Shkarupa D, Kubin N, Peshkov N, Zaytseva A, Pisarev A, Gadzhiev N.
Hypothesis / aims of study
In Russia, the prevalence of stress urinary incontinence (SUI) has been estimated at 38% and is permanently increasing. Midurethral sling is the gold standard for management of SUI. The purpose of the study is to evaluate the objective and subjective results in the treatment of female SUI using transobturator tape (TOT).
Study design, materials and methods
We conducted a prospective study including 356 women from Feb. 2011 to Dec 2014 with SUI underwent transobturator midurethral sling implantation. For this purpose synthetic polypropylene non-absorbable mesh "UroSling" by "Lintex, LLC" Russian Federation was used. Only173 women were available for follow-up (173/356, 48.59%). Data included: pre-operative and post-operative evaluation including urofloumetry, postvoid residual (PVR) volume, cough test, 24-hour pad test, POP-Q exam, questionnaires ICIQ-SF, PFIQ-7, PISQ-12. Patients were followed 6 weeks, 6 months and each year thereafter. Mean follow-up duration was 28.21 months (from 13 to 52 months). Treatment failure was defined as positive cough test and leakage on 24-hour pad test more than 2 gr.
Results
The objective and subjective cure effects after operation were 89% and 86% respectively with mean follow-up 28.21 months. Comparison of the results of the questionnaires before and after operation were following: ICIQ-SF before 15.61±2.41 and after 4.77±3.51; PFIQ-7 before 25.05±17.02, after 14.15±7.29; PISQ-12 before 18.39±11.62, after 13.16±12.01. Total complication rate were 10.4%: among them were bladder perforation -3 (0.84%), erosion - 2 (0.56%), de novo urgency-13 (7.5%), urinary retention (PVR>50ml) - 9 (7.78%), dyspareunia - 1(0.97%). There are 4 (1.1%) women who required reoperation for recurrence of SUI following the first intervention, 3 (0.84%) women had long-term urinary retention (PVR>50ml) and required removal of the tape, 2 (0.56%) women required excision of vaginal erosion. Pelvic organ prolapse (≥grade 2 using POP-Q system) recurrence was revealed in 7 women (4.05%).
Interpretation of results
This study showed good results SUI treatment with an acceptable complication rate and recurrence risk.
Concluding message
More than 4 years’ experience confirms high safety and efficacy of the implantation transobturator tape for SUI treatment in particularly synthetic polypropylene non-absorbable meshes "UroSling".