Transobturator Tape Procedure Research Articles

The dorsal nerve of the clitoris in relation to urinary incontinence sling procedures.

To avoid injury to the perineal branches of the pudendal nerve during urinary incontinence sling procedures, a thorough knowledge of the course of these nerve branches is essential. The dorsal nerve of the clitoris (DNC) may be at risk when performing the retropubic (tension-free vaginal tape) procedure as well as the inside-out and outside-in transobturator tape procedures. The purpose of this study was to identify the anatomical relationships of the DNC to the tapes placed during the procedures mentioned and to determine the influence of body variations. In this cadaveric study, the body mass index (cBMI) of unembalmed cadavers was determined. Suburethral tape procedures were performed by a registered urologist and gynecologist on a sample of 15 female cadavers; six retropubic, seven inside-out and nine outside-in transobturator tapes were inserted. After embalmment, dissections were performed and the distances between the DNC and the tapes measured. In general the trajectory of the outside-in tape was closer to the DNC than that of the other tapes. cBMI was weakly and nonsignificantly correlated with the distance between the trajectory of the tape and the DNC for the inside-out tape and the tension-free vaginal tape, but not for the outside-in tape. The findings suggest that the DNC is less likely to be injured during the inside-out tape procedure than during the outside-in procedure, regardless of BMI. Future studies on larger samples are desirable to confirm these findings.

The effects of stress incontinence surgery on sexual function and life quality of women

To evaluate Transobturator tape (TOT) and Burch colposuspension procedure's effects on sexual functions and life quality. A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Learning curves of a resident surgeon performing transobturator tape procedures for stress urinary incontinence

ObjectiveTo evaluate the number of procedures necessary for an untrained resident surgeon to learn transobturator tension-free vaginal tape (TVT-O) procedures for treatment of stress urinary incontinence (SUI). MethodsA prospective study was performed among patients aged 18–75 years who underwent TVT-O procedures at a center in Rome, Italy, between March 2, 2009, and November 30, 2012. The TVT-O procedure was performed by a right-handed resident surgeon working under the supervision of an expert surgeon. Total and partial operative times were recorded. ResultsAmong 18 patients included in analysis, the mean operative time was 22.2minutes (range 7–44). All total operative times fell within the confidence interval after the 10th procedure, with a difference between the mean times recorded in the first nine and the last eight procedures (29.5 vs 13.1minutes; P<0.001). The resident surgeon required nine procedures to learn right tunneling and 13 to learn left tunneling. ConclusionTen procedures were required for a resident surgeon to learn TVT-O procedures for SUI.

Five-year follow-up study of Monarc transobturator tape for surgical treatment of primary stress urinary incontinence

We hypothesized that transobturator tape (TOT) is safe and efficacious for the treatment of urodynamic stress incontinence in the long term. We conducted a prospective study of patients with confirmed urodynamic stress incontinence (USI) who underwent a MonarcTM TOT procedure in a tertiary center between February 2006 and March 2009 without other concurrent surgical procedures. Urodynamics were conducted at 1 and 3years postoperatively. Subjective evaluation included Incontinence Impact Questionnaire (IIQ-7), Urinary Distress Inventory Questionnaire (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Objective cure was defined as no urinary leakage demonstrable on provocative filling cystometry and/ or 1-h pad test of <2g. Subjective cure was based on a negative response to question 3 in UDI-6. Paired-samples t test, chi-square, and Fisher exact tests were applied; p < 0.05 was considered significant. The log-rank tests were used to compare event-free survival. Sixty patients were enrolled, and 56 were evaluated at 5years postoperatively. The majority were middle aged, postmenopausal, and overweight. Mean operating time was 31.1 ± 8.9min, intraoperative complications were minor, and median period of follow-up was 80.3 ± 9.6months. At 5years of follow-up, objective and subjective cure rates were 89.3% and 87.5%, respectively. No mesh-related complications were seen. One patient needed a repeat midurethral sling procedure, and one patient each had bladder and bowel cancer. Monarc TOT was safe and retained its high cure rate in the short- and long-term treatment of stress urinary incontinence.

Le succès thérapeutique après bandelette Monarc® est-il durable à moyen terme ?

Suburethral sling is the gold standard treatment for stress urinary incontinence (SUI). Short-term cure rates are high, but only few studies are available for longer assessment after transobturator tape procedure. The objectives of this study were to assess mid-term functional outcome for Monarc(®) transobturator tape after initial success, and to identify risk factors for recurrence. We conducted a single centre retrospective study (2004-2013) on consecutive women with SUI who underwent Monarc(®) transobturator tape procedure and were initially cured at the postoperative medical consultation. Pre- and postoperative data (age, weight, height, body mass index, hormonal status, surgical history, associated organ prolapse [Baden and Walker], associated urinary symptoms, postoperative complications [Clavien-Dindo]) were extracted from the electronic medical record. Subjective cure was defined by a score of zero from the ICIQ-SF questionnaire, no second intervention for recurrent SUI and no need for pads at latest news. Statistical analysis was performed using SAS(®) v9.3 (P<0.05). One hundred and thirty-three consecutive women underwent TOT Monarc(®) procedure, and 125 women were cured in the short-term. Among these women, 103 (82%) were available for mid-term evaluation. Sixty-four women (62%) had pure stress urinary incontinence. The mean follow-up period was 51 months [2-119]. At last follow-up, cure rate was 61%. Seventy-eight percent of women with recurrent urinary incontinence had SUI. Other women had mixed urinary incontinence (3/40), or de novo urgency (6/40). In univariate analysis, we could not identify pejorative prognostic factors for mid-term failure. In our experience, mid-term functional outcome after Monarc(®) transobturator tape procedure seems to deteriorate. After 4 years of follow-up, 61% of the women who were initially cured were still free from any leakage. 4.

Clinical effects of transobturator tape procedure with porcine small intestine submucosa for female stress urinary incontinence

The aim of this study was to evaluate the efficacy of the transobturator tape (TOT) procedure using porcine small intestine submucosa (SIS) for the treatment of female stress urinary incontinence (SUI). Forty-two consecutive patients with SUI who underwent the TOT procedure with porcine SIS were enrolled. The surgical outcomes, and data of urodynamic study and a questionnaire prior to and after surgery were collected and analyzed retrospectively. SUI was reported subjectively cured in 34 of the 42 patients (81.0%) 1 year after surgery, and declined to the rate of 66.7% at 5 years postoperatively. The subjective symptoms of frequency and nocturia also improved significantly (p < 0.01). Graft-versus-host disease (GVHD) developed in four patients, but without major complications. Despite the bladder volume at first desire to void increased significantly after surgery (p < 0.01), the remaining urodynamic parameters did not differ in a significant manner. In conclusion, the long-term cure rate of the TOT procedure with SIS is lower than with synthetic materials, but with relatively lower morbidity.

High urinary flow in women with stress incontinence: corrected flow-age nomogram evaluation after a transobturator tape procedure.

We noninvasively compared urinary flow in both pre- and post-transobturator tape (TOT) procedures in stress urinary incontinence (SUI) patients using previously reported corrected flow-age nomograms in healthy women. This retrospective cohort study included patients who underwent a successful TOT procedure to treat SUI. Non-instrumented uroflowmetry was performed before and 3months after surgery. Corrected maximum flow rate (cQmax) and average flow rate (cQave) were calculated using Qmax/√voided volume (VV) and Qave/√VV respectively. The ratio of corrected flow to age-adjusted corrected flow in healthy women was calculated in each patient. Each parameter was compared against pre-TOT and 3-months post-TOT values. Sixty-two patients were eligible for study inclusion. All urinary flow parameters were significantly higher pre-TOT than at 3months post-TOT. The number of patients with cQmax and cQave over mean flow-age nomogram, compared with healthy women, before the TOT procedure decreased 3months post-TOT; however, in many patients, cQmax and cQave were higher than in the corrected flow-age nomogram post-TOT. No significant difference in the ratio of cQmax to age-adjusted cQmax between pre- and post-TOT in the normal urinary flow group was observed, but significantly decreased in the high urinary flow group 3months after TOT. Urinary flow rates were higher in SUI patients compared with age-matched controls and successful TOT procedures normalized urinary flows in patients with high urinary flow. A simple evaluation of urinary flow using a corrected flow-age nomogram may be clinically useful in SUI patients.

Anatomy of the female pelvic viscera before and after transobturator tape procedures and anterior vaginal wall repair in patients with stress urinary incontinence

Anatomy of the female pelvic viscera was investigated before and after the Tension free Vaginal tape (TVT-O). Forty patients were included in the study. Surgery was performed between 2009 and 2012 in Clinic of Urology (Clinical Center Nis) and Department of Urology (Municipal Hospital Prokuplje). Stress Urinary Incontinence (SUI) and anterior vaginal wall prolapse was confirmed in all patients. In all patients with anterior vaginal wall prolapse (grade≥2) both tension free vaginal tape (TVT-O) and anterior vaginal wall repair were performed. Pelvic Organ Prolapse Quantification (POPQ) system was used for the evaluation of prolapse before and after the surgery. Mean age of patients was 61 years. Spinal anesthesia was performed in thirty patients and general anesthesia in 10 patients. Intraoperative blood loss was under 50 ml. There were no bladder, nerve and blood vessels injuries . Thirty eight out of forty patients (95%) were satisfied with the outcome of the surgery. There was a significant correction of prolapse after the surgery. Recurrence of prolapse was found in patients with the high grade prolapse before the surgery, as well as, in patients with the history of previous anterior vaginal repair. Pelvic organ prolapse, congenital or acquired, is supported by the congenital weakness of the pelvic floor.

Transvaginal tape or transobturator tape - what to opt for cure of female stress urinary incontinence

Background: Urinary incontinence is a very disturbing condition that affects quality of life. Stress urinary incontinence (SUI) is defined as the involuntary loss of urine associated with the sensation of urgency and is usually associated with exertion, sneezing or coughing. About 30-50% of women suffers from this condition and is conventionally treated with pelvic floor exercises, bladder drill, duloxetine and anticholinergic drugs with unsatisfactory results. Retro pubic and transobturator sub urethral slings such as TOT and TVT are the gold standard surgical treatment for women with USI. Methods: This is a prospective study conducted between May 2007 to March 2010 in RLJH hospital, Kolar in department of surgery under the guidance of urologist. Patients diagnosed with stress urinary incontinence were randomized by double blind technique, to the retropubic route (TVT) or the transobturator route (TOT) group. A total of 71 patients TVT = 36 and TOT = 35 patients were posted for respective operative procedures. The institutional ethical committee approved the study, and all women gave their written and informed consent after receiving full information about the study. Inclusion criteria were patients diagnosed with stress urinary incontinence and those who had recurrence after previous anti-incontinence surgery. Patients with mixed incontinence were excluded from our study. Results: The demographic data and pre and post-operative clinical parameters of all patients studied showed no significant differences between the two groups. Mean follow up was 30 months (24-48). Mean operative time was 36 (20-45) minutes in TVT and 20 (12-25) minutes in TOT. The post-operative urinary retention was seen in 13.8% (n = 5) in the TVT group and 2.8% (n = 1) in the TOT group. We had suprapubic haematoma 5.5% (n = 2) in the TVT group. Bladder perforation occurred in two cases of TVT. Two patients with previous failed incontinence surgery also did well in our study. Conclusions: Transobturator tape procedure has less complication, good postoperative outcome in terms of cure of stress urinary incontinence and improved quality of life and patient’s satisfaction. This technique is easy to learn and can be performed by general surgeons as day care surgery. This procedure has an advantage of easy performance in those patients who have a failed previous incontinence surgery.

Sexualité après cure d’incontinence urinaire par bandelette sous-urétrale transobturatrice et satisfaction des patientes

To evaluate the quality of sexual activity after a transobturator tape procedure for urinary incontinence and to examine the global satisfaction reported by patients. This is a bicentric retrospective study, postoperative questionnaires were sent to 247 women operated for urinary incontinence by TOT/TVT-O surgery, after 1 year, prolaps were excluded. Patients' overall improvement was assessed using the French version of Patient Global Impression and Improvement (PGI-I), urinary symptoms were assessed with the use of ICIQ-Fluts and quality of sexual function using Lemack and Zimmern questionnaire and ICIQ-Fluts-Sex. A logistic regression analysis was run to analyse the factors associated with women overall improvement. One hundred and sixty-five patients answered the questionnaire (66.8%). Average age was 55 (±11), and the average postoperative period was 39 months (±17.9). After surgery, according to the 135 women (81.8%) found an overall improvement, 22 (13.4%) found their condition unchanged and 8 (4.8%) women found it worse. Among the 165 women, 118 were sexually active, 37 (31.4%) reported improvement in intercourse satisfaction whereas 11 (9.3%) complained about sexual function deterioration and 70 (59.3%) felt unchanged. The 37 women who reported sexual improvement described decreased coital incontinence in 54% of the cases. Eleven women who felt sexually worse, reported dyspareunia. Results of the logistic regression analysis suggested that overall improvement after surgery depended not only on the incontinence score (OR 0.83) but also on the quality of the postoperative sexual activity (OR 12.96). One third of the women reported improvement of their sexuality after transobturator tape procedure. In fact, global satisfaction after surgery was as related to the improvement of urinary symptoms as it was to the quality of the sexual activity. 5.

Complications Following Outside-In and Inside-Out Transobturator-Tape Procedures With Concomitant Gynecologic Operations

retention (2.9%), 2 cases of vulva hematoma (1.0%), 7 cases of urinary tract infection (3.4%), 4 cases of de novo urgency (2.9%), and 4 cases of vaginal erosion (2.9%). There were no significant differences in complication rates between the two groups. Our results suggest that inside-out and outside-in procedures are simple and safe techniques that may have a low rate of complications when used with a concomitant gynecologic operation.

Comparison Between the Transobturator Tape Procedure and Anterior Colporrhaphy With the Kelly's Plication in the Treatment of Stress Urinary Incontinence: a Randomized Clinical Trial.

BackgroundStress urinary incontinence in women is a common problem that impairs the quality of life in patients. The extraordinary number of procedures to treat stress urinary incontinence reflects a lack of consensus on an appropriate intervention for this problem.ObjectivesThe current study aimed to compare the results of transobturator tape (TOT) procedure and anterior colporrhaphy with the Kelly’s Plication to treat women with stress urinary incontinence.Patients and MethodsThis randomized clinical trial was conducted on 60 patients with stress urinary incontinence referred to Afzalipour Hospital in Kerman, Iran. The patients were randomly divided into two surgery groups and were subsequently assessed regarding the outcomes of the procedures, incontinence symptoms and complications during the follow-up period.ResultsThe cure rates at follow-up period of one month, six months and one year after surgery were 86.7%, 80% and 80% in the TOT group versus 80%, 70% and 66.7% in the anterior colporrhaphy with the Kelly’s Plication group, respectively. There were no significant differences between the two groups in the aforementioned follow-up periods (P = 0.68, P = 0.54 and P = 0.22, respectively).ConclusionsThe current results showed no significant differences between the outcomes of the two procedures at short-term follow-up. However, the results might have changed in the long term.

Influence of Demographic and Clinical Factors on Surgical Outcomes of the Transobturator Tape Procedure in Patients with Stress Urinary Incontinence

Background: Stress urinary incontinence (SUI) is a prevalent problem within the female population with associated high psycho-social impact. Transobturator tape procedure is a well-established procedure to treat the same, but the results may be influenced by various preoperative demographic and clinical factors. Patients and Methods: The study group comprised of 50 female patients with genuine SUI, who were then divided into subgroups based on demographic and clinical factors. Outcomes were compared between these subgroups at 6 and 12 months using self-reported questionnaires and provocative stress test. Results: Our results show positive correlation with statistically significant better surgical outcomes in premenopausal patients, patients aged <50 years and those having urethral mobility > 30 degrees. Statistically significant poor outcomes were seen in those having undergone hysterectomy or Caesarean section. No correlation was found with history of smoking or the patient's body mass index. Conclusions: In conclusion, the transobturator tape procedure appears to be more effective in premenopausal women, women aged < 50 years, women without history of hysterectomy/lower section Caesarean section, and presence of urethral hypermobility > 30 degrees. On the other hand, outcomes do not appear to be influenced by the patient's body mass index or smoking status.

Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome.

We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m(2)) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m(2), respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.

