Correction of female SUI by trans-obturator tape: technique and results. Our experience

Aim. The aim of our study was the assessment of safety and efficacy of a minimally invasive approach in treatment of female stress urinary incontinence (SUI), placing a trans-obturator tape, in order to support the mid-urethra and to correct the SUI. Materials and methods. Our study was a retrospective observational one. Our experience is based on the analysis of 29 patients enrolled between January 2009 and October 2011, suffering from SUI with urethral hypermobility. The primary outcome is bhe complete bladder continence, measured by anamnestic and physical examination with stress test. Other analyzed variables were mean time of surgery and mean time of hospitalization. The follow-up visits were planned at 3 and 6 months after surgery. At each visit, patients underwent anamnestic and physical examination with stress test. Statistical analysis was performed with SPSS 18.0. All data are presented as mean ± standard deviation (SD) (range) or absolute frequency (percentage). Results. Mean time of surgery was 25.8 ± 5 minutes (range 20- 45 minutes) and mean hospitalization time was 3.1 ± 1 days (range 2-6 days). There were no bladder perforations or substantial blood loss. There were not observed cases of hematuria, fever or urinary retention during postoperative period. There was one case of laceration of bladder neck, repaired during surgery. After 3 months of follow-up all patients were continent. After 6 months of follow-up, 24 out of 29 patients (82.8%) had no urinary losses; 3 out of 29 (10.3%) reported improvements, but with persistence of a lower degree of incontinence, occasionally requiring use of pads. Other 2 patients (6.9%), who previously suffered from mixed incontinence, showed, after treatment, principally UUI symptoms (Urge Urinary Incontinence). Conclusions. The trans-obturator approach is undoubtedly an effective and safe surgical option to be taken into account when we move towards a surgical correction of SUI. The short hospitalization time allows a rapid recovery of bladder motility and spontaneous micturition, with reduced or absent bladder irritative symptoms. Further results will be available after a longer period of followup, with urodynamic examination, ultrasound evaluation and randomized controlled trials.