title: Effectiveness of transobturator tape in women with decreased urethral mobility.
abstract: OBJECTIVE
  To determine whether preoperative urethral mobility is associated with success of the transobturator insertion of suburethral polypropylene slings.
  
  
  METHODS
  A cohort of women who underwent a transobturator insertion of a suburethral polypropylene sling for urodynamic stress incontinence between October 2003 and January 2005 was prospectively assessed.
  
  
  RESULTS
  Of the 134 women in the study cohort, 107 (80%) provided postoperative data at a median followup interval of 10 months. Postoperatively, 92 (86%) reported complete resolution of stress urinary incontinence on the Urogenital Distress Inventory-6 questionnaire, and 15 (14%) reported persistent incontinence. The median preoperative urethral mobility was significantly decreased among women who were incontinent postoperatively compared to those who were continent (40 degrees [10-60] vs. 50 degrees [10-90], p=0.0049). Women with preoperative urethral mobility < 45 degrees were at least 4 times more likely to report postoperative incontinence compared with women with preoperative urethral mobility > or = 45 degrees (29.4% vs. 6.9%, RR 4.29, 95% CI 1.59-11.60, p = 0.005). In addition, women with preoperative urethral straining angles < 45 degrees from the horizontal were at least 5 times more likely to report postoperative incontinence compared with women with preoperative urethral straining angles > or = 45 degrees (41.7% vs. 8.7%, RR 5.21, 95% CI 1.88-14.42, p = 0.006). Neither patient age nor the concomitant performance of an anterior colporrhaphy affected these results.
  
  
  CONCLUSIONS
  Women with preoperative urethral mobility or preoperative urethral straining angles < 45 degrees appear to be at higher risk for failure following a transobturator insertion of a suburethral polypropylene sling.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, USA. minaglia@hawaii.edu
authors.forename: Steven
authors.initials: S
authors.lastname: Minaglia
authors.forename: Rebecca
authors.initials: R
authors.lastname: Urwitz-Lane
authors.forename: Micheline
authors.initials: M
authors.lastname: Wong
authors.forename: Begum
authors.initials: B
authors.lastname: Ozel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D053825:Suburethral Slings; D017211:Treatment Failure; D014521:Urethra / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D014563:Urodynamics