BERKELEY, CA (UroToday.com) - All the available data indicate that stress urinary incontinence (SUI) affects up to 45% of women and the prevalence of SUI is likely to increase in the future as the population ages. SUI, which often occurs with coughing, laughing, sneezing, running or jumping is not only embarrassing but also tends to prohibit many activities of today's active woman. SUI may seriously affect the quality of life (QoL) of women. During the past decade, a number of new minimally-invasive surgical procedures for the treatment of female SUI were introduced.[1] The meta analyses demonstrated that tension-free vaginal tape (TVT) and transobturator tape (TOT) had similar efficacy, although the risk of bladder perforations, pelvic hematoma, and lower urinary tract symptoms related with urinary storage were significantly less common in the TOT group.[2] The studies in the literature about long-term outcomes of mid-urethral sling surgery have focused mainly on TVT. There is little data on long-term outcomes of female SUI patients treated with TOT procedure.
In this retrospective study, our aim was to determine whether the high cure and patient satisfaction rates with minor complications of TOT procedure is persistent in the long-term follow-up. The women were evaluated with history, pelvic examination in lithotomy position, urinary system ultrasound with the measurement of post void residual urine, international consultation on incontinence questionnaire-short form (ICIQ-SF) questionnaire, and cough stress test (CST). Postoperative patient satisfaction was assessed using a visual analog scale (VAS) where 0 represented very dissatisfied = unbearable urinary complaints while 100 represented very satisfied = no urinary problems. We did not perform urodynamic studies (UDS) systematically; if the patient had pure SUI symptoms and positive CST, UDS were omitted. However, UDS were preserved for mixed urinary symptoms (MUI) and/or with post void residual urine more than 100 ml. UDS were reviewed to diagnose preexisting neurogenic bladder.
We analyzed the outcomes considering 4 postoperative parameters: objective cure, subjective cure, resolution of urge urinary incontinence (UUI), and patient satisfaction. Criteria for objective cure was a negative CST, no need for pads, and no re-operation for SUI. Subjective cure was defined by a score of 0 points from ICIQ-SF questionnaire and no need for pads. Resolution of UUI was defined by subjective patient reporting on the questionnaire and no need for antimuscarinic medication.
In most SUI trials, high cure rates in short term were similar with our data. However in long-term follow-up we documented that patient satisfaction and subjective cure rates decreased significantly due to UUI. Our data supported the previous prospective and retrospective trials.[3, 4] The present study shows that in the long-term follow-up, the dissatisfaction rate increases because the subjective cure rate decreases.
We concluded that TOT procedure is an the effective alternative for treatment of pure SUI and MUI with low complication rates, and the considerable influence of UUI on subjective cure rates determines patient satisfaction in the long term.
References:
- Nilsson CG, Falconer C, Rezapour M, Falconer C (2004) Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 104:1259-1262
- Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, et al. (2010) Updated systematic review and meta-analysis of the comperative data on colposuspensions, pubovaginal slings and midurehral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58:218-238.
- Abdel-Fattah M, Mostafa A, Familusi A, Ramsay I, N'dow J (2012) Prospective randomised controlled trial of transobturator tapes in management of urodynamic stress incontinence in women: 3-year outcomes from the evaluation of transobturator tapes study. European Urology 62:843-851.
- Li B, Zhu L, Lang JH, Fan R, Xu T (2012) Long-term outcomes of the tension-free vaginal tape procedure for female stress urinary incontinence: 7-year follow-up in China. J Minim Invasive Gynecol 19(2):201-205.
Written by:
Tarık Yonguc, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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