Modification of Double-TOT approach in the treatment of cystocoele with concomitant urinary incontinence and occult urinary incontinence – preliminary report
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Andrzej Malinowski, Grażyna Maciołek-Blewniewska, Tadeusz Pawłowski, Tomasz Augustyniak, Michał Wojciechowski

Klinika Ginekologii Operacyjnej i Endoskopowej ICZMP w Łodzi

summary

Introduction.

Cystocoele with concomitant urinary incontinence is one of the most frequent problems in the urogynecologist’s practice. Introduction of modern surgical techniques basing on prosthetic materials, like Double TOT approach has considerably improved the therapeutic outcome as far as the cystocoele alone is concerned. It has turned out not to be as efficacious in the treatment of concomitant manifest or occult urinary incontinence.

Objectives.

The aim of the study is to present the early results of treatment of cystocoele with concomitant manifest or occult urinary incontinence using modified Double TOT approach.

Materials and methods.

In 2007, in the Department of Surgical and Endoscopic Gynecology, Polish Mothers’ Memorial Hospital in Lodz, 30 patients were operated on for cystocoele with manifest (18 patients) or occult (12 patients) urinary incontinence, using modified Double TOT approach. The mesh was implanted through the upper and lower part of obturator foramens to support the urinary bladder. The upper mesh arms were placed, like in original TOT procedure, below the mid-urethra. The early results of cystocoele, manifest and occult urinary incontinence treatment and complications were analyzed. The results were compared to the therapeutic outcome of the

original Double TOT approach technique, common in our Department before 2007.

Results.

The modified Double TOT approach technique proved successful in the treatment of cystocoele with central and lateral defect. The mid-urethra, tension-free support allowed to treat concomitant manifest or occult urinary incontinence too. We did not observe any serious complication in our patients.

Conclusions.

The modified Double TOT approach with upper mesh arms implanted below mid-urethra seems to be an efficacious technique to treat cystocoele with concomitant manifest or occult urinary incontinence.