Treatment of Stress Urinary Incontinence Via Transobturator Route

 

Introduction and Objectives

The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress urinary incontinence (SUI).

204 patients with mean age of 58.8 years (range 31-72) who have completed a minimal follow-up of 12 months were enrolled in this study. 157 patients (77%) had history of stress incontinence and 47 patients (23%) had history of mixed incontinence. 153 patients had concomitant gynecological pathology (pelvic organ prolapse).

Methods

All patients were prospectively evaluated with history including pads use/day, physical examination including pelvic examination, urinalysis, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and the International Symptom Score Quality of Life Question (IPSSQoL) to determine the overall impact of urinary incontinence on their lives, and urodynamic studies. Urodynamic studies included filling cystometry, pressure- flow studies, and VLPP. The history of SUI and/or the demonstration of SUI during urodynamic studies constituted the indication for the sling procedure. 103 patients underwent TOT with Emmet needle and 101 patients underwent TVT-O with TVT-Obturator System (Ethicon Inc., Somerville, NJ). Postoperatively all patients were evaluated with history including PPD, physical examination, IIQ, UDI, and GSS. The patient continence status was recorded based on the history reported by the patient. All patients were carefully examined postoperatively for any evidence of vaginal tape extrusion, erosion, or infection. The functional results and patient satisfaction were assessed using the quality of life questionnaire.

Results

Detrusor overactivity during urodynamic studies was in 47 cases (23%). The mean VLPP was 54.94 ± 9.21cm H2O, the mean detrusor pressure at maximum flow rate (Pdet at Qmax) was 22.7 ± 15.6cm H2O, and the mean maximum flow rate (Qmax) was 18.3 ± 9.1 ml/sec. The mean number of PPD used was 3.5 ± 2.4 (range 0-10). The mean score on the IIQ was 17.3 ± 7.7 (range 0 -28), UDI 11.1 ±3.2 (range 0-18), and GSS 1.5 ±1. 7 (range 0-10). All patients were “unhappy” preoperatively in response to the IPSSQoL. 51 had the Transobturator tape alone, 153 patients had TOT+ prolapse surgery: 144 patients had cystocele repair, 37 patients had hysterectomy, 11 patients had enterocele repair, 69 patients had rectocele repair, and 15 patients had vaginal vault suspension, and 4 patients had genital hernioplasty. The mean hospital stay was 8.7 ± 5 day for patients with surgery for prolapse and 2.5 ± 1 day in patients with TOT alone. The mean duration of catheterization was 4.4 ± 1.3. At a mean follow-up of 26.9 ±14.7 months, 35 (17%) reported persistence of preoperative urge incontinence, and 1 (0.5%) has de novo urge incontinence. No cases of recurrent stress incontinence occurred. The mean PPD use is 0.15 ± 0.56 (range 0-3) and 177 patients (86.9%) do not use pads. The mean score on the IIQ is 1.47 ± 5.14 (range 0-23), UDI 3.28 ±3.09 (range 0-14), and GSS 8.29 ±1.64 (range 0-10). Data from patients who did have history of SUI preoperatively were used in the calculation of the rate of success or failure of the procedure. Thus, the overall improvement rate for SUI is 89%; mixed incontinence 74%, PPD 94%, IIQ 91%, UDI 71%, and IPSSQoL is 83%. Different complications were observed in 9 patients (4.4%). Six patients (2.9%) developed obstructive voiding witch didn’t require tape release. Three cases of perineal cellulites were diagnosed on the 6 postoperative day was managed with antibiotics. No patient experienced urethral, bladder, neural, vascular, or bowel injuries and none required blood transfusion.

Conclusion

The TOT is an effective and safe technique for the treatment of female stress urinary incontinence alone or in combination with prolapse repair.

Keywords

Stress urinary incontinence, transobturator tape

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