Effectiveness of Transobturator Tape Procedure in Obese and Severely Obese Women: 3-Year Follow-up

To assess the efficacy and safety of transobturator tape (TOT) for the treatment of stress urinary incontinence in severely obese and obese women. We retrospectively reviewed the women who underwent a TOT procedure at 2 institutions between March 2005 and March 2013. The patients were divided into 3 groups according to the World Health Organization body mass index (BMI) values: normal weight group (BMI<25kg/m(2); group 1), obese group (BMI= 30-34kg/m(2); group 2), and severely obese group (BMI≥35kg/m(2); group 3). Overweight women (BMI= 25-29kg/m(2)) were omitted. Patients filled in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) preoperatively and at the postoperative follow-up visits. The severity of urinary incontinence was classified by ICIQ-SF: slight (1-5), moderate (6-12), severe (13-18), and very severe (19-21). Patient satisfaction was assessed using a visual analog scale. Subjective improvement was defined as an ICIQ-SF score≤12 and satisfaction with surgery (visual analog scale score≥80). A total 470 women met the requirements for inclusion. There were 153 women in group 1, 72women in group 2, and 32 women in group 3. Mean follow-up period was at least 12months in all the groups. The difference between the groups according to mean operative time was significant (P<.001). The objective cure, subjective success (cured and improved), patient satisfaction rates, and complications were similar between the groups. Obesity and severe obesity do not seem to be risk factors for the failure of TOT procedure. However,postoperative urgency urinary incontinence rate was higher in severely obese women,andmore women showed improvement instead of cure among severely obese women.

Editorial Comment

The authors 1 Yonguc T. Degirmenci T. Bozkurt I.H. et al. Effectiveness of transobturator tape procedure in obese and severely obese women: 3-year follow-up. Urology. 2015; 86: 244-249 Scopus (5) Google Scholar present their experience on the use of the transobturator tape technique (TOT) in obese women. The populations of women examined were divided into normal weight (body mass index [BMI] <25 kg/m2), obese (BMI = 30-34 kg/m2), and severely obese (BMI ≥35 kg/m2). Patients who were merely overweight (BMI = 25-29 kg/m2) were omitted. The examined population was relatively youthful, with no patient being older than 65 years. Cure was defined by stout criteria including no use of pads, a negative cough stress test, and no further surgical procedures for the incontinence. The authors used the International Consultation on Incontinence-Short Form. Findings included no statistical difference in subjective success (cure and improvement) among the groups. There was a statistical difference in cure rates and improved rates, with the severely obese women experiencing a lower cure rate and a higher improved rate than the other groups. The surgery took a statistically longer time in the severely obese patients. Surgical complication rates were about the same in all the groups. Effectiveness of Transobturator Tape Procedure in Obese and Severely Obese Women: 3-Year Follow-upUrologyVol. 86Issue 2PreviewTo assess the efficacy and safety of transobturator tape (TOT) for the treatment of stress urinary incontinence in severely obese and obese women. Full-Text PDF ReplyUrologyVol. 86Issue 2PreviewWe are pleased to be given the opportunity to state our opinions about the editorial comment.1 According to the World Health Organization report updated in January 2015, the worldwide prevalence of obesity more than doubled between 1980 and 2014. In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these, over 600 million were obese. Observational studies suggest that obesity is a strong risk factor for urinary incontinence.2 The prevalence of stress urinary incontinence (SUI) is increased with higher body mass index. Full-Text PDF

Outcomes of Transobturator Tape Surgery with Safyre T® Slings for Female Stress Urinary Incontinence after 96 Months of Follow-Up

Background/Aims: To report the outcomes of transobturator tape (TOT) surgery with Safyre T® (Promedon, Argentina) slings for female stress urinary incontinence (SUI) at a 96- month follow-up. Methods: We conducted a clinical follow-up study of 153 patients diagnosed with SUI between January 2005 and December 2014. Patients were provided with detailed a priori information pertaining to the TOT procedure and were invited to attend follow-up visits at 1, 3, 12, 24, 48, 72 and 96 months. Follow-up visits included physical examination involving sling palpation, checking of the vaginal mucosa for erosion, cough test, as well as validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. Results: The overall objective success rates, based on cough test results, were 91.3% at 12 months, 86.8% at 48 months and 77.6% at 96 months. Similarly, the overall subjective success rate, based on the validated UDI-6 and IIQ-7 scales, was 77.6% at 96 months. Conclusion: The cure rates achieved, following TOT treatment of SUI at 1-year follow-up, showed a statistically significant decline over an 8-year period, especially at months 48 and 96.

Surgical anatomy of the pudendal nerve and its branches in South Africans.

