Tension-free transobturator vaginal tape and autologous rectus fascia transobturator vaginal sling for the treatment of urinary stress incontinence: a prospective clinical study

Abstract

Original Research ArticleTension-free transobturator vaginal tape and autologous rectus fascia transobturator vaginal sling for the treatment of urinary stress incontinence: a prospective clinical study Mervat A. Elsersy* INTRODUCTIONStress urinary incontinence (SUI) is a common disorder affecting adult females due to weak mechanisms of urethral closure. 1,2 Behavioral changes and pelvic floor muscle training are considered conservative nonsurgical options for treatment. [3][4][5] Tension-free vaginal tape has become a popular method for surgical treatment of urodynamically proven stress incontinence (USI), since it was introduced by Ulmsten in 1995. The retro pubic approach of tension-free vaginal tape (RT-TVT) procedure was widely accepted worldwide as the standard surgical treatment for SUI. 6 Tension free vaginal sling procedures had achieved good long-term success together with lower complication rates; but they had some failure rate due to either excessive or failure to achieve the desired tension, which resulted in voiding difficulties or urinary leakage persistence, respectively. 7Transobturator route (TVT-O) was considered as the second-generation, utilizing either outside-in or inside-out approaches, so avoiding the passage into the retro pubic ABSTRACT Background: A large proportion of adult women complain of urinary incontinence, which has considerable drawbacks on their quality of life and social incorporation in the community. Conservative measures had been tried for several decades but with limited efficacy in huge proportion of patients. Vaginal sling procedures, since it was introduced in medical field had achieved good success rates with low complication rates. However, they still cause problems. Since Ulmsten introduced the tension-free vaginal tape in 1995, it has become a popular method for surgical treatment of urodynamically proven USI. In this study, we are going to compare between tension-free Trans obturator vaginal tape (TVT-O) using synthetic polypropylene macro porous monofilament mesh and autologous rectus fascia Trans obturator sling. Methods: 80 patients had stress urinary incontinence were randomly assigned to either group (1) who underwent insertion of synthetic tension free vaginal tape using (Aris-Transobturator Sling System) or group to (2) to whom autologous rectus fascia transobturator vaginal sling was applied. Results: Objective and subjective cure rates were comparable in both groups, but patients in group (1) had shorter operative time and less duration of post-operative catheterization. Patients in group (1) were statistically more satisfied than patients in group (2). Conclusions: Both techniques are effective in the treatment of female stress incontinence.

Role of Incontinence Severity Index in Evaluating Severity and Impact of Treatment Of Stress Urinary Incontinence

“…[ 15 16 17 ] However, due to cases of mesh erosion and adverse publicity and their nonavailability in some countries, natural rectus fascial slings are becoming popular. [ 18 19 20 25 26 ] However, rectus fascial sling is a bigger operation then artificial tape and is associated with larger operation time and increased immediate morbidity. [ 18 19 20 ] Large systemic review and meta-analysis and of surgical treatment of SUI found Burch's colposuspension, rectus fascia sling, and tension-free tapes to be equally effective and safe.…”

“…[ 18 19 20 25 26 ] However, rectus fascial sling is a bigger operation then artificial tape and is associated with larger operation time and increased immediate morbidity. [ 18 19 20 ] Large systemic review and meta-analysis and of surgical treatment of SUI found Burch's colposuspension, rectus fascia sling, and tension-free tapes to be equally effective and safe. [ 27 ] Other large studies also found the tapes and other treatments effective.…”