Effects of Transobturator Adjustable Tape Sling Procedure on the Therapeutic Outcome in Patients with Stress Urinary Incontinence and Detrusor Underactivity

Abstract

Purpose: To evaluate the outcome and efficacy of transobturator adjustable (TOA) tape sling operations on women with intrinsic sphincter deficiency (ISD) and/or detrusor underactivity (DU) combined with stress urinary incontinence (SUI). Materials and Methods:This retrospective analysis comprised 60 TOA patients. 30 patients hadDU (Qmax < 15ml/s) and/or ISD (Valsalva leak point pressure;VLPP < 60cmH 2 0) on the preoperative UDS and the rest only had SUI. I-QoL, visual analog scale (VAS), Patient's Perception of Urgency Severity (PPUS), and Self-Assessment/Sandvik Questions were performed before and 1 year after surgery. The mesh tension was controlled at 1 day after surgery. The objective cure rate was defined as no leakage using the cough test with a full bladder. Results: Patients were divided into two groups: Group A:SUI with ISD and/or DU, n=30; Group B:only SUI without ISD and DU, n=30. The two groups showed a difference in Qmax and VLPP preoperatively. Objective success rates were 18 (60.0%) completely cured, 10 (33.3%) improved in Group A, and 23 (76.7%) completely cured, 7 (23.3%) improved in Group B. Three cases needed tape-tension adjustment due to urinary leakage one-day after surgery (2 in Group A, 1 in Group B). There was no postoperative urinary retention. Conclusions: After TOA for SUI with ISD and/or DU, 3 cases were needed tension adjustment after surgery. TOA procedures seem to be effective and safe, more clinical studies with long-term follow up are required for a definite conclusion.

Surgical results in women with detrusor underactivity and stress urinary incontinence undergoing suburethral sling procedure—Predictive factors for successful outcome

“…Although anti‐incontinence surgery may increase the risk of urinary retention or large PVR in women with both SUI and DU, many urologists take this challenge in achieving a satisfactory outcome. With adjustable or non‐adjustable retropubic suburethral sling or transobturator sling, the success rate of being dry or having improvement can be achieved in up to 80%–90% . However, postoperative voiding dysfunction remains a problem and a baseline Pdet of ≤12 cmH 2 O has been found to predict postoperative voiding dysfunction in women with SUI and DU who underwent transobturator mid‐urethral sling .…”

“…The sling tension can be adjusted the next day if patients still leak during ambulation or with increase in abdominal pressure. Recently, several types of adjustable suburethral slings have been developed with satisfactory outcome in women with SUI and DU . The evaluation of detrusor function preoperatively is important because the presence of DU might affect the postoperative voiding condition …”

“…Therefore, the suburethral procedure is not widely applied to treat SUI in patients with DU. Nevertheless, suburethral sling procedure has been tried in this specific patient group to eradicate SUI, and amazingly, a satisfactory outcome has been achieved although some of the patients need clean intermittent catheterization (CIC) after operation . Till now, there was little study to evaluate the predictive factors which may influence the surgical outcome in patients with SUI and DU.…”

Efficacy and safety of a readjustable midurethral sling (Remeex system) for stress urinary incontinence with female voiding dysfunction

“…De Leval [ 10 ] further improved the TOT method and developed the inside-out TVT obturator, and it became the new way of performing the sling operation. To date, numerous surgical techniques that can allow tension adjustment to reduce complications, such as urinary leakage or retention, have been introduced [ 11 ]. These include the Remeex system, transobturator adjustable tape, and adjustable transvaginal tape.…”

Clinical implications of underactive bladder

“…These meshes include transvaginal adjustable tape (Agency for Medical Innovations, Feldkirch, Austria), Regulation Mechanical External (Remeex; Neomedic International, Terrassa, Spain), and transobturator adjustable tape (TOA) (Agency for Medical Innovations, Feldkirch, Austria). Jo et al [ 49 ] described the success rate for TOA in SUI patients with DU (Qmax <15 mL/s) of 93.3%. Lee et al [ 50 ] performed a multicenter, prospective study of 65 women who underwent TOA due to severe SUI and combined SUI and voiding difficulty (Qmax ≤12 mL/s with a voided volume ≥100 mL).…”