Dissection of the pudendal nerve (PN) and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in South Africans. The course of the PN from the gluteal region into the perineum was dissected in an adult sample of both sexes and of African and European ancestry. Distances between PN and branches to applicable landmarks were measured. Basic descriptive statistics and comparisons were carried out between groups. In 5/13 African females, the inferior rectal nerve (IRN) entered the gluteal region separately and in 12/13 cases it passed medial to the ischial spine with the PN. The dorsal nerve of the clitoris or penis (DNC/DNP) was closer to the bony frame in those of European ancestry. The IRN branches were more superficial in females, but deeper in males of European ancestry. In African females, a PN block and Richter stitch should be placed more medial. Outside-in transobturator tape procedures might endanger the DNC/DNP in obese individuals. In females of European ancestry the IRN branches are compromised during ischioanal abscess drainage. In males of European ancestry, the dorsal penile nerve block might be less effective. Predictions should be verified clinically.

TOT versus TVT – mesh surgical treatment in stress urinary incontinence

Introduction: Stress urinary incontinence is a highly debilitating condition, with an important impact over the quality of life. When the conservative treatment fails, the surgical treatment is a viable solution. Minimally invasive sling procedures have become the gold standard of surgical management for stress urinary incontinence (SUI) in women. Material and methods: The study was conducted on 68 patients with stress urinary incontinence, 52 have undergone the retropubic tension-free vaginal tape and 16 patients were operated using the transobturator tape procedure. All the patients were evaluated before the operation and the indication of the surgical treatment was established on the basis of physical examination (all the patients had positive cough test), abdominal ultrasound (to determine postvoid residual urine volume), urinalysis and urine culture (the majority of the patients have had before the operation recurrent urinary tract infections). Results: The satisfaction was similar in both groups of patients, with an average satisfaction rate of 91% for TVT and 86% for the patients who have undergone TOT procedure. The patients were in a proportion of 78,9% at menopause, with an average number of natural births of 1.9 and a mean BMI of 28.2. Regarding the surgical duration, this has varied between 20 and 40 minutes, being higher in the TVT cases (up to 5-7 minutes longer than TOT), because cystoscopy was performed during the operation to verify if the bladder was perforated or not. The urethral catheter was removed immediately after the operation in the case of the TOT procedure and in the day after the operation for the patients who have undergone TVT procedures (all of these patients associated genital prolapse). The hospitalization time was 3 days. We haven’t encountered significant intraoperative and postoperative complications. Conclusions: The TOT and TVT procedures have proven to be highly effective and safe methods in the treatment of SUI. There are no significant differences regarding the efficacy of these two surgical methods, but the risk of intraoperative complications is a little higher for the TVT procedure. The mid urethral sling procedures improve significantly the quality of life for patients with stress urinary incontinence.

7 Effectiveness of transobturator tape procedure in obese and severe obese women: 3-year follow-up

Objective To assess the efficacy and safety of transobturator tape (TOT) for the treatment of stress urinary incontinence in severely obese and obese women. Methods We retrospectively reviewed the women who underwent a TOT procedure at 2 institutions between March 2005 and March 2013. The patients were divided into 3 groups according to the World Health Organization body mass index (BMI) values: normal weight group (BMI <25 kg/m2; group 1), obese group (BMI = 30-34 kg/m2; group 2), and severely obese group (BMI ≥35 kg/m2; group 3). Overweight women (BMI = 25-29 kg/m2) were omitted. Patients filled in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) preoperatively and at the postoperative follow-up visits. The severity of urinary incontinence was classified by ICIQ-SF: slight (1-5), moderate (6-12), severe (13-18), and very severe (19-21). Patient satisfaction was assessed using a visual analog scale. Subjective improvement was defined as an ICIQ-SF score ≤12 and satisfaction with surgery (visual analog scale score ≥80). Results A total 470 women met the requirements for inclusion. There were 153 women in group 1, 72 women in group 2, and 32 women in group 3. Mean follow-up period was at least 12 months in all the groups. The difference between the groups according to mean operative time was significant (P <.001). The objective cure, subjective success (cured and improved), patient satisfaction rates, and complications were similar between the groups. Conclusion Obesity and severe obesity do not seem to be risk factors for the failure of TOT procedure. However, postoperative urgency urinary incontinence rate was higher in severely obese women, and more women showed improvement instead of cure among severely obese women.