Transobturator tape for treatment of female stress urinary incontinence: objective and subjective results after a mean follow-up of two years.

OBJECTIVES: To verify the objective and subjective outcomes of transobturator tape (TOT) in the treatment of female stress urinary incontinence due to urethral hypermobility.

METHODS: A total of 108 consecutive patients with stress urinary incontinence (mean age 58 +/- 4.5 years), who underwent the TOT procedure (43 patients received the ObTape, 55 patients the Monarc, and 10 patients the I-STOP sling) from June 2002 to December 2004, were assessed in December 2005. Before surgery, the patients were evaluated by history, physical examination, stress test, cotton swab test (Q-Tip test), and ultrasonography. After surgery, the compilation of a specific quality-of-life questionnaire was also included. Of the 108 patients, 35 had previously undergone urogynecologic surgery; associated prolapse was repaired simultaneously in 45 patients. The outcomes were analyzed considering five postoperative aspects: obstructive symptoms, irritative symptoms, urinary continence, pain, and satisfaction.

RESULTS: Postoperatively, 74% reported minimal obstructive symptoms, 78.7% had no urge symptoms, and de novo urgency occurred in 14.8%. Objective continence rates were increased significantly (80%), although the subjective rate was significantly greater (92%). Also, 88% of patients reported no pelvic pain, and only 7.3% reported dyspareunia; 88% of patients were significantly satisfied with the TOT procedure. Regarding complications, vaginal erosions were reported, using the ObTape, in 6.4% of patients, sling rejection in 3.8%, and incorrect positioning or sliding of the sling in 6.4%. Morbidity did not seem to be affected by previous or associated surgery.

CONCLUSIONS: The TOT procedure is a simple, safe, and effective technique for the treatment of stress urinary incontinence due to urethral hypermobility. Our data have demonstrated good global success with a low rate of minor complications.