Transobturator suburethral tapes in the management of urinary incontinence: success, safety and impact on sexual life

This study aims to assess transobturator tension-free vaginal tapes (TOT) in regard to subjective cure rates, patient satisfaction, long-term morbidity and impact on patients’ sexual life. It also aims to compare the safety profile of two TOTs: Obtape (outside-in technique) vs. TVT-O (inside-out technique). This is a retrospective study of all patients who had a TOT procedure for the management of urodynamic stress incontinence (USI) in a tertiary referral centre between July 2002 and January 2005. All patients identified from theatre records were sent an anonymous validated assessment questionnaire including the urinary domain of Birmingham Bowel and Urinary Symptoms Questionnaire, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Sexual Impact Questionnaire and a visual analogue scale (VAS) to assess patients’ satisfaction. Case notes were examined to ascertain preoperative urodynamic diagnosis and perioperative complications. Two hundred and seventy-six women were identified from theatre records: 94 patients underwent TVT-O and 182 underwent Obtape . Mean age was 49 (range 34–78) years, and mean parity was two (range: 0–6). There was no difference between groups in regard to body mass index, urodynamic diagnosis and previous incontinence surgery. Intraoperative complications included bladder injury 0.4%, urethral injury 0.7%, lateral vaginal tears 4.3% and blood loss >200 ml in 5.4%. There was no statistically significant difference in intraoperative ( p = 0.2) and early postoperative ( p = 0.65) complications between groups. Late postoperative complications were mainly related to the tape material and included de novo urgency (6.9%), vaginal erosions (5.1%) and ischiorectal abscess (1.1%). A significantly higher rate of late postoperative complications occurred in the Obtape group ( p = 0.047). Median follow-up was 28 ± standard deviation (SD) 4.8 (range 10–40) months. Subjective success rate, defined as absent or occasional episodes of incontinence according to the ICIQ-SF was 86% in the USI group compared with 52.4% in the mixed incontinence group ( p < 0.001). Following the operation, there was no significant change in patients’ sexual life as regards frequency of intercourse and pleasure and/or pain during penetration ( p = 1.000), whereas there was significant decrease in coital incontinence ( p < 0.0001). TOT is a relatively safe procedure in the treatment of USI and is associated with a high subjective success rate with a median follow-up of 28 months. Coital incontinence is likely to be cured, and the vast majority of women described an improvement or no change in their sexual life following the TOT procedure. There was no significant difference in the complication rates between the outside-in vs. the inside-out techniques; however, significantly more “tape-related complications” occurred in the Obtape group.