Transobturator tape procedure outcome: a clinical and quality of life analysis of a 1-year follow-up

Comparative Assessment of Female Sexual Function Following Transobturator Midurethral Sling for Stress Urinary Incontinence

Urinary incontinence (UI) is a significant social problem. According to the World Health Organization, UI affects as much as 30% of premenopausal women and 60% of postmenopausal women. Urinary incontinence can lead to certain problems that negatively affect a woman’s sex life. They result from the fact that certain processes take place in the body during intercourse. As a result of orgasm, the intra-abdominal pressure increases, which in women with urinary incontinence can cause an uncontrolled leakage of urine. The discomfort that this causes, in turn, lowers sexual attractiveness, as well as causes embarrassment. The study involved 50 patients hospitalized in the period from February to May 2019 at the Gynecology Department of the Independent Public Healthcare Center of the Ministry of the Interior and Administration in Wrocław. All patients underwent surgical treatment of stress urinary incontinence using the transobturator tape (TOT) method. To assess sexuality, the international standardized Female Sexual Function Index (FSFI) questionnaire. Analysis of the results obtained from the FSFI questionnaire shows that the operation significantly affects the reduction in pain sensation during intercourse, a reduction in the sensation of sexual arousal, and a worsening vaginal wetness. Stress urinary incontinence significantly affects women’s sex life.

Comparison of outcomes of Burch colposuspension and transobturator tape and single incision needleless procedures (DynaMesh®-SIS minor) for the surgical treatment of female stress urinary incontinence patients who underwent combined pelvic reconstructive surgery or hysterectomy

PURPOSE

Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, transobturator tape (TOT), and single-incision needleless (DynaMesh^®-SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy.

METHODS

We performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life.

RESULTS

We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group.

CONCLUSIONS

Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.

Effectiveness and quality of life 10 years after transobturator suburethral tape surgery for stress urinary incontinence

AIM

We aimed to measure the effectiveness and quality of life (QoL) 10 years after transobturator suburethral tape surgery.

METHODS

We carried out a prospective observational study of 42 women assessed 10 years after surgical intervention with the transobturator technique. The main outcome measures were subjective and objective cure or improvement, complications, and changes in QoL.

RESULTS

The median abdominal leak point pressure had been 92 (82-113) mL H₂ O prior to surgery. Thirty-six women (85.7%) remained cured (negative cough test) and 13 (31%) reported urine leakage during physical activity, percentages which were similar to those at a previous assessment at the 5th year. Urgency urinary incontinence was reported by 18 women (42.9%), 16 of whom required the use of anticholinergic drugs. Nineteen women had undergone some form of surgical pelvic reconstruction concomitantly with the TOT procedure, four of whom presented with relapse. The QoL tests indicated that cure and improvement persisted in 85.7% (n = 36, Urogenital Distress Inventory-6) and 92.9% (n = 39, Incontinence Impact Questionnaire-7) of the 42 evaluable women, respectively.

CONCLUSION

Rates of objective and subjective effectiveness remained stable after 10 years of surgery and QoL did not deteriorate significantly during that interval. The increase in urgency incontinence needs to be further investigated.

Transobturator suburethral tape in the treatment of stress urinary incontinence: efficacy and quality of life after 5 year follow up

OBJECTIVES

Stress urinary incontinence (SUI) is a highly prevalent dysfunction in middle-aged and elderly women. One recent technique places a sub-urethral tape passed through the transobturator foramen. Efficacy and quality of life were assessed after five years of treatment with the transobturator technique in women suffering SUI. This evaluation followed a previous control at the first year post-intervention.

STUDY DESIGN

Sixty-three women were assessed five years after operation with the transobturator technique. Additionally, twenty-nine women of these women had undergone pelvic floor reconstruction due to different forms of genital prolapse. Quality of life (QoL) was assessed by the Urogenital Distress Inventory-6 (UDI-6) and the Incontinence Impact Questionnaire-7 (IIQ-7) tests.

MAIN OUTCOME MEASURES

Subjective and objective cure or improvement, complications, and changes in QoL.

RESULTS

Fifty women (79%) remained cured, as assessed by the cough test. Eighteen women (28%) reported urine leakage during physical activity. These objective and subjective data were worse than those reported at the one-year follow-up. De novo urge urinary incontinence was reported by 11 women or 17%. Nine of these women had undergone additional pelvic floor surgery. The QoL tests confirmed that cure or improvement was achieved in 78% (49) (UDI-6) and 79% (50) (IIQ-7) of the women.

CONCLUSIONS

The transobturator tape procedure resulted in acceptable rates of efficacy after five years. Moreover, QoL tests showed cure or improvement in almost four of five women. Nonetheless, women should be informed of the risk of de novo urinary urgency incontinence and the progressive loss of efficacy with time.

Retrospective study on tension-free vaginal tape obturator (TVT-O)

INTRODUCTION AND HYPOTHESIS

We aim to report the 3-year outcome and complications of the tension-free vaginal tape obturator (TVT-O) in treating female stress urinary incontinence (SUI).

METHODS

Retrospective analysis for complications and outcome of surgery was performed in 419 women undergoing the TVT-O from 2004 to 2006.

RESULTS

Three patients (0.8%) with an isolated TVT-O had a blood loss of more than 200 ml. Two patients (0.5%) had bladder perforation. Out of 11 readmitted patients (2.6%), 10 were due to voiding difficulty. Six patients (1.4%) required tape loosening or division. Persistent pain occurred in 3.6% and erosion in 2.4% of patients. One hundred eighty-five patients (44.2%) came for follow-up at 3 years. The actual subjective and objective success rates were 89.7% and 99.9% at 3 years follow-up, respectively. With imputation, the 3-year subjective and objective success rates were 86.9% and 97.4%, respectively.

CONCLUSIONS

The TVT-O is effective in treating female SUI with minimal complications.

Patient Reported Goal Achievement Following the Midurethral Sling Procedure for Female Stress Urinary Incontinence

OBJECTIVES

Patient perspective is very important for evaluating surgical outcomes. We investigated patient reported goal achievement, overall satisfaction and objective outcome following the midurethral sling (MUS) procedure for female stress urinary incontinence (SUI).

METHODS

The study prospectively enrolled 88 SUI patients who underwent the MUS procedure between August 2006 and December 2006. Patient examination included medical history, physical examination and an urodynamic study prior to surgery. Before surgery, patients were shown a list and asked to nominate one goal which they most wanted to achieve with surgery (i.e., the target goal). The goals were classified as: symptom-related, daily life-related, personal relationship- and emotion-related, and others. Before and after the surgery, patients completed a Bristol Female Lower Urinary Tract Symptom-Short Form questionnaire. At 1 year postoperatively, patients were assessed in terms of achievement of the target goal, overall satisfaction and cure rate.

RESULTS

At the 1-year follow-up, overall target goals were achieved in 90.1% of patients, 82 (93.2%) patients were satisfied with the treatment, and 82 (93.2%) patients were cured. For most patients, the target goals were symptom-related (47 patients, 53.4%). The patients whose goal achievement was less than overall goal achievement were significantly less satisfied than those who fully achieved their goal, and goal achievement was also related to objective cure.

CONCLUSION

Achievement of patient goals was high and could be a good measure of surgical success following MUS for female SUI.

Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence

BACKGROUND

Current research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment.

METHODS

PubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search.

RESULTS

Of 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL.

CONCLUSION

HRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.