N60 Treatment of the stress incontinence using different types of Trans Obturator Tape (TOT) in women – analysis of failures after surgery

The estimation of the efficacy of different types of trans obturator tape in the treatment of the stress urinary incontinence in women and the analysis of the causes of failure after surgery.

Between October 2003 and June 2008, 160 TOT (outside – inside) procedures were performed. The following tape types were used: Obtape (Porges-Mentor) 70, Aris (Coloplast) 84, Monarc (AMS) 5 and Pelvicol 1. Average age of the patients was 56 years (40–77 years). Max flow rate (Q max) was on average 29.4 ml/sec before the procedure. The follow-up was 6–62 months, 27 on average. In case of a failure after the procedure, gynecological examination, cystoscopy and again a urodynamical examination was performed.

139 (86.9%) of the patients were cured completely – continence was defined as a lack of any involuntary leakage of urine and ceasing of sanitary pads use. In 14 (8.75%) patients, the recurrence of stress incontinence (SUI), in 2 patients a mixed urinary incontinence and in 5 (3.12%), symptoms of overactive bladder with urge incontinence was found. Among the patients with recurring SUI and mixed urinary incontinence, four (25%) had in the past one or more surgeries of the pelvis floor, one patient one year after procedure was pregnant with a Caesarean section birth, one had a small gynecological procedure (vagina polipus removing) in the third year since the tape implantation and this worsened continence. Average age of the patients with the recurrence of the incontinence was 59 years. Tape extrusion into vagina happened in 4 (2.5%) patients. In two cases this was the Obtape (on 70 procedures) (2.8%) and in two Aris (on 84 procedures) (2.4%). All extrusions were on anterolateral vagina wall. In two patients, the first symptome of the tape extrusion was urinary incontinence recurrence, and two had no symptoms at all. In 7 (4.4%) patients, a postvoiding residual urine with urethra obstruction (Qmax <15 ml/s) was found. Three (1.9%) complete urinary retention happened, one in a patient with neurogenic bladder. one in patient with hypofunction of the detrusor – the tape was removed 5 months after the primary procedure, without incontinence recurrence. One patient, 3 months after CIC voids normally.

1. TOT is effective method of treatment of SUI in a medium time follow-up – above 85% patients are completely cured. 2. The type of the used tape does not impact the percentage of the patients that are fully cured of SUI and does not impact the risk of the vagina tape extrusion. 3. The recurrence of the urinary incontinence could be the first symptom of the tape extrusion. 4. Having surgeries of the pelvis floor in the past and second gynecological procedures after the tape implantation are a potential cause of recurrence of SUI.