Interest of Trans-Obturator Tape (Tot) in Stress Urinary Incontinence :Series of 173 Women and 1 Man

Abstract

TOT sub-urethral slings have an important role in terms of stress urinary incontinence. They have proven to have excellent functional results over time, with minimal or even exceptional complications. The technique of tape insertion is not complex but requires an experienced surgeon. We report a series of 173 women and 1 man, collected in the urology department of the Nord Franche-Comte Hospital inTrevenans (HNFC) between 03/2017 and 03/2022. The data were collected by a computer system set up at the NFC Hospital through the codes JDDB005 and JDDB007 designating the placement of TOT strips. The mean age was 53.03 years. Our patient complained of isolated SUI following radical prostatectomy surgery, wore one pad per day, had no post-void residual volume (PVR) and had a total improvement of his symptomatology after the installation of the Virtue-coloplast tape, no postoperative complications. At the 3-month postoperative consultation the patient reported a disappearance of the SUI with total satisfaction All our patients had stress urinary incontinence (SUI), of which 133 (76.87%) had isolated SUI, SUI associated with urgency with predominance of SUI in 40 patients (23.12%), with positive Bonney maneuver in all our patients. On gynecological examination, 15 patients had a grade 2 cystocele, 13 patients had a grade 1 cystocele and 90 patients had urethral hypermobility the post-void residual volume (PVR) measured by suprapubic ultrasound in the consultation was between 0cc and 110cc, the average maximum flow rate (average Qmax) was 17.5ml/s, and sphincter insufficiency (calculated by the 110-age formula) was noted in 83 patients on urodynamic examination. Failure of perineal rehabilitation in all our patients. The immediate postoperative period was marked by pain in 09 patients, malaise and vomiting in 05 patients, resulting in 24-hour hospitalization for monitoring. Intraoperatively, 03 patients had an estimated bleeding between 150 cc and 200 cc, a 24h hospitalization for monitoring was indicated. The follow-up appointment after 6 months showed persistence of SUI in 19 patients (10.98%), persistence of urgency in 15 patients (8.67%) and appearance of dysuria in 11 patients (6.35%). Decrease of the Qmax of all our patients postoperatively with average Qmax at 15.3ml/s compared to 17.5ml/s. Given the persistence of SUI, the decision was made to monitor and re-investigate for possible re-insertion of sub-urethral strips. Cystoscopy was performed in the 15 patients with persistent urgency and did not reveal any abnormalities decision to repeat the ECBU, continue the anticholinergic and monitoring with the attending physician.In our study, it was concluded that TOT type sub-urethral slings proved to be effective in the treatment of SUI with few complications, which is in agreement with other studies.