PTU - Polskie Towarzystwo Urologiczne
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CODE: 12.2 - Trans obturator tape-obtape in the treatment of the stress urinary incontinence in women
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Magdalena Mikulska-Jovanović, Zbigniew Wolski, Aleksander Łapuć, Maciej Gruszczyński, Tomasz Drewa
Katedra i Klinika Urologii Collegium Medicum w Bydgoszczy UMK w Toruniu

summary

Introduction. In the last years, a method introduced by Ulmsten (1995) - retro pubic tension free vaginal tape (TVT) found its way to the treatment of stress urinary incontinence in women. In spite of a good efficacy, this method is not free of complications: bladder perforations, bladder instability de novo, urinary retention and other rarely occurring complications: vascular and bowel injuries and retropubic hematomas. To avoid these complications, Delorme proposed a new approach, with introduction of the tape through foramen obturator - (outside-inside), trans obturator tape (TOT).
Objectives. Personal experiences with TOT tapes implantation in women with the primary stress urinary incontinence and the women that had earlier ineffective corrective operations in the treatment of urinary incontinence. The estimation of the efficacy and safety of the method.
Materials and methods. Between October 2003 and December 2005, 55 TOT procedures were performed, using non-woven polypropylene tape - Obtape (Porges-Mentor) with approach through the foramen obturator. The mean operating time was 28 minutes. During the procedure, cystoscopy was not performed. Ten (18.2%) patients were operated earlier due to urinary incontinence: in 7 patients anterior colporaphy, in 2 patients Miszczerska method were applied and in 1 patient, an urethro-vaginal fistula appeared after the TVT procedure, which necessitated TVT tape removal and few repairing procedures. This did not bring the relief of symptoms of urinary incontinence. The average patients age was 56 years. Max flow rate (Q max) before operation was, on average, 28 ml/sek. In all women, pre-operative work-up included: clinical examination, urodynamic with cystomanometry, cough and Boney test, post voiding residual urine estimated in ultrasound. After the procedure, patients were examined after one, three and six months. The follow-up was 2-26 months (11 months on average). During the first visit a cough test with a full bladder, gynecological examination with an estimation of the healing of the anterior vaginal wall, uroflowmetry and ultrasound with the post voiding residual urine (PVR) measure were performed.
Results. During the follow-up, stress urinary incontinence completely resolved in 48 (87.3%) patients, and partially in 3. In 3 patients, the symptoms of urinary incontinence did not resolve, in one case the vaginal erosion was found two months after implantation and the tape was removed with incontinence recurrence. 4 patients (7.2%) were found to have obstructing voiding disorders, defined as (Qmax<15 ml/s), and postvoid residual urine. In 3 (5.4%) patients, the pre-operative residual urine after voiding (max. 150 ml) due to the underactive bladder detrusor did not change. One complete urinary retention in patient with neurological dysfunction of the bladder and one temporary urinary retention were found. The temporary retention resolved after 3 weeks of self catheterisation. The mean Q max. 4 weeks after the procedure was 22.5 ml/sec. The TOT technique could be used in all cases with no serious surgical problems. During the operation, in three patients a perforation of the vaginal vault was observed after the insertion of the tunneler with the tape. This was immediately intraoperatively repaired, without removing the tape. The Foley catheter, inserted during the procedure, was removed on the first postoperative day, the overall clinical stay was 4 days. In the 7th day after the operation, one patient returned to the hospital with vaginal bleeding which was treated conservatively.
Conclusions. 1. TOT seems to be a safe and effective method of treatment of the stress urinary incontinence in the short follow-up, even in women that had ineffective earlier operative treatments of the incontinence. 2. A longer follow-up is required for the exact evaluation of the method.