title: Both the middle and distal sections of the urethra may be regarded as optimal targets for 'outside-in' transobturator tape placement.
abstract: OBJECTIVE
  To investigate whether the position of the tape under the urethra may influence 'outside-in' transobturator sling (TOT) outcome.
  
  
  METHODS
  The study comprised 141 women who underwent TOT for clinically and urodynamically proved stress urinary incontinence. The postoperative ultrasound examination with an endovaginal biplane probe was performed before discharging the patients from hospital. The measurements obtained described the position of the tape relative to the urethra and pubic symphysis, as well as anatomical relationships in the anterior compartment.
  
  
  RESULTS
  Ninety-six (68.1 %) patients were cured, 27 (19.1 %) significantly improved, and in 18 cases (12.7 %), the surgery failed. The tape position under the midurethra (40-70th percentile of the urethral length) or distal urethra (>70th percentile) coincided with better results (cure rate 67.1 and 82.4 %, respectively) than the location in the proximity of the bladder neck (<40th percentile) (21.4 % cured, p = 0.0015 and p < 0.001, respectively). However, the risk of failure was the lowest when the tape was located under the distal urethra. Other ultrasonographic findings were not related to treatment results.
  
  
  CONCLUSIONS
  The highest failure rate for 'outside-in' TOT is associated with the location of the tape under the proximal third of the urethra. Both the middle and distal sections of the urethra may be regarded as targets for transobturator tape placement.
authors: 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland, mbogusiewicz@yahoo.com.
authors: Michał
authors: M
authors: Bogusiewicz
authors: Marta
authors: M
authors: Monist
authors: Krzysztof
authors: K
authors: Gałczyński
authors: Magdalena
authors: M
authors: Woźniak
authors: Andrzej P
authors: AP
authors: Wieczorek
authors: Tomasz
authors: T
authors: Rechberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation; D012307:Risk Factors; D053825:Suburethral Slings; D017211:Treatment Failure; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging* / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*