title: Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study.
abstract: OBJECTIVE
  To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral urogynaecology centre.
  
  
  METHODS
  390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006.
  
  
  METHODS
  Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test.
  
  
  METHODS
  Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques.
  
  
  RESULTS
  241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures.
  
  
  CONCLUSIONS
  LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.
authors.affiliation: Urogynaecology Unit, South Glasgow University Hospitals NHS Trust, Glasgow, UK. mohamed.abdelfattah@sgh.scot.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Abdel-Fattah
authors.forename: I
authors.initials: I
authors.lastname: Ramsay
authors.forename: S
authors.initials: S
authors.lastname: Pringle
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries*; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods