title: Evaluation of transobturator tension-free vaginal tapes in management of women with recurrent stress urinary incontinence.
abstract: OBJECTIVE
  To assess the efficacy of transobturator tapes in the treatment of women with recurrent urodynamic stress incontinence.
  
  
  METHODS
  We performed a secondary analysis of a prospective, randomized, single-blinded study. A total of 341 women were recruited (April 2005 and April 2007) and randomly assigned to undergo "inside-out" TVT-O or "outside-in" TOT-ARIS. Of these women, 46 had undergone ≥1 previous continence procedures and were included in the present study. The preoperative assessment included a urodynamic assessment and completion of validated symptom severity and quality-of-life questionnaires. The primary outcome was the patient-reported success rate at 1 year as assessed using the Patient Global Impression of Improvement (very much/much improved). The secondary outcomes included changes in quality of life, sexual function, the objective success rates defined as negative findings on the standard 1-hour pad test, and a comparison between both routes of transobturator tapes. Multivariate analysis was performed to identify the risk factors for failure.
  
  
  RESULTS
  All 46 women completed the 1-year follow-up period. The patient-reported success rate and objective cure rate was 69.6% and 76.5%, respectively, with no significant differences between the 2 transobturator routes (P = .104, odds ratio [OR] 2.933, 95% confidence interval [CI] 0.803-10.719; and P = .077, OR 4.524, 95% CI 0.849-24.109, respectively). Of the 46 women, 35 (76.1%) reported >10-point improvement on the total King's Health Questionnaire scores and 71% of sexually active women (n = 22) showed an improvement in the total 12-item Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire scores. On multivariate analysis, a maximal urethral closure pressure of <30 cm H(2)O was the only independent risk factor for failure (P = .016, OR 9.206, 95% CI 1.511-56.104).
  
  
  CONCLUSIONS
  Transobturator tapes have good patient-reported and objective success rates at 1 year of follow-up in women with previous failed incontinence surgery. A low maximal urethral closure pressure was the only independent predictor of failure.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom. m.abdelfattah@abdn.ac.u
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
authors.forename: Ian
authors.initials: I
authors.lastname: Ramsay
authors.forename: Stewart
authors.initials: S
authors.lastname: Pringle
authors.forename: Chris
authors.initials: C
authors.lastname: Hardwick
authors.forename: Hassan
authors.initials: H
authors.lastname: Ali
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.forename: Alyaa
authors.initials: A
authors.lastname: Mostafa
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016037:Single-Blind Method; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*