Underwent Transobturator Tape Research Articles

The effect of the distance between mesh and the urethra on sexual function in patients who underwent transobturator tape

To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound.

Comparison of success, complication and satisfaction rates of TOT and TVT-O surgical techniques.

Two different surgical techniques "inside-out" and "outside-in" have been described for transobturator tape procedure, one of the most preferred methods for the surgical treatment of stress urinary incontinence in the last ten years. This study aimed to compare the success, complication, and patient satisfaction rates related to both techniques in patients who underwent transobturator tape procedure due to stress urinary incontinence in a 21-month period. A total of 71 patients including 46 patients who underwent transobturator tape operation with "outside-in" technique and 25 patients who underwent tension-free vaginal tape obturator operation with "inside-out" technique were involved in this study. Patients were evaluated in aspect of postoperative complications, pelvic examination results, stress test results, satisfaction, and quality of life scales. Patients operated with both techniques were similar in terms of age, body mass index 15, and menopausal status. Considering the complication rates, dyspareunia was found to be higher in the group using the inside-out technique (p = 0.002). Operation success rates were similar in the two surgical techniques both in subjective and objective evaluation. In addition, although there were differences between the two groups in terms of patient satisfaction rate and quality of life score, overall satisfaction rates were found to be high. Transobturator tape operation is a procedure that provides high success rates in the treatment of stress urinary incontinence regardless of the used technique. Operation success rates, patient satisfaction rates, and postoperative quality of life scores were found to be almost similar in both surgical techniques.

Evaluation of Lower Urinary Symptoms Following Vaginal Reconstructive Surgery for Prolapse and Urinary Incontinence

Background: Urinary incontinence (UI) may be associated with symptoms of overactive bladder (OAB) that may persist after anti-incontinence surgery. Objectives: The present study was performed to evaluate the effect of prolapse and anti-incontinence reconstructive surgery in women who had the symptoms of OAB and UI at the same time. Methods: This descriptive cross-sectional study was performed on 56 women with OAB symptoms and stress UI (SUI)/urgency UI (UUI) with or without prolapse who were candidates for restorative and anti-incontinence surgery. At baseline, urinary symptoms, including urinary frequency, nocturia, SUI, and UUI, were recorded. Patients who finally underwent vaginal reconstructive surgery with anti-incontinence surgery were assessed for urinary symptoms six months after the operation. Results: A total of 28 patients underwent transobturator tape (TOT) surgery, of whom 23 patients were subjected to other anti-incontinence surgeries and 5 patients underwent restorative surgeries. There was no significant difference between the two groups (TOT and others) in terms of age, body mass index, number of deliveries, history of medical problems, and history of surgery or cesarean section. The urinary frequency and nocturia before surgery were observed in 46 (82%) and 20 (36%) patients, respectively, which were not significantly different between the two groups. Before the study, occult UI was observed in 2 patients (4%), UUI in 3 patients (5%), SUI in 18 patients (32%), and mixed UI in 33 patients (59%). Nocturia was completely improved in all 20 patients. Urinary frequency was partially or completely improved in 41 patients (89%), which was not significantly different between the two groups (P=0.051). Overall, 53 patients (95%) had partial or complete improvement in UI, which was not significantly different between the two groups (P=0.058). Both patients with occult UI and all three patients with UUI were completely improved. Sixteen out of 18 patients (89%) with SUI were completely improved and the other 2 patients were partially improved. Thirty patients (91%) with mixed UI had a complete or partial recovery that was not significantly different between the two groups (P=0.137). Conclusion: The findings of the present study showed that six months after anti-incontinence or reconstructive surgery, nocturia in all patients and urinary frequency in 89% of patients improved partially or completely. Various forms of UI partially or completely improved in 95% of patients, as well.

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.

Bladder Injury: A complication of Transobturator Tape Surgery

Minimally invasive vaginal surgeries are often a preferred mode of surgical treatment of stress urinary incontinence. It is associated with fewer complications. However, complications including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries are observed. We encountered intraoperative bladder injury in a 40-year-old female patient with stress urinary incontinence who underwent transobturator tape (TOT) surgery. Cystoscopy demonstrated a small defect post procedure. She was managed conservatively with foley catheterization for 2 weeks following TOT procedure. She was dry and continent upon follow up.

Does the sexual function of the spouses change after the TOT procedure?

