Tension-free transvaginal (TVT) and transobturator (TOT) tapes in women with multiple failed incontinence procedures or complex urogynaecological intervention

Summary 

Objectives

We report the outcomes of transvaginal (TVT)/transobturator (TOT) tape in women with multiple or complex urogynaecological intervention and persistent stress urinary incontinence (SUI).

Patients and methods

Thirty-seven patients with multiple procedures (median 3) or complex urogynaecological intervention for SUI, McGuire classified on video-urodynamics, underwent TVT (n=26) or TOT (n=11) placement. Patients categorised outcome as excellent, good or poor. Excellent was defined as dry, asymptomatic and completely satisfied. Good was defined as no SUI but residual or de novo urgency, or lack of complete satisfaction. Poor was defined as minimal improvement of symptoms. All patients with residual symptoms underwent repeat video-urodynamics.

Results

Mean follow-up was 37 months. Thirty-two patients (86%) were cured of SUI. According to the outcome definitions 46% were excellent, 30% good and 24% poor. Of six patients with McGuire type III SUI, five (83.3%) had persistent SUI, accounting for all with persistent SUI. Bladder perforation and de novo urgency occurred in 11.5% and 19.2% of TVT, but none of those with TOT. Temporary voiding difficulty occurred in 11.5% TVT and 9.1% TOT. Protracted retention occurred in two TVT cases, of which one required tape division.

Conclusions

TVT/TOT cured SUI in 86% of patients with multiple SUI procedures or complex urogynaecological intervention, with minimal morbidity. Subjective outcomes were less than objective outcomes mainly due to urgency. The TOT route reduced the risk of bladder injury and de novo urgency. Type III SUI on preoperative urodynamics predicted failure.

Keywords: Bladder, Vagina, Incontinence, Stress, Re-operation