Role of Transobturator Tape in the Treatment of Mixed Urinary Incontinence in Women.

Corresponding Author:
Dr. Neelakandan R.,
Department of Urology,
E2-OPD, Medical Centre,
Ramachandra Medical College & Hospital,
Porur-600116, Tamilnadu, India.
E-mail: drneelakandan@gmail.com

ABSTRACT

BACKGROUND

Globally, urinary incontinence (UI) is frequently observed in women and impairs every aspect of her life. Mixed urinary incontinence (MUI) refers to the presence of both stress (SUI) and urgency urinary incontinence (UUI). There are variable cure rates of midurethral slings (MUS) procedures in MUI. Thus, the present study was performed to evaluate the effectiveness of transobturator tape (TOT) technique, influence of outside-in TOT on objective and subjective cure rates and quality of life, and to assess the post-operative complications in women with MUI.

METHODS

This was a prospective interventional study involving 31 women who had undergone TOT procedure for MUI at Department of Urology, Sri Ramachandra Medical Centre & Sri Ramachandra Medical College Hospital, Chennai, over the last 2 years. The study was performed over a period of 25 months (i.e., September 2016 to September 2018). MUI was diagnosed on the basis of urodynamic tests such as pressure flow study. Urodynamic evaluation was done using Laborie urodynamic device. All patients filled in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) both pre-operatively and post-operatively (at 6 months). Incontinence bothersome scale (IBS) was used to evaluate post-operative satisfaction and if the IBS score was > 80, patient was considered to be satisfied. All patients were routinely evaluated at 2 weeks post-operatively and then on the 6^th month post-operatively with pelvic examination, cough stress test (CST), IBS score, and ICIQ–SF.

RESULTS

Majority of patients belonged to the age group of 41-50 years (35.4%) and were post-menopausal (61.3%). Post-operatively, there was a significant decrease in the number of patients with symptoms related to both SUI and UUI (< 0.05). Moreover, there was significant postoperative increase in Pdet Qmax (< 0.05) and a reduction of maximum flow (Qmax) (< 0.05). Subjective and objective SUI cure was achieved in 90.32% and 87.09% patients, respectively. While, subjective UUI cure was achieved in 70.96% patients. VAS score > 80 was observed in 77.41% patients. Only 5 patients developed post-operative complications including dyspareunia, severe groin pain, recurrent UTI, and urinary retention.

CONCLUSIONS

During follow-up, TOT procedure was found to be highly successful in the treatment of MUI. There was no incidence of injury to urethra or bladder, and no complications related with bowel or nervous system. Hence, TOT will definitely improve MUI control, decrease women’s dissatisfaction, and improve quality of life.

KEYWORDS

Midurethral Slings, Mixed Urinary Incontinence, Transobturator Tape, Urinary Incontinence