This prospective study aimed to evaluate sexual function in women who underwent transobturator tape (TOT) sling surgery and their male sexual partners compared to before the procedure. The study included a total of 202 women with stress urinary incontinence who underwent the TOT procedure between April 2018 and February 2020, and their partners. All of the women completed the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and Female Sexual Function Index (FSFI) questionnaire while their partners completed the International Index of Erectile Function (IIEF-5) questionnaire before and 6months after the procedure. Mean IIQ-7 and UDI-6 scores were significantly lower at postoperative month 6 compared to preoperative values (p < 0.001). Mean FSFI scores were 22.5 ± 1.7 preoperatively and 27.8 ± 1.6 at postoperative month 6 (p < 0.001). Pain score did not change significantly (p = 0.4), but there were significant increases in the other FSFI domains of desire, arousal, lubrication, and satisfaction (p < 0.001, p < 0.001, p < 0.001, p < 0.001). The partners' mean IIEF score was 50.05 ± 5.4 preoperatively and increased to 59.7 ± 6.8 postoperatively (p < 0.001). No significant differences were detected in erectile or orgasmic function (p = 0.16, p = 0.67), whereas desire, intercourse satisfaction, and overall satisfaction scores increased significantly (p < 0.001, p < 0.001, p < 0.001). TOT surgery improves sexual function not only in women but also their partners.

The Effects of Transobturator Tape Surgery on Sexual Functions inWomen With Stress Urinary Incontinence.

IntroductionStress urinary incontinence (SUI) can adversely affect the patient's sexual function.AimTo evaluate the sexual functions in women who underwent transobturator tape (TOT) surgery because of stress urinary incontinence and factors affecting the treatment results.MethodsThe study was conducted in 2 tertiary level clinics between 2013 and 2019 and included sexually active patients with a diagnosis of SUI who underwent TOT operation. The preoperative and postoperative (6 months after surgery) Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the patients were evaluated. The patients were evaluated according to the score changes of an increased score (benefited) and the same or lower score (did not benefit). The PISQ-12 questionnaire has 3 subdomains of behavioral-emotive (Q: 1–4), physical (Q: 5–9), and partner-related (Q: 10–12). Each question is scored from 0 to 4, giving a total ranging from 0 to 48. A higher PISQ-12 score indicates better sexual function.Main Outcome MeasurePISQ-12.ResultsThe study included 117 patients with a median age of 52 years (range, 32–67 years), and 51.3% of the patients were postmenopausal. When the preoperative and postoperative PISQ-12 scores were evaluated in the whole group, there was a statistically significant improvement (from 24.66 to 26.52, P = .001). In the analysis of domains, there was a statistically significant improvement in physical score (from 11.68 to 13.53, P < .001), whereas behavioral-emotive and partner-related scores did not significantly change. In the multivariate analysis of menopausal status, parity and presence of diabetes mellitus were all independently and significantly associated with poor PISQ-12 outcome (OR: 2.60, 95% CI: 1.41–4.81, P = .002; OR: 1.59, 95% CI: 1.03–2.47, P = .034; and OR: 2.42, 95% CI: 1.28–4.58, P = .007, respectively).ConclusionBoth physical and psychological statuses should be taken into consideration when planning treatment in patients with urinary incontinence, and it should be noted that postsurgical sexual function status may not be positively affected in postmenopausal, multiparous, and diabetic patients.Kizilkan Y, Tohma YA, Senel S, et al. The Effects of Transobturator Tape Surgery on Sexual Functions in Women With Stress Urinary Incontinence. Sex Med 2020;8:777–782.

Interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women.

Surgery is a common treatment modality for stress urinary incontinence (SUI), usually offered to women for whom conservative treatments have failed. Midurethral tapes have superseded colposuspension because cure rates are comparable and recovery time is reduced. However, some women will not be cured after midurethral tape surgery. Currently, there is no consensus on how to manage the condition in these women.This is an update of a Cochrane Review first published in 2013. To assess the effects of interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women; and to summarise the principal findings of economic evaluations of these interventions. We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 9 November 2018). We also searched the reference lists of relevant articles. We included randomised and quasi-randomised controlled trials in women who had recurrent stress urinary incontinence after previous minimally invasive midurethral tape surgery. We included conservative, pharmacological and surgical treatments. Two review authors checked the abstracts of identified studies to confirm their eligibility. We obtained full-text reports of relevant studies and contacted study authors directly for additional information where necessary. We extracted outcome data onto a standard proforma and processed them according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. We included one study in this review. This study was later reported in an originally unplanned secondary analysis of 46 women who underwent transobturator tape for recurrent SUI after one or more previous failed operations. We were unable to use the data, as they were not presented according to the nature of the first operation.We excluded 12 studies, five because they were not randomised controlled trials (RCTs) and four because previous incontinence surgery was not performed using midurethral tape. We considered a further three to be ineligible because neither the trial report nor personal communication with the trialists could confirm whether any of the participants had previously undergone surgery with tape.We had also planned to develop a brief economic commentary summarising the principal findings of relevant economic evaluations but supplementary systematic searches did not identify any such studies. There were insufficient data to assess the effects of any of the different management strategies for recurrent or persistent stress incontinence after failed midurethral tape surgery. No published papers have reported exclusively on women whose first operation was a midurethral tape. Evidence from further RCTs and economic evaluations is required to address uncertainties about the effects and costs of these treatments.

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.

Evaluation of Quality Of Life in Patients who Underwent Transobturator Tape (TOT) surgery for Stress Incontinence

Evaluation of Quality Of Life in Patients who Underwent Transobturator Tape (TOT) surgery for Stress Incontinence

The outcomes of transobturator tape intervention in the treatment of stress urinary incontinence: Two years' follow-up.

Objective:To evaluate the clinical outcomes and the effects on quality of life of transobturator tape surgery during a 2-year follow-up period in our clinics.Methods:Eighty-seven patients with stress or mixed urinary incontinence who underwent transobturator tape surgery were included in the study conducted in Istanbul. Taksim. Training. and Research Hospital Gynecology and Obstetrics Clinic, between 2011 and 2013. The patients’ demographic features, incontinence questionnaires, quality of life scores [Incontinence Impact Questionnaire (IIQ-7) and urinary distress inventories (UDI-6)], examination findings, urodynamic results, stress tests, Q tip tests, number of daily pads, ultrasonography, surgery, and cystoscopy results were recorded. Patients were evaluated 23-27 months (mean: 25.40±1.31 months) after their discharge in terms of symptoms, quality of life scores, urodynamic findings, complications, and stress test.Results:Sixty-three (72.4%) patients had stress incontinence and 24 (27.6%) patients had mixed urinary incontinence. No perioperative complications were observed in our study. After a follow-up period of two years, a significant improvement was detected in the IIQ-7 and UDI-6 questionnaires when compared with the preoperative period. Moreover, the objective cure rate was found as 88.5% (n=77). De novo urge incontinence was obtained in 5.7% (n=5) of patients and was treated with anticholinergics. Perineal pain was present in 3 (3.44%) patients and was treated with analgesics and cold packs. In 2 (2.29%) patients, vaginal mesh erosion was detected and full recovery was achieved with an excision. Urinary retention and bladder perforation was not seen in any patients.Conclusion:Our study revealed a high objective cure rate, and an improvement in symptoms and quality of life with the transobturator tape operation.

Is There a Difference in the Outcome of Mid-Urethral Sling Operations Performed by Urogynecologists Compared with Supervised Residents?

Study ObjectiveTo compare the operative results of midurethral sling (MUS) surgeries for stress urinary incontinence (SUI) performed by residents under the guidance of an attending specialist in urogynecology and those performed by attendings. DesignRetrospective chart review (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsA retrospective analysis of all MUS surgeries performed at a single public tertiary medical center between January 2009 and December 2013 was carried out. A total of 257 patients underwent transobturator tape (TOT) placement during the study period, including 136 (52.9%) placed by an attending specialist in urogynecology (group A) and 121 (47.1%) placed by a resident, under the guidance of an attending (group B). MeasurementsThe efficacy of treatment was evaluated in terms of early postoperative course, reoperation, and symptom improvement, as based on the Pelvic Floor Distress Inventory short form (PFDI-20) questionnaire. The primary outcome was patient-reported symptoms of SUI, as assessed with the PFDI-20 questionnaire, as well as absence of surgical retreatment for SUI. ResultsImmediate postoperative complications were comparable in the 2 groups, as were subjective failure and self-reported SUI. The primary outcome—moderate and severe symptoms of SUI—were reported by 23.7% of the patients in group A and 23.6% of those in group B (p = .91). At a mean follow-up of 40 months in both groups, symptoms, as assessed using the urinary scale and prolapse scale of the PFDI-20, were also similar in the 2 groups. The rate of reoperation with repeated sling for SUI was 5% in both groups. ConclusionThe operative results of TOT surgery for SUI performed by residents under the guidance of an attending specialist in urogynecology did not differ significantly from those performed by the attendings themselves.

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.

Trans-Obturator Tape Operation Using MONARC Technique (Outside-In Technique) --- Revisited Objective And Subjective Assessment

Objective: This study was undertaken to describe and evaluate the outcome of trans-obturator tape (TOT) operation using Outside-In technique without cystoscopy. This procedure was carried out either solely or as a part of pelvic reconstructive surgery. Design: Retrospective cohort study with follow up objective and subjective assessment. Population: 84 women were presented with urodynamic stress incontinence at North Cumbria NHS Trust. They were treated with transoturator tape operation using outside-in technique between the years 2007 and 2008. Method: Eighty-four women underwent trans-obturator tape operation (outside-in technique) without cystoscopy. Diagnosis of stress urinary incontinence (SUI) was made by uro-dynamic studies. They were all operated only by a single surgeon. The mean length of follow-up was 6 months. Operative complications were recorded. The anatomic integrity of urethra, the anterior vaginal wall was objectively assessed at follow up visit. Subjective assessment was made during patient consultation. Objective failure was defined as persistence of urodynamic stress urinary incontinence. Subjectively, failure was defined mainly as persistence of stress incontinence symptoms. Other related symptoms are noted like voiding difficulties and sexual dysfunction. Results: In the study data eighty four women underwent a TOT operation. The mean age was 50 years (38-63). Pre-operatively, of those 84 patients, SUI was diagnosed in 62 patients while mixed urinary symptoms were present in 22 patients. Transobturator tape operation was carried out using MONARC subfacial hammock system in all women. Additional pelvic surgical procedures were performed according to the presence of other pelvic defects. No intraoperative complications were recorded. The estimated blood loss was 125 mL (range, 50-200 mL). None of the patient had suspected bladder or urethral injury intraoperatively. Transient urinary retention was observed in 8% (n= 7) of women in immediate postoperative period. Three women developed urinary tract infection in immediate postoperative period and in one woman urethral pus was noted which resolved with the help of oral antibiotics. Postoperative objective assessment was made with speculum examination and stress provocation tests like cough and valsalva manoeuvres. There was no stress incontinence on stress provocation tests. Two women developed de novo urge incontinence that was treated with anticholinergics. Two complained of worsening urge incontinence symptoms and none of the women having concurrent urge incontinence symptoms showed any improvement in their urge incontinence symptoms. The overall subjective success rate was 92% (n= 77). Six women judged themselves to be improved in terms of stress incontinence but were still wearing protection, although less, to avoid any urinary leakage. One woman gave history of prickling sensation in the vagina after the procedure at her follow-up visits, from 6 weeks to 9 months although she was reassured and that prickling sensation resolved at 9 month follow-up. Conclusion: Transobturator tape operation (outside-in technique) without cystoscopy seems an effective and safe treatment of urodynamic stress incontinence. It has a good subjective and objective outcome. A large study may be required to confirm the results.

Comparing the Effectiveness between Mid Urethral Retro Pubic Tvt and Transobturator Tot or Tvt-O in Mixed Pattern Urinary Incontinence with Stress Incontinence Predominating

In the TVT (Retro pubic) group 60.52% (23/38) patients were fully continent while 8/38 (21.05%) had partial improvement even with anti cholinergics. Out of these 23 patients 10 (43.47%) needed anti cholinergics while 5/23 (21.73%) needed Botulinum toxin in addition. While in the Transobturator group 24/28 (85.71%) patients were completely continent without complications and only 7/24 (29.16%) needed anti cholinergics and 1 (4.1%) needed Botulinum toxin. One out of 28(3.57%) had partial improvement. 3.57% (1/28) had late failure after initial complete response for 3years. Two out of 3 patients which showed bladder over activity on urodynamics study and underwent Transobturator tape had complete response without any additional treatment. Six out of 38 (15.78%) patients in TVT group presented post op with dysfunctional voiding compared to none in TOT/TVT-O group. Out of these, 2 needed tape division and 1 needed chronic SIC and 1 pt needed early SIC only. In TVT arm 3/38 (7.89%) had AUR all had chronic diff voiding 2 on SIC and 1 Partial response while none in TOT group. In TOT/TVT-O group 3.57% (1/28) Perennial pain needing tape division and 3.57% (1/28) short-term leg pain was seen but not in TVT group [1-3].

Results of trans obturator tape procedure in cerrahpasa faculty of medicine

Objectives: The aim of the study is to analyze the short and long term results of our experience of 162 cases who underwent trans obturator tape (TOT) procedure.

