A PROSPECTIVE STUDY OFTRANSOBTURATOR TAPE’S OUTCOME IN LONG- TERM: SINGLE SURGEONEXPERIENCE OF 152 CONSECUTIVE CASES
M. B. DINIZ1, G. M.SILVA 2, L. C. DINIZ 2, G. M. PEREIRA 3,A. S. LOPES-FILHO 4, M. MEINBERG 4, Z. N. REIS4, M. V. MONTEIRO 4;
1vila daserra Hosp., belo horizonte, Brazil, 2Hosp. vila da serra,belo horizonte, Brazil, 3Women's Health, Univ.e Federal deMinas Gerais, Belo Horizonte, Brazil, 4universidadefederal de minas gerais, belo horizonte, Brazil.
Introduction: In 2003 Delormedeveloped a transobbturator version of the original TVT system tryingto decrease complications. The transobturator sling is one of themost done surgeries for urinary incontinence in the world but thereare few studies with long term efficacy and complications. Thesubjective cure for the transobturator sling rates ranged from 43% to92% 1 but most of these results come from a group ofexperienced surgeons or centers.
Objective: To evaluateobjective and subjective cure rates, complications and risk factorsof failure at least five years after the transobturator slingprocedure done by one surgeon.
Methods: A prospectiveobservational study was conducted with all patients with urodynamicmixed and stress urinary incontinence that underwent transobturatorsling done by the author between 2005 and 2011. The study wasapproved by the hospital ethics and research committee and we usedIUGA-ICS terminology. The patients, after informed consent, answeredby telephone ICIQ-SF questionnaire to evaluate the objective cure.ICIQ-SF values between 0 and 6/212 were considered as anobjective cure criteria outcome. To evaluate the subjective cure,patients were asked how they felt about primary urinary complaints:cured, improved, unchanged or worsened. Clinical and surgical datawere obtained from records in medical records for the evaluation ofrisk factors for failure and description of complications. Thestatistical methods used were Pearson Chi-squared and Fisher´s exacttest.
Results: In the 2005-2011 period, 215 patients wereoperated by the transobutrator technique by the same surgeon and 152patients accepted to participate. The median follow-up was 87 months(60-127) and the median age at the time of surgery was 51,5 years(range from 27 to 85). The median BMI was 26,8kg/m2(18,7-42,6). Associated surgery was anterior colporrhaphy, posteriorcolporrhaphy and hysterectomy and occurred in 75 patients. 90 (63,4%)patients had urodynamic diagnosis of urinary stress incontinence and62 (36,6%) had mixed incontinence. The leak point pressure was lessthan 60 cmH2O in20 (14,8%) patients and 22 patients had previousincontinence surgery. Complications occurred in 20 patients: urinarytract infection (7), local infection (7), urinary retention (1) anderosion (2). 111(73,0%) patients had ICIQ-SF 0-6 (objective cure) and101(66%) patients considered themselves cured (subjective cure). 7patients said unaltered and one patient related that her symptomsbecame worst after the surgery. There was no difference between the 5types of transobturator tapes used ( Monarc, IVS, TVO-T, Unitape,Safyre). In 8 patients with failure, the only statisticallysignificant risk factor was mixed incontinence.
Conclusions:Subjective and objective cure rates after at least five years aftertransobturator sling procedure were 73% and 66,4% respectively. Thisstudy confirms that the transobturator sling is efficacious and safein the long term. Patients with mixed urinary incontinence had theworst results. The results presented by the experience of a singlesurgeon probably are those found in clinical practice.
References:1. Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral slingoperations for stress urinary incontinence in women. CochraneDatabase Syst Rev. 2015(7):Cd006375. 2. Karmakar D, Mostafa A,Abdel-Fattah M. A new validated score for detecting patient-reportedsuccess on postoperative ICIQ-SF: a novel two-stage analysis from twolarge RCT cohorts. Int Urogynecol J. 2016