Complications of Transobturator Tape Procedure – Our 2 Year Experience

ABSTRACT

Objectives: The aim of this study is to show complications of transobturator tape (TOT) procedures, performed at Department of Urology and Department of Gynecology. The main indication for this treatment was stress urinary incontinence and absence of significant prolapse of uterus.

Methods: In period of 2005-2006 we performed 43 TOT operations, with “inside to out” technique with Gynacare TVT Obturatos System. In every case we performed standard diagnostic tests for urinary stress incontinence and gynecological examination before surgery. The grading systems for anterior vaginal wall prolapse are described using criteria from the Organ Prolapse Quantitation (POPQ) system.

Results: In 14 (32,56%) patients we noticed prolapse of anterior vaginal wall (cystocoele grades II and III), and in this cases we surgically correct this disorder before TOT procedure. We conduct 24 months follow-up in all cases, and control visits were performed immediately after surgery, after first and second year, and even often if it was necessary. We didn’t have any intraoperative complications. Immediately after surgery, 3 (6,98%) patients has pain in femoral region, that pass away within 72 hours with analgesics. In 1 ( 2,32%) patient we notice small sub dermal haematoma. Other complications were erosion of the tape and surrounded tissue ( 1-2,32%), urinary retention ( 1-2,32%). In both cases we performed partial excision of TOT tape, and after that placed 2 sutures in pubocervical fascia region and covering that defect with mobilizing of vaginal epithelia. Stress incontinence relapse was found in 4 (9,30%) patients after first year. Other 39 ( 90,70%) patients are still without clinical sings of stress incontinence. “De novo urgency“ syndrome developed in 3 (6,98%) patients and we resolve this problem with conservative treatment.

Conclusions: Transobturator tape (TOT) as surgical treatment with the mid-urethral tape representing a minimally invasive option and comparable cure rates to the other surgical methods, even better because there are not any bladder injuries. The complications of this procedure are those inherent to all continence procedures and specific to the tape itself.

KEYWORDS: TOT procedure, complications

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