Predictors of postoperative antimuscarinics in women with mixed urinary incontinence after transobturator surgery

The study sought to identify the risk factors of postoperative use of antimuscarinics after transobturator surgery in women with mixed urinary incontinence (MUI) displaying both urodynamic stress urinary incontinence (SUI) and involuntary detrusor contraction (IDC) with leakage in urodynamic study. The clinical data of 103 patients with MUI who underwent transobturator tape (TOT) sling surgery were retrospectively reviewed. The patients were followed at least a year. To determine risk factors for postoperative use of antimuscarinics, variables of only those with P values < 0.05 on univariate analysis were included in the multivariate logistic regression analysis with forward stepwise building. Eight-four (81.6 %) of 103 patients were included in this study. The cure rate of urge urinary incontinence (UUI) was 69.0 % (58/84). Antimuscarinics were prescribed postoperatively in 22 (26.2 %) of 84 patients. Variables affecting postoperative use of antimuscarinics were age, parity, episode of any UUI, preoperative use of antimuscarinics, predominant urgency incontinence type, detrusor pressure at maximum flow, and Urogenital Distress Inventory 6. Increasing age and preoperative use of antimuscarinics increased the odds of postoperative use of antimuscarinics following TOT surgery. Patients who were older and had taken antimuscarinics preoperatively were significantly associated with postoperative use of antimuscarinics.

Correlation of three validated questionnaires for assessment of outcomes following surgical treatment of stress urinary incontinence in women

ObjectivesTo assess the correlation between women's responses to the “Patient Global Impression of Improvement” questionnaire (PGI-I) and changes in women's quality of life and sexual function following surgical treatment of stress urinary incontinence (SUI). Study designAncillary analysis of data from a prospective randomised surgical trial: 299 women underwent transobturator tape insertion as a sole procedure and completed the King's Health Questionnaire (KHQ) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at baseline and at 12-month follow-up in addition to PGI-I at 12 months. Spearman's correlation coefficient was used to evaluate the degree of association between PGI-I responses and the changes in total KHQ and PISQ-12 scores. Kruskal–Wallis tests were performed to compare the 7-point scale PGI-I responses in terms of changes in KHQ and PISQ-12 scores. ResultsThere was a significant positive correlation between PGI-I responses and changes in the total KHQ scores (r=0.48, p<0.001). The changes in the total KHQ score became larger (i.e., more positive) as the PGI-I responses became more positive. There were statistically significant differences across the PGI-I groups with respect to the changes in total KHQ scores (p<0.001). “Very much improved/Much improved” responses on PGI-I were associated with median (IQR) improvement in KHQ scores of 46 (32, 60) and 35 (18, 49) points respectively. An 18-point improvement in total KHQ score was required to clearly indicate a “better” response on PGI-I. There was a statistically significant, but weak, positive correlation between PGI-I responses and the changes in the total PISQ-12 score (r=0.17, p=0.019). ConclusionThe Patient Global Impression of Improvement Questionnaire strongly correlates with changes in Kings Health Questionnaire scores following surgery for SUI and can reliably predict improvement and deterioration in women's quality of life. CondensationThe Patient Global Impression of Improvement Questionnaire strongly correlates with, and can predict changes in, Kings Health Questionnaire scores following surgery for stress urinary incontinence.

Predictors of Success With Postoperative Voiding Trials After a Mid Urethral Sling Procedure

We identified predictors of passing a voiding trial after incontinence surgery with a mid urethral sling and examined if successful performance on a voiding trial was maintained. A total of 89 women scheduled for incontinence surgery were enrolled from July 2005 until April 2006. Voiding trials were performed the day of discharge from the hospital, with a two-thirds volume void after a 300 ml fill considered passing. Those who passed underwent a second voiding trial 3 hours later. Of the participants 60 (67.4%) underwent tension-free vaginal tape surgery, 29 underwent transobturator tape (32.6%) and 64 (71.9%) underwent concurrent vaginal repairs. A total of 59 (67.0%) participants passed the first voiding trial. Univariate analysis identified 12 potential predicting variables for passing the first voiding trial. From these 12, model building via backward stepwise logistic regression found maximum flow on preoperative uroflowmetry to be the only significant predictive variable (p = 0.0002). Of the 59 women who passed the initial voiding trial 9 (16.4%) failed the second voiding trial. None of the 11 participants who had maximal flow rates greater than 30 cc per second failed the first or second voiding trial, whereas 17 of 22 subjects (77.3%) who had maximal flow rates less than 15 cc per second failed either of these trials. Maximum flow rates on preoperative uroflowmetry were the best predictor of passing an initial voiding trial after undergoing a mid urethral sling procedure for incontinence. However, the ability to maintain performance on a second voiding trial, even only 3 hours after passing an initial trial, is not assured.