Transobturator Tape Procedure Research Articles

Transobturator Tape (TOT) in Management of Female Stress Urinary Incontinence

BACKGROUND Transobtorator tape (TOT) is a minimally invasive procedure that gained increased popularity in the surgical field for management of patients with stress urinary incontinence . The use of TOT had significantly simplified the surgical procedure and made it safer. OBJECTIVES To evaluate the safety and efficacy of the TOT procedure in women with SUI PATIENTS AND METHOD Thirty female patient are complaining of urinary incontinence presented at urology department of Ghazi Al-Hariri surgical specialties hospital from January 2012-Oct. 2013 were enrolled in this study. All of our patients are with pure SUI. The procedure was done under spinal anesthesia. TOT require placement of macroporous polypropylene tape at the mid urethra through the obturator membrane with minimal vaginal incision. The patients were followed up before discharge, 1 month and six month using cough test. RESULTS Mean patients age is 48.2 year (range 30-60 year) with a mean parity of 5(range from 3-7 child). The mean operating time is 26.5 minutes (ranging from 20-30 minutes). Intraoperative complications occur in 6 patients (20%), include hemorrhage in 5 patients, hematoma in one patient. The total incidence of postoperative complication was 36%, transient thigh pain occurred in seven patients, two patients got retention, two patients got de novo urgency. The objective cure rate was 93.3% CONCLUSION The TOT procedure is a safe and effective technique for the management of patient complaining of SUI.

Transobturator tape material detected in the bladder neck: a case report

IntroductionStress urinary incontinence surgeries (transobturator tape and tension-free vaginal tape) are safely performed with success rates over 90%. The transobturator tape procedure attracted more attention due to the lack of major complications, such as intraabdominal organ and vascular injuries, related to the tension-free vaginal tape procedure. Although there are no major or mortality-related complications, more lower urinary complaints, especially vaginal erosion, are reported in transobturator tape surgery. Here we present a rare complication of transobturator tape surgery: the accidental placement of mesh material in the bladder neck. With this case report, we aimed to discuss the diagnosis and management of misplaced transobturator tape material.Case presentationA 38-year-old Caucasian woman who had stress urinary incontinence that had persisted for 6 years underwent transobturator tape surgery in a different clinic 2 years ago. Subsequently, she presented to our clinic with lower urinary tract complaints such as incontinence and dysuria. A physical examination was unremarkable besides total incontinence. A diagnostic cystoscopy was performed and sling material that crossed her bladder neck from 3 o’clock to 10 o’clock was identified. The misplaced transobturator tape material was cut endoscopically with an internal urethrotomy knife. Afterwards, a midurethral incision was made and mesh parts were removed bilaterally. After successful removal of the mesh material, a new transobturator tape was placed.ConclusionsEven though transobturator tape surgery is a safe and effective procedure for stress urinary incontinence, certain complications can be encountered. Misplacement of the mesh material through the bladder neck is a rare complication and can be managed by successfully removing the mesh material and appropriately placing new transobturator tape material.

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

IntroductionThe midurethral sling has become the current standard for the treatment of female stress urinary incontinence.AimTo assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures.Material and methodsThe analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6- and 12-month follow-up.ResultsA significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13–0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16–0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97–6.3; OR = 2.3, 95% CI: 0.95–5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality.ConclusionsTVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

Efficacy of the trans‑obturator and retropubic mid‑urethral slings for stress urinary incontinence

Background: The aim of our study was to report the extended long-term results of the use of tension-free vaginal tape (TVT) and trans-obturator tape (TOT) for the treatment of female urinary stress incontinence (SUI) at the Division of Gynaecology and Obstetrics / UMC Ljubljana. There are few data on this topic in the literature. Our aim was to find out whether and how the procedure improved the patients’ quality of life and for how long, whether the patients had complications after the procedure, and how this type of procedure affected the long-term results.Methods: A retrospective clinical trial comparing the use of TVT and TOT was carried out from January to August 2017 and included all the patients operated on at the Division of Gynaecology and Obstetrics / UMC Ljubljana with TVT or TOT procedure for stress or mixed urinary incontinence (UI) associated with urethral hyper mobility (the stress component was clinically predominant). The exclusion criteria were more than 10 years from procedure, age more than 80 years in 2016, previous anti-incontinence surgery and/or pelvic organ prolapse more than stage I on POP–q in any vaginal compartment. After inclusion and exclusion criteria, 1104 patients were sent quality-of-life questionnaires (PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, ICIQ-UI Short Form (Slovenian)) with questions about the diagnosis, procedures, complications, reoperations, post-operative results, and satisfaction with the procedure. Till August 2017 (6 months after sending) we received 466 questionnaires (42.2 % response rate). After 225 questionnaires were excluded due to incomplete data, 241 questionnaires were analysed.Results: In the analysed group of patients (N = 241), 189 (78 %) had TOT and 52 (22 %) had TVT. Our retrospective study has confirmed that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The TOT and TVT groups did not differ significantly from each other in PGI-S, PGI-I, SANDVIK SEVERITY SCALE, UDI-6, IIQ-7, and ICIQ-UI Short Form or in postoperative complication rate. Repeat surgery was needed in 25/189 (13.2 %) TOT patients and 12/52 (23.1 %) TVT patients; p = 0.082. Urinary retention appeared in 18/189 (9.5 %) TOT patients and 7/52 (13.5 %) TVT patients; p = 0.411. Mesh erosion/inflammation appeared in 12/189 (6.3 %) TOT patients and 2/52 (38 %) TVT patients; p = 0495.Conclusion: We can conclude that the efficacy and safety of TOT and TVT in the surgical treatment of SUI are comparable. The choice of the technique should be based on the relative pros and cons of techniques and the surgeon’s experience.

Surgical outcome of the transobturator tape procedure for management of female urinary incontinence: A single center experience

Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patients (10%) needed an indwelling urethral catheter because of voiding difficulties. At the second follow-up, 2 (5%) patients still had a positive cough test, 2 patients (5%) had still the need for an indwelling catheter because of significant postvoid residual (PVR) urine volumes and 2 patients (5%) had a positive urine culture. At the three and six months, postoperative assessment. 3 patients (7.5%) still had a positive cough test. After six months 36 patients (90%) were considered as cured, 1 patient (2.5%) improved and 3 patients (7.5%) were classified as a failure. Conclusion. These results concur with the results of the other published short-term studies that analyzed the surgical outcome of the TOT procedure for female urinary incontinence. This allows us to confirm that the transobturator tape technique is a safe, effective and straightforward procedure after adequate training.

Impact of the mid-urethral sling for stress urinary incontinence on female sexual function and their partners’ sexual activity

ObjectiveTo assess the impact of the transobturator mid-urethral sling (MUS) procedure on female sexual function and their partners’ sexual activity. Materials and methodsSexually active women with stress urinary incontinence who underwent a transobturator MUS procedure at the Department of Obstetrics and Gynecology of two medical centers were prospectively enrolled. All participants and their partners were required to complete questionnaires before surgery and 3 months after surgery. ResultsEighteen women undergoing both the transobturator tape (TOT) procedure (n = 14) and the tension-free vaginal tape obturator (TVT-O) procedure (n = 4) were enrolled. The female sexual function index scores did not differ between the baseline and postoperative data. However, the overactive bladder symptom scores improved significantly 3 months after surgery. Patients also had an improvement in their arousal score after TOT procedures; however, there was no between-group difference in the post-treatment changes in the arousal scores. Thirteen partners completed their questionnaires at both the baseline and postoperative phases. Fifty-four percent (7/13) of partners stated that sexual intercourse improved after surgery, and 46% (6/13) described no change after surgery. In addition, no change in pain level due to vaginal narrowing or dryness after surgery was observed. Only one partner noticed the tape during intercourse and complained of pain due to the tape. ConclusionAlthough most female sexual function remains unchanged after the transobturator MUS procedure, a significant percentage of partners in the study felt that their sexual activity improved after surgery.

A minimally invasive modified technique for female stress urinary incontinence: transobturator tape without paraurethral dissection.

