TENSION – FREE VAGINAL TAPE: THE INSIDE-OUT TRANS-OBTURATOR TECHNIQUE IN THE TREATMENT OF STRESS URINARY INCONTINENCE IN WOMEN

Abstract

Aim: The objective of this study was to assess the effectiveness and safety of stress urinary incontinence (SUI) treatment in women with placement of tension-free transobturator vaginal tape using the inside out technique (TVT-O).
Methods: Thirty eight patients with clinically and urodynamically - proved SUI constituted the subjects of this study. The transobturator inside-out tension-free urethral suspension in which a synthetic tape is passed from underneath the urethra, through the obturator foramen, towards the thigh fold, without entering the pelvis, was performed. The tape is positioned without tension under the mid-urethra.
Results: Mean operative time was 18 minutes (range: 13 – 25 minutes). With the exception of only one case (2.6%) of a significant (> 200 ml) bleeding, no other intra-operative complication was reported. Also, no hematoma or wound infection was noticed after the procedure. Five patients (13.2%) developed significant pain in the upper thigh which required injectable analgesics and inpatient stay for 24 - 48 hours post-operatively. Two patients (5.3%) developed urine retention which necessitated intermittent self catheterisation for 3 - 4 weeks. Three patients (7.9%) reported de novo urgency at 6th weeks. In two of them, this symptom disappeared spontaneously at the 3rd month. The remaining patient had her tape, eventually, cut under a general anaesthetic. Only one case (2.6%) of mesh erosion, which was repaired surgically, has been noted in this study. Two patients (5.3%) reported persistence of their SUI. Therapeutic failure diagnosis was confirmed on urodynamic assessment (UDA). All of the 36 women who attended their last follow up visit reported no further SUI and, therefore, were considered cured.
Conclusion: The experience gained through this study indicates that the TVT-O procedure for treating SUI in women is associated with a very low morbidity and high rates of success. However, further studies in larger populations with longer follow up are warranted to determine the presumed efficacy and significantly decreased morbidity of this procedure.
Keywords: Stress urinary incontinence, Transobturator, TVT-O