Hypothesis / aims of study
Recurrent incontinence is one of the most disastrous complications of continence surgery. Midurethral slings are commonely used nowadays for female stress urinary incontinence .Recurrenct incontinence ,Tape erosion and sometimes infection l still a big problem with these techniques . Fascial Sling is another good option in such like cases especially in sever incontinence.However fixation of fascial sling is more invasive and needes more dissection ,so we replaced the mid part of the tape (around the urethra )by rectus fascia or fascia lata and connect it on both sides by polpropyline tape to pass through obturator foramen like TOT.we compared this technique with the standard TOT. In this study we evaluated efficacy, safety and long term results of transobturator fascial sling and Trans obturator tape in recurrent female stress urinary incontinence.
Study design, materials and methods
From jan. 2010 till April 2015, 71 female patients with recurrent SUI were evaluated. After counselling all patients about surgery and signing written consent, They were randomly divided into 2 groups :Group 1(G1) 34 patients underwent (TOFS )using either rectus fascia or fascia lata patch one by two centimeters connected on both sides by polypropylene tape . and Group 2 (G2) 37 patients underwent Transobturator Tape (TOT) .
Operative time, intra and postoperative complications using (Clavien grading system), duration of catheterization and Hospital stay as well as success rate of surgery were recorded.
All patients were evaluated by history, physical examination, urine culture, pelviabdominal ultrasound, and urodynamics. International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), and female sexual function index (FSFI) questionnaire (Arabic versions were applied for all patients . patients were followed for 3years.3 patients did not complete the follow up period ,2 from G1 and 1 From G2.
Results
Both groups were matched at baseline for mean age (33.41±12.36 and 34.95±11.63 years group 1 and 2 respectively), comorbidity profile, (ICIQ-SF) , and (FSFI) questionnaire . Operative time, intra-operative bleeding were significantly lower in ) G2 ( 24.08 ± 4.06 versus 43.94 ± 7.7 minutes , ( p <0.001) as regard time and 0.3±0.4 versus 1.1±0.2 as regard HB drop, ( p <0.001). No significant difference could be detected as regard catheterization period and hospital stay with range 1-2 and 1-3 days for both (P >0.05). Significant improvement in ICIQ-SF occurred in both groups ( from15.1±3.6 to1.6 ±5.5), in G1 and (15.9±1.2 to 8.5±5.7)in G2 ( p <0.001). Success rate defined as cure and improvement was 93% (30 patients) in GA, 64% (23 patients) in GB. In Patients with valsalva leak point pressure less than 60cm H2O (9 cases in GA and &6 in GB) only one in GA failed while no improvement recorded in G2( p <0.001). .Vaginal erosion occurred in 2 cases and urethral erosion in 1 case in G2 within the 1st year follow up. (p <0.001). 91% of sexually active women in G1 achieved significant improvement in their sexual FSFI ,while only 50% in G2. Four cases of recurrence occurred in G2 after 1 year while no recurrence occurred in G1all over three years follow up.
Interpretation of results
Vaginal and urethral erosion occured with TOT technique while not in TOFS ,at the same time there is significant difference in success rate in favor of TOFS.