Journal List > Korean J Urol > v.49(12) > 1005038

TOOLS
Lee, Kim, Kim, Jung, Lee, and Yoon: Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence
Original Article

Korean J Urol 2008;49(12):1119-1124.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.12.1119

Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence

Sung Hoon Lee, Tae Beom Kim, Khae Hawn Kim, Han Jung, Min, Sung Lee, Sang Jin Yoon

From the Department of Urology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea

Received 27 June 2008       Revised 8 October 2008

Copyright © 2008 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Canal transobturator tape (TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling (DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT.

Materials and Methods

Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes.

Results

The mean operative time for Canal TOT was 22.4 minutes (range: 15–39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency (n=3), weak stream (n=4) and difficult emptying (n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair (n=7), rectocele repair (n=5), rectocele and cystocele repair (n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy (n=1). The average follow-up was 4.5 months (range: 3–12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence.

Conclusions

Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate. (Korean J Urol 2008;49:1119–1124)

Go to : Goto

Keywords: Stress urinary incontinence, Suburethral sling

References

1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003; 61:37–49.
crossref
2. Blaivas JG, Romanzi LJ, Heritz DM. Urinary incontinence: pathophysiology, evaluation, treatment overview and nonsurgical management. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. editors.Campbell's urology. 7th ed.Philadelphia: Saunders;1998. p. 1007–43.
3. Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand. 1990; 153(Suppl):7–31.
4. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996; 7:81–6.
crossref
5. Rodriguez LV, Raz S. Polypropylene sling for the treatment of stress urinary incontinence. Urology. 2001; 58:783–5.
crossref
6. Rodriguez LV, Raz S. Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol. 2003; 170:857–63.
7. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995; 14:131–9.
8. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994; 3:291–306.
9. Lam TC, Hadley HR. Surgical procedures for uncomplicated (“routine”) female stress incontinence. Urol Clin North Am. 1991; 18:327–37.
crossref
10. Haab F, Zimmern PE, Leach GE. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management. J Urol. 1996; 156:3–17.
crossref
11. Yoo JW, Jung HC. Tension free vaginal tape procedure for the treatment of female stress urinary incontinence: 1 year follow up. Korean J Urol. 2001; 42:1058–62.
12. Paick JS, Ku JH, Shin JW, Son H, Oh SJ, Kim SW. Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure. J Urol. 2004; 172:1370–3.
crossref
13. Ku JH, Oh JG, Shin JW, Kim SW, Paick JS. Age is not a limiting factor for midurethral sling procedures in the elderly with urinary incontinence. Gynecol Obstet Invest. 2006; 61:194–9.
crossref
14. Zilbert AW, Farrell SA. External iliac artery laceration during tension free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12:141–3.
15. Amna MB, Randrianantenaina A, Michel F. Colic perforation as a complication of tension-free vaginal tape procedure. J Urol. 2003; 170:2387.
crossref
16. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001; 11:1306–13.
17. Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:330–4.
crossref
18. Davila GW, Johnson JD, Serels S. Multicenter experience with the Monarc transobturator sling system to treat stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:460–5.
crossref
19. Seok NS, Suh HJ, Lee DH. Clinical outcome of transobturator Monarc procedures for treating of women with stress urinary incontinence: 2-year follow up. Korean J Urol. 2006; 47:835–40.
20. Mazouni C, Karsenty G, Bretelle F, Bladou F, Gamerre M, Serment G. Urinary complications and sexual function after the tension-free vaginal tape procedure. Acta Obstet Gynecol Scand. 2004; 83:955–61.
crossref
21. Whiteside JL, Walters MD. Anatomy of the obturator region: relations to a transobturator sling. Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15:223–6.
crossref
22. Rutman M, Itano N, Deng D, Raz S, Rodriguez LV. Longterm durability of the distal urethral polypropylene sling procedure for stress urinary incontinence: minimum 5-year followup of surgical outcome and satisfaction determined by patient reported questionnaires. J Urol. 2006; 175:610–3.
crossref
23. Andonian S, St-Denis B, Lemieux MC, Corcos J. Prospective clinical trial comparing Obtape and DUPS to TVT: one-year safety and efficacy results. Eur Urol. 2007; 52:245–51.
crossref
24. Langer R, Lipshitz Y, Halperin R, Pansky M, Bukovsky I, Sherman D. Long-term (10–15 years) follow-up after Burch colposuspension for urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12:323–6.
crossref
25. Cross CA, Cespedes RD, McGuire EJ. Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol. 1998; 159:1195–8.
crossref
26. Holmgren C, Nilsson S, Lanner L, Hellberg D. Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence–a longterm follow-up. Eur J Obstet Gynecol Reprod Biol. 2007; 132:121–5.
crossref
Go to : Goto