IntroductionMid-urethral slings, including transobturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and a single incision sling, are the most popular procedures for the treatment of stress urinary incontinence (SUI). Although the classical TOT procedure is a minimally invasive technique, we believe that this technique can be further improved.AimTo determine whether there was a difference in success and complication rates between the classical TOT technique and a novel technique called “modified transobturator tape” (mTOT), which avoids periurethral dissection.Material and methodsIn total, 98 patients who underwent incontinence surgery between July 2011 and January 2017 were recruited for this prospectively planned study. Of the 98 patients, 47 patients underwent classical TOT, and 51 patients underwent the new mTOT procedure. Incontinence Impact Questionnaire-7 (IIQ-7) and visual analogue scale (VAS) scores were obtained preoperatively and postoperatively. Average or serious symptomatic scores in IIQ-7 were considered as subjective failure.ResultsNerve damage, vascular damage, retropubic hematomas, and bladder-urethra erosion were not observed in either group. There were no significant between-group differences in IIQ-7 scores. There were also no between-group differences in postoperative 1-month, 6-month, and 1-year VAS scores, but postoperative first day scores of the mTOT group were significantly lower than those of the classical TOT group (p < 0.05).ConclusionsThe proposed modified technique provides the same efficiency and reliability as the classic technique but is more advantageous in terms of reduced pain and resumption of earlier sexual activity.

The Efficacy of Transobturator Tape (TOT) in Treatment of Mixed Urinary Incontinence in Females

Background: mixed urinary incontinence (MUI) is defined as the complaint of involuntary loss of urine, associated with urgency and also with effort. Urodynamic studies (UDS) are widely considered the gold standard investigation for determining the type of incontinence. Aim of the Work: It evaluates the safety and efficacy of transobturator tape (TOT) procedure in treatment of women with mixed urinary incontinence. Patients and Methods: this study was carried out at Ain Shams Urology Department and National institute of urology and nephrology in the period from October 2017 to may 2018. This Study included 20 female patients with MUI who failed to respond to medical treatment and other forms of conservative methods. Post operative evaluation was carried out at 2 weeks, 3, and 6 months following operation. Results: Our study showed statistically significant cure rate for urge component 12 cases (60%), and also significant cure rate for stress component 17 cases (85%), no statistically significant difference in the cure rate depending on the age factor by dividing the patients into two groups group below forty (11 cases) and group above forty (9 cases). Conclusion: our study showed statistically significant cure rate for urge component 12 cases (60%), and also significant cure rate for stress component 17 cases (85%). The limitations in our study were small number of patients and short time of postoperative follow-up. We advocate that the TOT procedure should always be tried in the management of mixed urinary incontinence in female population as it is an effective and simple procedure.

Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery

Objective: This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery. Methods: This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation. Results: When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020). Conclusion: The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.

The Effect of Diagnosis-Related Group Payment System on Quality of Care in the Field of Obstetrics and Gynecology among Korean Tertiary Hospitals.

PurposeTo examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care.Materials and MethodsUsing the 2012–2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs.ResultsDRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p<0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p<0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased.ConclusionImplementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.

Postoperative urinary symptoms after transobturator tape in normal-weight compared with overweight and obese woman.

ObjectivesTo examine the clinical outcome of obesity in women who underwent the transobturator tape procedure for stress urinary incontinence and to compare postoperative urinary symptoms after transobturator tape surgery between normal-weight women and overweight and obese women.MethodsWe performed a retrospective cohort study of the risk of postoperative urinary symptoms, including recurrence after transobturator tape surgery, in normal-weight women compared with overweight and obese women at our institution from January 2009 through October 2011. We compared the body mass index (BMI) among the four groups. The primary outcome was the occurrence of postoperative urinary symptoms.ResultsThree hundred ten patients who underwent transobturator tape surgery were reviewed. At the 1-year follow-up, 281 women were analyzed: 89 (34%) normal-weight women, 78 (25%) overweight women, 101 (37%) obese 1 women, and 13 (3%) obese 2 women. There was a significant difference in the occurrence of postoperative urinary symptoms. They occurred in 3.4% (n=3) of normal-weight women, 5.1% (n=4) of overweight women, and 12.9% (n=13) of obese 1 women (P=0.038). The most common postoperative urinary symptom was frequent urination (n=14). There was a significant difference in leakage; it occurred in 1.1% (n=1) of normal-weight women, 3.9% (n=3) of overweight women, and 7.9% (n=8) of obese 1 women (P=0.139). Postoperative urinary symptoms were almost four times more likely to occur in obese 1 women than in normal-weight women.ConclusionTransobturator tape surgery seems effective regardless of BMI, but obese women had a higher occurrence of postoperative urinary symptoms than did normal-weight women.

The Effects of Outside-in Versus Inside-out Transobturator Tapes, for Stress Urinary Incontinence, on Sexual Function and Quality of Life: A Prospective Study

Objective: To assess the effects of outside-in versus inside-out transobturator tapes for stress urinary incontinence on sexual function, quality of life and psychosocial state. Material and Methods: The study was performed on a total of 101 females, who underwent transobturator tape outside-in or inside-out procedures for stress urinary incontinence with no concomitant prolapse repair, between September 2014 and October 2015 at the clinic in Istanbul, and completed a validated quality of life, sexual function, and psychosocial state questionnaires before and after surgery. The scales used for the assessment included the Hospital Anxiety and Depression Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Sexual Quality of Life Questionnaire-Female. Results: The HADS scores showed a statistically significant decrease (an indicator of improvement of anxiety and depression) in the postoperative period in both the groups (p<0.05). The PISQ-12 scores increased in both the groups in the postoperative period, indicating improvement (p<0.05). The preoperative sexual and partner relationship SQoL-F scores were significantly higher in the inside-out group than in the outside-in group (p<0.05). Conclusion: The results of this study suggest that transobturator tape procedures for stress urinary incontinence have a positive outcome on female sexual function and quality of life. However, further prospective studies, with more participants, are warranted to support these preliminary findings to be able to compare the impact of transobturator tape outside-in or inside-out routes on female sexual function, quality of life and psychosocial state more precisely.

Impact of Preoperative Patient Characteristics and Flow Rate on Failure, Early Complications, and Voiding Dysfunction After a Transobturator Tape Procedure: A Multicentre Study.

PurposeTo evaluate the impact of preoperative patient characteristics and flow rate on failure, early postoperative complications, and voiding in patients who underwent transvaginal tension-free vaginal tape-obturator (TVT-O) treatment for uncomplicated stress urinary incontinence (SUI). MethodsWe retrospectively reviewed patients who underwent TVT-O for SUI at 3 Italian centres. The exclusion criteria were predominant voiding and storage symptoms suggestive of detrusor overactivity, the presence of grade >1 urogenital prolapse, previous pelvic radiotherapy or other clinical contraindications for surgical procedures, neurogenic bladder dysfunction, and collagen diseases. Multivariate logistic regression models were constructed to identify predictors of early voiding dysfunction after TVT-O. ResultsA total of 219 patients underwent TVT-O between January 2010 and December 2015. All patients received follow-up at 3, 6, and 12 months, and underwent a stress test, uroflowmetry, and bladder ultrasound to evaluate the postvoid residual volume. They also responded to the Urogenital Distress Inventory (UDI-6) questionnaire. The rates of persistent incontinence after TVT-O, postoperative complications, and satisfaction were 16.4% (36 of 219), 24.2% (53 of 219), and 86.3% (189 of 219), respectively. Nineteen patients (9.5%) experienced early voiding dysfunction. Based on an analysis of baseline characteristics, we determined that a cutoff value of 9.0 on the UDI-6 predicted postoperative SUI with 62% specificity, 72% sensitivity, and 66% accuracy. In the multivariate logistic regression analysis, a preoperative UDI-6≥9.0 was an independent predictor of postoperative SUI. The predictors of complications were menopause (P = 0.04) and the preoperative UDI-6 score (P = 0.01). ConclusionsMenopause and UDI-6 scores could be prognostic factors for persistent SUI after TVT-O. Well-designed prospective studies with a suitable number of patients are needed to corroborate our findings.

