Long-term outcome of transobturator tape (TOT) for treatment of stress urinary incontinence in females with neuropathic bladders.
METHODS
Retrospective review of prospectively collected data.


OBJECTIVE
Stress urinary incontinence (SUI) is a cause of significant distress in women with neurogenic bladder dysfunction (NBD) due to spinal cord injury (SCI). Transobturator tape (TOT) has not previously been studied in this select group for cure of SUI. We aim to determine the long-term safety and efficacy of TOT in SCI patients with NBD and SUI.


METHODS
London, the United Kingdom.


METHODS
All patients undergoing TOT between 2005 and 2013 were identified (27 patients). All patients had pre-operative videocystometrogram (VCMG) and all had VCMG-proven SUI. Mean follow-up was 5.2 years. Patient-reported leakage, satisfaction, change in bladder management, complications and de novo overactive bladder (OAB) were recorded.


RESULTS
Mean age was 56 years (range 30-82) with complete follow-up. Twenty-two patients (81.5%) reported complete dryness from SUI post surgery. One patient (3.7%) reported SUI only when her bladder was very full but was satisfied. Twenty-three patients (85.2%) were happy. Four patients (14.8%) remained wet. Twenty-five patients (92.6%) had no change in bladder management. Two out of five patients (40%) who voided by straining prior to surgery required clean intermittent self-catheterisation (CISC) post-operatively. Two patients (7.4%) developed de novo OAB. No bladder or vaginal injuries, tape erosions or urethral obstruction were seen. Three patients (11.1%) had transient thigh pain.


CONCLUSIONS
In women with NBD and SUI, TOT should be considered safe and effective with very good medium/long-term outcomes. There may be an increased risk of CISC in women who void by straining pre-operatively.
1] Department of Neurourology, Royal National Orthopaedic Hospital, London, UK [2] Department of Urology, University College Hospital, London, UK.
G S
GS
Losco
Department of Neurourology, Royal National Orthopaedic Hospital, London, UK.
J R
JR
Burki
Department of Neurourology, Royal National Orthopaedic Hospital, London, UK.
Y A I
YA
Omar
1] Department of Neurourology, Royal National Orthopaedic Hospital, London, UK [2] Department of Urology, University College Hospital, London, UK.
P J R
PJ
Shah
1] Department of Neurourology, Royal National Orthopaedic Hospital, London, UK [2] Department of Urology, University College Hospital, London, UK.
R
R
Hamid
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013119:Spinal Cord Injuries / Q000150:complications; D053825:Suburethral Slings / Q000009:adverse effects; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods