Korean J Urol.  2008 Dec;49(12):1119-1124.

Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence

• Lee SH
• Kim TB
• Kim KH
• Jung H
• Lee MS
• Yoon SJ

Abstract

PURPOSE: Canal transobturator tape(TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling(DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT.
MATERIALS AND METHODS
Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7(IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes.
RESULTS
The mean operative time for Canal TOT was 22.4 minutes(range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency(n=3), weak stream(n=4) and difficult emptying(n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair(n=7), rectocele repair(n=5), rectocele and cystocele repair(n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy(n=1). The average follow-up was 4.5 months(range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence.
CONCLUSIONS
Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate.

Keyword

Stress urinary incontinence; Suburethral sling

MeSH Terms

Cystocele
Female
Follow-Up Studies
Humans
Hysterectomy, Vaginal
Operative Time
Polypropylenes
Rectocele
Retrospective Studies
Suburethral Slings
Urinary Incontinence
Urodynamics
Polypropylenes

Reference

References

1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003; 61:37–49.

2. Blaivas JG, Romanzi LJ, Heritz DM. Urinary incontinence: pathophysiology, evaluation, treatment overview and nonsurgical management. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. editors.Campbell's urology. 7th ed.Philadelphia: Saunders;1998. p. 1007–43.

3. Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand. 1990; 153(Suppl):7–31.

4. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996; 7:81–6.

5. Rodriguez LV, Raz S. Polypropylene sling for the treatment of stress urinary incontinence. Urology. 2001; 58:783–5.

6. Rodriguez LV, Raz S. Prospective analysis of patients treated with a distal urethral polypropylene sling for symptoms of stress urinary incontinence: surgical outcome and satisfaction determined by patient driven questionnaires. J Urol. 2003; 170:857–63.

7. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995; 14:131–9.

8. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994; 3:291–306.

9. Lam TC, Hadley HR. Surgical procedures for uncomplicated (“routine”) female stress incontinence. Urol Clin North Am. 1991; 18:327–37.

10. Haab F, Zimmern PE, Leach GE. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management. J Urol. 1996; 156:3–17.

11. Yoo JW, Jung HC. Tension free vaginal tape procedure for the treatment of female stress urinary incontinence: 1 year follow up. Korean J Urol. 2001; 42:1058–62.

12. Paick JS, Ku JH, Shin JW, Son H, Oh SJ, Kim SW. Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure. J Urol. 2004; 172:1370–3.

13. Ku JH, Oh JG, Shin JW, Kim SW, Paick JS. Age is not a limiting factor for midurethral sling procedures in the elderly with urinary incontinence. Gynecol Obstet Invest. 2006; 61:194–9.

14. Zilbert AW, Farrell SA. External iliac artery laceration during tension free vaginal tape procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12:141–3.

15. Amna MB, Randrianantenaina A, Michel F. Colic perforation as a complication of tension-free vaginal tape procedure. J Urol. 2003; 170:2387.

16. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001; 11:1306–13.

17. Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:330–4.

18. Davila GW, Johnson JD, Serels S. Multicenter experience with the Monarc transobturator sling system to treat stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:460–5.

19. Seok NS, Suh HJ, Lee DH. Clinical outcome of transobturator Monarc procedures for treating of women with stress urinary incontinence: 2-year follow up. Korean J Urol. 2006; 47:835–40.

20. Mazouni C, Karsenty G, Bretelle F, Bladou F, Gamerre M, Serment G. Urinary complications and sexual function after the tension-free vaginal tape procedure. Acta Obstet Gynecol Scand. 2004; 83:955–61.

21. Whiteside JL, Walters MD. Anatomy of the obturator region: relations to a transobturator sling. Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15:223–6.

22. Rutman M, Itano N, Deng D, Raz S, Rodriguez LV. Longterm durability of the distal urethral polypropylene sling procedure for stress urinary incontinence: minimum 5-year followup of surgical outcome and satisfaction determined by patient reported questionnaires. J Urol. 2006; 175:610–3.

23. Andonian S, St-Denis B, Lemieux MC, Corcos J. Prospective clinical trial comparing Obtape and DUPS to TVT: one-year safety and efficacy results. Eur Urol. 2007; 52:245–51.

24. Langer R, Lipshitz Y, Halperin R, Pansky M, Bukovsky I, Sherman D. Long-term (10–15 years) follow-up after Burch colposuspension for urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12:323–6.

25. Cross CA, Cespedes RD, McGuire EJ. Our experience with pubovaginal slings in patients with stress urinary incontinence. J Urol. 1998; 159:1195–8.

26. Holmgren C, Nilsson S, Lanner L, Hellberg D. Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence–a longterm follow-up. Eur J Obstet Gynecol Reprod Biol. 2007; 132:121–5.