EARLY OUTCOME OF TOT SURGERY FOR URINARY INCONTINENCE IN SULAIMANI TEACHING HOSPITAL

Background&#x0D; Female urinary incontinence is a major health issue affecting about 30% of adult women and majority of them is stress type. Transobturator tape (TOT) technique is relatively safe and associated with minimum complication rate.&#x0D; Objectives&#x0D; To identify the safety, success rate and efficacy of TOT procedures performed for female patients with stress urinary incontinence. &#x0D; Patients and Methods&#x0D; A prospective study included thirty patients with history of urinary incontinence (22 patients with stress type and 8 patients with mixed type UI). They underwent TOT procedure in Sulaimani teaching hospital under general or spinal anesthesia; they were collected over a year from June 2014 to June 2015, all of them referred from urological clinic with history of stress or mixed urinary incontinence. The response of TOT surgery was assessed in both subjective and objective ways, using the ICIQ-UI short form and both cough stress test and Q-tip test (before and after surgery), 20 of them had urodynamic study before surgery to confirm the diagnosis, follow up done at one week, three months and six months postoperatively. &#x0D; Results &#x0D; A total of 30 females with mean age (48.8±9.51) years, Mean number of deliveries for studied females was (4.9±2) deliveries. Main type of urinary incontinence among studied females was stress urinary incontinence (73, 3%); followed by mixed urinary incontinence (26, 7%), all of them were from Sulaimani city and its peripheries. In this study; we found that the success rate is 80% (considering both objective and subjective outcome) which is comparative to similar studies. The early complications were mainly perineal (groin) and upper thigh pain, while the late complications were the development of de novo detrusor over activity, there were no vaginal or urethral erosions. &#x0D; Conclusion&#x0D; Transobturator tape (TOT) is an efficient and safe way of managing stress urinary incontinence with high success rate and short hospitalization with minimum and simple early complications.

P-04-001 Evaluation of the sexual functions of the spouses according to the Body Mass Index before and after the Transobturator Tape (TOT) procedure

P-04-001 Evaluation of the sexual functions of the spouses according to the Body Mass Index before and after the Transobturator Tape (TOT) procedure

Recurrence rate of stress urinary incontinence in females with initial cure after transobturator tape procedure at 3-year follow-up.

PurposeTo assess recurrence rates of urinary incontinence in women with initial cure after transobturator tape (TOT) procedure at 3-year follow-up.Materials and MethodsBetween June 2006 and May 2013, a total of 402 consecutive patients underwent the TOT procedure for female stress urinary incontinence (SUI) at Dongguk University Ilsan Hospital. Of the 402 patients, 223 had sufficient medical records for analysis. Therefore, they were followed-up for 3 years postoperatively. Patient characteristics, urinary symptoms, physical examination, and urodynamic parameters were evaluated. The primary end point of “cure” was defined as the absence of any complaint of urinary leakage without needing pads for usual activities.ResultsOf the 223 patients, 196 patients (87.9%) were initially cured within 6 months postoperatively. Of the 196 patients, 70 (35.7%) had recurrent urinary incontinence at 3 years postoperatively, 51 (26.0%) had SUI, 16 (8.2%) had urgency urinary incontinence, and 3 (1.5%) had mixed urinary incontinence. In univariate analysis, preoperative urinary obstructive symptom was found to significant contributor to the recurrence of urinary incontinence at 3-year postoperatively (p=0.004).ConclusionsIn our study, 35.7% of the women with initial cure after TOT experienced the recurrence of urinary leakage during the 3-year follow-up. The cure rate of TOT was decreased as time went by, although the initial cure rate was high.

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.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m2 were considered as obese, while <30 kg/m2 were non-obese. And women with BMI ≥35 kg/m2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

Day case transobturator tapes: a cut and dried solution

The transobturator tape (TOT) has been utilized in the surgical management of SUI since 2001 when it was first described and is associated with minimal risk of trauma as its purely perineal insertion avoids entry to the retropubic space. Given its high success rate, low associated peri-operative morbidity and relative ease of insertion, it has been increasingly used as a day case procedure worldwide. This study aims to demonstrate the suitability of the transobturator tape (TOT) as a day surgery procedure in the Republic of Ireland. A retrospective review of all the patients who underwent TOT as a day case procedure at a tertiary referral centre in Dublin over a 1year period (March 2015-March 2016) was carried out. This was post the introduction of the procedure as a day case for a select group of patients. The outcomes evaluated included intraoperative and postoperative complication rates, voiding dysfunction rates, unscheduled inpatient admissions following the procedure and continence rates post-procedure. Fifteen cases were reviewed. There was one case with minor intraoperative complication of bladder perforation which was managed as an outpatient. One patient (6%) failed to achieve adequate voiding within the 6-h timeframe allowed and, therefore, required overnight admission. All patients reported dryness at the 6-week review. Major elective waiting time for the gynaecology list decreased from 28 to 10weeks 1year post-commencement of the protocol. We conclude that the transobturator tape procedure is suitable as a day case in a select group of patients in the Irish healthcare setting. There was no increased rate of morbidity demonstrated in the group and readmission rates were low. It has reduced waiting times by increasing throughput of cases and ultimately will lead to reduced costs for hospitals.