Hypothesis / aims of study
The mid-urethral slings are the gold standard surgical treatment of urinary stress incontinence. However, despite the success of this type of surgery, the studies are almost all conducted in well experienced centers. The aim of this study is to access the efficacy of transobturator midurethral slings (TOT) procedure in our Urology Department. We evaluate this surgical procedure in terms of efficacy, safety and improved quality of life.
Study design, materials and methods
Two-hundred patiens who underwent TOT for urinary incontinence (mixed and stress) from January 2010 and August 2017 were followed up. The general characteristics of the patients, incontinence risk factors, obstetric history and urodynamic examination results were recorded.
Scales were used in the follow-up, such as urinary incontinence severity score (UISS), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared.
Results
The mean age was 53 years, with a range of 40-80 years. The mean follow-up time was 50 months, with a range of 4-90 months. Sixty four percent of the patiens had stress urinary incontinence, while 36% had mixed urinary incontinence. Five percent of the patiens (n=10) had experienced prosthesis extrusion. None of the patients had other complications including injury of bladder, urethra, obturator vessel or nerve during the surgery. After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination. At the first follow-up visit, 1 month after surgery, 73% of all patients were free of complaints. The overall cure rate for stress urinary incontinence was 80% with 100 patients cured, and for mixed urinary incontinence was 65% with 45 patients cured. The patients' life quality also improved significantly.
Interpretation of results
Our work demonstrates that TOT surgery provides good success rates and has a positive impact on life quality. The ease of application and lower complication rate makes TOT still a valuable alternative for other treatment approaches in the surgical treatment of stress urinary incontinence.