Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up.
BACKGROUND
The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.


METHODS
It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris, Obtape, TVT-O). Follow-up information was available for 225 (96.6%) women.


RESULTS
There were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris, Obtape and TVT-O respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001).


CONCLUSIONS
Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
Department of Gynecology and Obstetrics, Division of Gynecology, Perineology Unit, University Hospitals of Geneva, University of Geneva, Switzerland. Isabelle.Kaelin@hcuge.ch
Isabelle
I
Kaelin-Gambirasio
Sandrine
S
Jacob
Michel
M
Boulvain
Jean-Bernard
JB
Dubuisson
Patrick
P
Dällenbach
D000368:Aged; D015331:Cohort Studies; D020878:Device Removal; D004414:Dyspareunia / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics