TOT, quienes precedieron un turno el mismo día o el día precedente a las pacientes operadas con la cinta uretral. El promedio de edad fue 56 años y el tiempo promedio del procedimiento fue 18 minutos. Las complicaciones consistieron en dolor en la zona inguinal (13 casos), extrusión de malla (2 casos) y, una de cada caso, dehiscencia de sutura de la colpoporrafia anterior, presencia de granuloma inguinoperineal izquierdo por reacción a la malla, hematoma en zona obturatriz izquierda. En los 50 casos tratados con cinta suburetral, el promedio de edad fue 56 años, el tiempo operatorio 7 minutos y no existió complicación alguna. El costo del kit de la TOT fue alrededor de US$ 1 000.00; la cinta suburetral costó US$ 50.00. Conclusiones. En la presente serie de manejo de la incontinencia urinaria de esfuerzo, la técnica de la cinta suburetral resultó más segura que la técnica de la cinta transobturatriz y fue de menor costo.

Female sexual function associated with the use of tension free vaginal tape for stress urinary incontinence

IntroductionFemale urinary incontinence is a common problem in middle-aged women. Up to 50% of the adult female population have stress urinary incontinence, and the prevalence of sexual dysfunction in these women is around 50%. The aim of this study is to evaluate sexual function before and after a urinary incontinence surgical procedure using tension-free vaginal tape (TVT) or transobturator tape (TOT). Material and methodsA prospective study was conducted on 22 sexually active women who underwent TVT or TOT procedures for stress urinary incontinence by assessing the Female Sexual Function Index (FSFI) before, and 3 and 6 months after surgery. ResultsThe study included 22 women with a mean age of 48.3±6.46 years, who underwent TVT or TOT for stress urinary incontinence. The median abdominal leak point pressure (ALPP) was 85.5±17.2cm H2O, with a median pelvic organ prolapse quantification (POPQ) of 0.28±0.45. Female sexual function assessed with the FSFI improved in all the aspects of the questionnaire. The mean total FSFI score before surgery was 21.57±3.53, at 3 months after surgery it was 26.05±3 (P=0.0001), and at 6 months post-op it was 27.28±5.03 (P=0.001). Coital incontinence improved in 90% of the participants, and 95% responded that they were satisfied with the results of the procedure. ConclusionSexual function in women who underwent TVT and TOT procedures improved considerably up to 6 months after surgery. Coital urinary incontinence improved in most of the women. Despite the evidence being variable as regards the outcomes in terms of sexual function after TVT and TOT, it is considered that these procedures substantially improve sexual function in women with stress urinary incontinence.

Función sexual femenina asociada al uso de cintas libres de tensión para el manejo de la incontinencia urinaria de estrés

IntroductionFemale urinary incontinence is a common problem in middle-aged women. Up to 50% of the adult female population have stress urinary incontinence, and the prevalence of sexual dysfunction in these women is around 50%. The aim of this study is to evaluate sexual function before and after a urinary incontinence surgical procedure using tension-free vaginal tape (TVT) or transobturator tape (TOT). Material and methodsA prospective study was conducted on 22 sexually active women who underwent TVT or TOT procedures for stress urinary incontinence by assessing the Female Sexual Function Index (FSFI) before, and 3 and 6 months after surgery. ResultsThe study included 22 women with a mean age of 48.3±6.46 years, who underwent TVT or TOT for stress urinary incontinence. The median abdominal leak point pressure (ALPP) was 85.5±17.2cm H2O, with a median pelvic organ prolapse quantification (POPQ) of 0.28±0.45. Female sexual Function assessed with the FSFI improved in all the aspects of the questionnaire. The mean total FSFI score before surgery was 21.57±3.53, at 3 months after surgery it was 26.05±3 (P=.0001), and at 6 months post-op it was 27.28±5.03 (P=.001). Coital incontinence improved in 90% of the participants, and 95% responded that they were satisfied with the results of the procedure. ConclusionSexual function in women who underwent TVT and TOT procedures improved considerably up to 6 months after surgery. Coital urinary incontinence improved in most of the women. Despite the evidence being variable as regards the outcomes in terms of sexual function after TVT and TOT, it is considered that these procedures substantially improve sexual function in women with stress urinary incontinence.

Effect of Preoperative Flow Rate on Postoperative Retention and Voiding Difficulty After Transobturator Tape Operation

PurposeControversy exists over the preoperative risk factors for postoperative urinary retention after the midurethral sling procedure for stress urinary incontinence (SUI). We intended to analyze the effect of preoperative flow rate on postoperative urinary retention after the transobturator tape (TOT) operation.Materials and MethodsA total of 322 patients who underwent TOT from June 2006 to May 2012 were included in this retrospective study. All patients were preoperatively investigated for urinary symptoms and underwent preoperative urodynamic studies including urine flow rate. Postoperative urinary retention, voiding difficulty, and uroflowmetry were checked. Urinary retention was defined as the need for additional catheterization longer than 1 day. Patients were divided by preoperative peak flow rate (Qmax) of 15 mL/s (low Qmax group and normal Qmax group).ResultsThere were 3 cases of postoperative urinary retention (0.9%) and 52 cases of voiding difficulty (16.1%). The low Qmax group included 40 patients (12.4%) and the normal Qmax group included 282 patients (87.5%). Between the two groups, there were no significant differences in age, previous pelvic surgery history, or past medical history. The low Qmax group had higher scores for voided volume and detrusor pressure at Qmax. However, there was no significant difference in postoperative voiding difficulty between the two groups. Furthermore, three patients who experienced postoperative retention showed high flow rates preoperatively.ConclusionsOur results suggest that voiding difficulty in the group with low preoperative flow was tolerable and the treatment success rate was comparable to that in patients in the normal flow group. According to our analysis, patients with a low flow rate preoperatively can be safely treated with TOT for SUI.

Efficacy and Safety of Tension-Free Vaginal Tape Compared With Transobturator Tape Among Obese Women With Stress Urinary Incontinence: A Retrospective Cohort Study

ObjectiveTo determine the efficacy and safety of tension-free vaginal tape (TVT) compared with transobturator tape (TOT) in obese women with stress urinary incontinence (SUI). MethodsWe performed a retrospective chart review of patients who underwent insertion of TVT or TOT for stress urinary incontinence between January 2003 and October 2009. Women were excluded if they had had previous surgery for SUI or had a diagnosis of intrinsic sphincter deficiency. ResultsOne hundred eighty obese women (BMI >30 kg/m2) with SUI and with follow-up for at least one year were identified (90 had TVT and 90 had TOT). The rates of success on the objective criteria were 91% for the TVT group and 88% for the TOT group (P = 0.46) and 87% versus 80% (P = 0.23) on subjective assessment. ConclusionOur retrospective cohort study demonstrated similar rates of cure for obese women with SUI who underwent insertion of TVT and TOT.

Mesh erosions after transobturator suburethral tape: a case series

The transobturator tape (TOT) is a widely used minimally invasive procedure for the treatment of stress urinary incontinence (SUI). Despite the reported low rate of intraoperative adverse events after TOT, many cases of delayed vaginal erosion were published and are cause of great concern. We reviewed our experience with the TOT procedure using Uratape® (Mentor-Porges, Le Plessis Robinson, France), a non-woven, non-elastic polypropylene tape. In our series of 102 patients treated with TOT for SUI, we noted three cases of delayed vaginal wall erosion (2.9%). All patients were treated with excision of the eroded portion of the tape. Other reports have shown, in some cases, a considerably higher rate of erosion after TOT using the same mesh. Further investigation is needed to evaluate prospectively the relationship between the type of mesh used for surgery and erosions, and the possible aetiological role of other concomitant factors.

Trans Obturator Tape for Female SUI

The Trans Obturator Tape (TOT) is a new technique, based on positioning of a tape under the middle urethra through the obturator foramina. The outcomes and complications of the TOT at 1 year follow up were evaluated. Materials and Methods 50 patients underwent to TOT for stress urinary incontinence (SUI) have been prospectively evaluated. In the first 6 patients was used the Uratape, a polypropylene tape covered by silicon in the middle part. Eventually, because of 1 case of extrusion due to the silicon part, it was created and used the Obtape, the same tape without the silicon part. The patient was positioned in lithotomy position and a Foley catheter was inserted. A small (2 cm) incision was performed 1 cm below the external meatus in order to allow the digital dissection of the paraurethral. Through the skin the obturator foramen was identified and a small incision was done in the medial part just above the level of the urethral meatus bilaterally. Eventually a hooked tunneler was inserted through the incision at the level of the obturator foramen and the obturator fascia is perforated anteroposteriorly. The tunneler is than directed medially in the paraurethral space previously prepared and under direct digital control. The tape is inserted into the eye of the tunneler to retract the tape through the obturator foramina. The procedure is repeated on the other side. Patients were evaluated preoperatively, at 1, 6, 12 months of follow up with a physical examination, validated questionnaire (AUA score) and reported percentage of improvement, and uroflowmetry. Results The mean age was 57 (range 36 – 76). 70% of the patients had urodynamic stress incontinence, 30% had stress incontinence associated with urgency. The median follow up was 12 months (range 1–24 months). - The average of the AUA score has been decreased of 13 points (form 16 to 3) and the average percentage of improvement was 81 % up to a maximum follow up of 18 months. - 88% (44/50) patients were dry one year after the surgery and 12% (6/50) were improved.- No significant changes in uroflowmetry parameters. One case of extrusion have been reported, using the Uratape, no cases of extrusion have been reported using the Obtape. One patient had developed new urgency. Conclusions The Trans Obturator Tape is a simple, direct and quick procedure. It is associated with good outcomes and high patient satisfaction up to an average follow up of 12 months. Additionally the Obtape does not seem associate to erosion, extrusion or alteration of the normal voiding.