Outside-In transobturator tape as a minimally insasive method for treatment of female stress urinary incontinence

ABSTRACT

Evaluation of the safety and the efficacy of a suburethral, tension-free vaginal tape placed perennially between the obturator foramens [outside-in technique]. Twenty two female patients with clinical and urodynamic diagnosis of pure stress urinary incontinence [SUI] were included in this study. Patient's age ranged from 30-65 years [median age 48]. Exclusion criteria included urge incontinence, Urodynamically proven detrusor overactivity, patients with vaginal prolapse [more than grade 1], and patients with residual urine > 20% of bladder capacity and/or weak flow [Q max < 15 ml/sec.]. The surgical procedure performed was the insertion of a tape coursed through the obturator membrane and the muscles over it via the lower segment of the obturator foramina to avoid the neurovascular bundles at the upper margin. The ends of the tape were tunneled percutanously with a tunneler. The retropubic space was not violated, and cystoscopy was not required. Patients were followed up for a mean of 18 months. Nineteen patients were cured with 86% success rate. Two were improved, while one patient showed no improvement. No signs of deterioration were recorded over the follow up period. No defects of healing or tape rejection or erosion were observed. All patients voided spontaneously post-operatively except in two patients who had reduced flow and detrusor hypotonia on pre-operative urodynamic study. De novo urge incontinence was recorded in one patient. Mean operative time was 25 minutes, and there was no report of intraoperative complications. Outside-in Transobturator vaginal tape is a minimally invasive procedure for treatment of female stress urinary incontinence with efficient, safe, and durable effect. The approach of the tape insertion minimizes the risk of trauma to internal organs, blood vessels, nerves, and urinary bladder. The retropubic space was not violated and Cystoscopy was not needed