Implantation of transobturator suburethral tape with deferred tape adjustment for surgical treatment of stress urinary incontinence in women
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Ewa Bres-Niewada, Piotr Radziszewski, Tomasz Borkowski, Andrzej Borkowski

Klinika Urologii Ogólnej, Onkologicznej i Czynnościowej Warszawskiego Uniwersytetu Medycznego

summary

Introduction.

The surgical technique of implantation of suburethral tape using foramen obturator approach (TOT – trans obturator tape) was introduced by Delorme in 2001. Since then it is widely used as an alternative method for the retro pubic tension free vaginal tape (TVT) procedure.

Objectives.

The aim of the study is to present the technique of implantation of transobturator suburethral tape with deferred tape adjustment.

Materials and methods.

The film presents the technical details of the procedure and the possibility of intra- or post-operative tape adjustment. Between 10.2007 and 01.2008 ten women with the primary stress urinary incontinence underwent the TOT procedure using A.M.I. TOA Sling kit. The procedure kit includes polypropylene monofilament mesh sling equipped with 10 polypropylene sutures which enable tape adjustment up to 3 days following operation. The procedure technique is typical, with outside-in transobturator approach. Three threads are attached to both tape ends and protrude through skin incisions following surgery. When incontinence is still present after the procedure the tension of the implant can be increased by simply pulling these threads ends. In the middle of the tape there are four sutures witch protrude through the anterior vaginal wall on both sides of the vaginal incisions. In case of the urinary retention or large post-void residual it is possible to decrease the implant tension by pulling sutures down.

Results.

In the first or second post-operative day after cough test and post void residual test it is possible to adjust the tape tension by pulling polypropylene sutures. In two women in the presented group it was necessary to adjust tape tension because of positive cough test in the first post-operative day. After local anesthesia of the foramen obturator region with 1% lignocain the implant position was adjusted by pulling up of the positioning threads attached to the tape ends. The urinary retention or large post-void residual were not observed so decreasing of the tape tension was not necessary. Positioning sutures were removed within two days following surgery after adjustment of tape position. The postoperative complications or vaginal tape erosion were not reported.

Conclusions.

The usage of the transobturator suburethral tape with the possibility of deferred tape adjustment changes neither the procedure technique nor the operation time. In case of positive cough test the possibility of the tape adjustment improves the procedure success rate. On the other hand, by decreasing the tape tension in case of urinary retention, the risk of surgical intervention (tape removal or urethrolylis) is minimal.