Modified transobturator tape (canal transobturator tape) surgery for female stress urinary incontinence.
OBJECTIVE
To mitigate TOT complications we designed a modified TOT technique called canal TOT. We describe this new technique and evaluate its feasibility.


METHODS
Between October 2006 and June 2007, 105 consecutive women with stress urinary incontinence underwent a canal TOT procedure. Two oblique lateral incisions were made in the anterior vaginal wall and a suburethral canal was created between the incisions. Mesh was transferred beneath the canal. The subsequent canal TOT surgical steps were identical to those of the original TOT procedure. All patients were evaluated by urological examination and self-assessment questionnaires (Incontinence Impact Questionnaire-Short Form and Urogenital Distress Inventory-Short Form) preoperatively and 12 months postoperatively. Reportedly dyspareunia developed after the operation.


RESULTS
A minimum 1-year followup was available in 99 patients. Median operative time was 25 minutes (range 15 to 50). No mesh erosion, retropubic hematoma or complete bladder retention developed. Transient postoperative voiding dysfunction and transient de novo urgency were observed in 2 (2.0%) and 8 patients (8.1%), respectively. Dyspareunia developed after surgery in 4 patients (4.0%). Postoperatively Incontinence Impact Questionnaire-Short Form and Urogenital Distress Inventory-Short Form scores decreased significantly (p <0.05). Objective and subjective cure rates were 98.0% and 89.9%, respectively.


CONCLUSIONS
The canal TOT procedure is feasible and effective for mitigating the complications of the original TOT procedure. This technique might be especially useful in patients with cystocele because of the paravaginal defect as well as in patients with obesity or prior vaginal surgery. However, a large-scale and long-term followup study is required to verify the effectiveness of this technique.
Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jung Hun
JH
Lee
Hyo Jin
HJ
Yoon
Su Jin
SJ
Lee
Kye Hyun
KH
Kim
Joong Sub
JS
Choi
Kyo Won
KW
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods