The Monarch Transobturator Tape in our Centre: Initial Results Promising, but Beware Worsening of Bladder Overactivity

Introduction and Objectives: Transobturator tapes (TOTs) are a well established procedure performed in female stress incontinence. The relatively low rate of complications and reduced hospital stay make it an attractive alternative to traditional incontinence surgery. The purpose of this study was to demonstrate our experience of TOTs since introduction in our hospital in 2005.

Methods: We prospectively studied 40 patients undergoing TOT insertion at Queens Hospital, Burton using the Monarc tape device. Preoperative urodynamic studies, operation notes, hospital records, and postoperative correspondence were examined. Patients were contacted by telephone to assess satisfaction with the procedure following discharge from our care, and they were asked to quantify satisfaction with the procedure and report leakage and pad usage.

Results: All patients underwent preoperative urodynamic studies, and where doubt existed regarding diagnosis, a further study was performed. Only two-thirds of our patients managed to fill out a voiding chart before urodynamic assessment. Most TOTs were inserted in patients in whom genuine stress incontinence was demonstrated on urodynamics testing. However, a small number of patients had mixed overactivity/stress incontinence on urodynamics. These patients had studies repeated whilst being treated with anticholinergic medication, and were found to have marked predominance of their stress incontinence at this time. Only a small proportion of our patients opted to try Duloxetine treatment prior to surgery. In all these cases treatment was discontinued due to severe side effects or ineffectivity of Duloxetine. Over 60% of our patients stayed in the hospital for just 1 night and 18% were performed as a day case. A small number of patients required catheterization for painful urinary retention postoperatively. Further complications were rareley reported, in particular, leg pain was only a problem for 1 patient. Over 70% of our patients were completeley dry and pad-free at the first follow-up appointment. Three patients continue to complain of stress incontinence and remain under our care. A small number of our patients reported symptoms of bladder overactivity postoperativeley. These were mainly mild, but more marked in those patients in whom mixed overactivity and stress incontinence were found at initial urodynamics testing. Despite anticholinergics, these symptoms do seem to worsen post-TOT isertion. Satisfaction rates regarding happiness with TOT and long-term success are encouraging, with most patients scoring above 90% for satisfaction and long-term dryness. Initial results following the introduction of the Monarc TOT in our center are encouraging. We have a high pad-free follow-up rate with low complications. In particular, leg pain is very rare. However, a small number of patients will require short-term catheterization. Those patients in whom overactivity is evident preop are at higher risk of worsening symptoms postoperatively. Although controlled well with medical treatment preoperativeley this may not be the case following insertion of TOT. Our patients consented accordingly.