Table 1.
The preoperative patients characteristics
Characteristic  
Median age (range) 54 (34–81)
Menopausal patients (%) 46/87 (53)
No. of prior hysterectomy (%) 7/87 (8)
Median No. of vaginal deliveries (range) 2.1 (0–6)
Table 2.
The operative data
Postoperative results (sling only) Median (range)
Operation time (minutes) 22.4 (15–39)
Hemoglobin change (g/dl) 0.67 (0–2.3)
Hospital stay (days) 3 (2–6)
Follow up (total) (month) 4.5 (3–12)
Concomitant procedure No. of patients (%)
Sling alone 55 (63)
Cystocele repair 7 (8)
Rectocele repair 5 (6)
Cystocele, rectocele repair 14 (16)
Cystocele, rectocele repair, VTH 5 (6)
Cystocele, rectocele repair, LAVH c BSO, staging op. 1 (1)
Intraoperative and short-term No. of
complications patients (%)
Bladder perforation 0 (0)
De novo urgency (transient) 3 (3)
Weak stream 4 (5)
Hematoma in Retzius' space 0 (0)
Difficult emptying 2 (2)
Long-term complications No. of patients (%)
Urinary obstruction 0 (0)
Inguinal pain 0 (0)
Mesh erosion 0 (0)
Dyspareunia 0 (0)

VTH: vaginal total hysterectomy, LAVH: laparoscopic-assisted vaginal hysterectomy, BSO: bilateral salphingo-oophorectomy

Table 3.
The results of the preoperative and postoperative Incontinence Impact Questionnaire (IIQ)-7
IIQ-7 (%) Preoperative Postoperative p-value
Has urinary leakage and/or prolapse affected your:      
1. Household chores 1.60±0.96 0.07±0.30 ＜0.001
2. Physical reaction 1.64±0.85 0.10±0.34 ＜0.001
3. Entertainment activities 1.77±0.86 0.21±0.51 ＜0.001
4. Travel over 30 minutes away from home 1.38±0.99 0.09±0.33 ＜0.001
5. Social activities 1.68±0.88 0.14±0.44 ＜0.001
6. Emotional health (nervouness, depression, etc) 1.18±0.98 0.07±0.26 ＜0.001
7. Feeling frustrated 0.24±0.51 0.03±0.18 ＜0.001

p-value: paired t-test, Score: 0=not at all, 1=slightly, 2=moderately, 3=greatly

Table 4.
The results of the preoperative and postoperative Urogenital Distress Inventory (UDI)-6
  Preoperative Postoperative p-value
Do you experience, and, if so, how much are you bothered by:      
1. Frequent urination 1.62±1.00 0.21±0.51 ＜0.001
2. Leakage related to feeling of Urgency 0.51±0.76 0.28±0.48 　0.002
3. Leakage related to activity, coughing, or sneezing 2.38±0.70 0.13±0.39 ＜0.001
4. Small amounts of leakage (drops) 1.69±1.07 0.24±0.46 ＜0.001
5. Difficulty emptying bladder 1.53±0.99 0.11±0.39 ＜0.001
6. Pain or discomfort in lower abdominal or genital area 0.68±0.81 0.07±0.26 ＜0.001

p-value: paired t-test, Score: 0=not at all, 1=slightly, 2=moderately, 3=greatly

TOOLS
Similar articles