Stress urinary incontinence (SUI) can occur as a complication of neurogenic bladder dysfunction in patients following spinal cord injury (SCI) especially in those who have an infra-sacral lesion. Synthetic mid-urethral tapes have been used for many years in the treatment of SUI in non-neurogenic cases, but have recently been withdrawn by the National Institute of Clinical Excellence (NICE) in the UK in the majority of cases due to increased potential for complications. We present the extended follow up of a group of women with SCI who underwent insertion of a trans-obdurator tape (TOT) to manage their SUI at our centre.

27 female patients underwent insertion of TOT between 2005-2013 at our centre. An earlier study with a mean follow up of 8 years showed that 22 had reported they were dry following surgery, 4 reported as failed and one was lost to follow up. For the extended follow up, the current continence status, bladder management, complication and additional bladder interventions were recorded.

Of the initial cohort of 27 patients, 9 have subsequently died. The average age at death was 77.6 years (52-88 years). The current mean age of the surviving patients is 56 years (43-76 years). 15/27 of the patients emptied their bladder with clean intermittent self-catheterisation (CISC), 9/27 had an SPC, and 3 were voiding spontaneously. 2 patients who were strain voiders prior to TOT converted to CISC, however, one has subsequently reverted to strain voiding. In the most recent follow up a further strain voider has changed to CISC on clinical advice. In the original study, 22 /27 reported being dry after insertion of TOT. However, 9 have subsequently died; of these patients, 6 remained dry at their death and 2 had recurrence of incontinence. Of the surviving 13 dry patients; 7 remain dry. 6 reported that they were now incontinent. One has undergone formation of a rectus fascial sling (RFS) and others have had intra-detrusor botulinum toxin for pre-existing detrusor over-activity (DO). One had remained continent for 10 years post-surgery but had a recurrence of incontinence in the last 12 months. In the original study, 2 patients developed de novo DO and were treated accordingly. No further cases of de novo DO were recorded. No tape erosions or pain were reported.

We report the extended follow up of a group of female patients with SUI following SCI who were treated with TOT. Of the 27 initial patients, 19 remain dry (including 6 deceased who were dry at date of death) without further treatment, and of those who did have recurrence of incontinence, these have been treated with additional intra-detrusor botox injections due to mixed incontinence; whilst 2 have undergone RFS operations.

We believe that TOT remains a safe and effective treatment option for female SCI patients with SUI.