CLASSIC TRANSOBTURATOR TAPEPLACEMENT VERSUS INTRAOPERATIVE SLING TENSION ADJUSTMENT: EIGHT YEARSFOLLOW UP
F. KAPLAN1, R. FLORES1, O. BECERRA 1, C. FIGUEROA 1, C.CASANOVA DEMMLER 1, J. ALVAREZ 2;
1UROGYNAECOLOGY, Hosp. DE QUILPUE, QUILPUE, Chile,2Urogyneccology department, Hosp. Padre Hurtado, Santiago,Chile.
Introduction: Mediurethral sling(MUS) procedure is the most common surgery for the treatment offemale stress urinary incontinence (SUI). It is widely accepted thatMid urethral slings must be left free of tension at the momement ofplacement, however, the "tension-free" statement asdescribed by Delorme in 2001 is somewhat ambiguous and this is why inclinical practice several particular techniques are used by surgeonsto achieve this "free-of- tension" concept. Based onMacmillan’s researches, where he showed that women without SUI andunder spinal anaesthesia present urinary leakage with averageintravesical pressures of 39 cm H2O, we believe that theintraoperative sling tension adjustment in trasnsobturator tape (TOT)should be with intravesical pressures between 35 and 40 cm H2O.This adjustment will probabably improve the objective and subjectivesuccess rate of surgery.
Objective: The aim of the study isto compare the objective and subjective success rate between classicTOT placemente as described by Delorme versus TOT with intraoperativesling tension adjustment.
Methods: We performed aretrospective cohort study that included all patients undergoingclassic TOT (Group 1) and intraoperative sling tension adjustment TOT(Group 2) for SUI or mixed urinary incontinence. All the patients hadundergone this procedure at a single center in Chile from January2005 to Decembre 2015. Patients with urinary incontinence surgerieshistory, pelvic radiation, neurological pathologies, or post voidingresidue greater than 150 ml were excluded. The data was obtained frompatient’s records and hospital surgical database in addition to aninterview and physical examination in the post-surgery follow-up. Forthe intra operative sling tension adjustment group, the intravesicalpressure was measured with an 8-french catheter connected to a 10french graduated tube and intravesical pressure over 35 cm H2Owas achieved by suprapubic bladder compression. Objective success wasdefined as a full bladder cought test and subjective success wasmeasured through the “Patient Global Improvement Index” (PGI-I).In addition, intraoperative and postoperative adverse events, SUIreoperation surgery and visual or palpable mesh exposure wererecorded
Results: Four hundred TOTs were performed duringthe study period, 166 patients were contacted and 145 (38.5%) camefor follow up. Eighty-four patients for group 1 and 61 for group 2.Demographic variables of age and body mass index (BMI) were similarfor both groups but the parity was significantly higher in group 2and the follow-up time was also significantly higher in group 1(Table 1). The objective success rate was higher in group 2 but thedifference was not statistically significant (88.1 % group 1 vs 95.1% group 2, p=0.146). The subjective success rate was significantlyhigher in group 2 (76.2% in group 1 versus 88.5% in group 2, p =0.05). The rate of intraoperative complications, mesh exposure andreoperation by SUI was similar in both groups (Table 2).
Table 1:Demographic and Baseline information.
Group1 n 84
Group2 n 61
Table 2: Group 1 versus Group 2
Group1: Classic TOT-free tensionmesh-. Group 2: Intraoperative sling tension adjustmentTOT.
Conclusions: The intraoperative sling tensionadjustment TOT has higher subjective success rate compared to classicTOT for the SUI without increasing complications rate.