Transobturator Slings for Female Stress Urinary Incontinence

Abstract

Introduction: Stress urinary incontinence affects about 20- 40% of women. Treatment with transobturator mid-urethral slings is consensually accepted nowadays. The goal of this study was to evaluate the success rate and most frequent complications of surgical treatment with transobturator mid- urethral slings in stress urinary incontinence.
Material and Methods: This study evaluated 363 patients who underwent correction of stress urinary incontinence with a transobturator tape in Hospitais da Universidade de Coimbra between January 1st 2008 and July 1st 2010.
Results: The mean age of patients was 56 [28-86]. In 13.5% of women, the correction of stress urinary incontinence was associated with other vaginal surgery. The majority of these women (95.3%) had urethral hypermobility. Only 0.8% of women suffered of perioperative complications, 5.2% of immediate postoperative complications and 15.7% of late postoperative complications. The global success rate was 93.7%. The success rate in patients with fixed urethra was lower (77.8%) comparing with the results of those with urethral hypermobility, being successful in 94.5% (p = 0.02). The success rate was similar in patients with or without vaginal surgeries.
Discussion: Treatment with transobturator mid-urethral slings has high success rates and it became the first treatment chosen to stress urinary incontinence, even if they were treated with the technique outside-in (TOT®) or inside-out (TVT-O®). Both techniques were conceived to avoid passing through the retropubic space, decreasing the complicate matters number.
Conclusions: The cure rates for the transobturator surgical approach range between 80 and 95%. The cure rate increases when the mechanism responsible for the urinary incontinence is urethral hypermobility, although it is not modified when are performed other vaginal surgeries concomitantly.
Keywords: Urinary Incontinence, Stress; Suburethral Slings.