Lower Urinary Tract Injuries After Transobturator Tape Insertion by Different Routes: A Large Retrospective Study

Abstract

A new approach to treating urodynamic stress incontinence (USI) is the transobturator tension-free vaginal tape (TOT). Inserting a suburethral tape at the mid-urethral level by the perineal route provides a minimally invasive means of reinforcing the structures that support the urethra. This approach, first described as the tension-free vaginal tape procedure, makes it unnecessary to gain blind entry into the retropubic space with the attendant risks of injuring the bladder, bowel, major blood vessels, or nerves.This retrospective cohort study was planned to determine the frequency of-and risk factors for-lower urinary tract (LUT) injuries in 389 women who, in the years 2002-2006, had a TOT procedure as treatment for USI at a tertiary referral urogynecology center. The outside-in technique was used in 241 cases, most often with Obtape®, while the remaining 148 women were operated on using the inside-out technique. In 70% of cases, the TOT procedure was primary surgery for USI. In 111 cases, another surgical procedure was carried out at the same time.Four LUT injuries were documented, 2 affecting the urethra and 2 the bladder. All 4 women had surgery using the outside-in technique, but this was not a statistically significant finding. Three of the 4 women with injuries underwent another procedure involving colporrhaphy. Both women with urethral injury underwent TOT surgery as a secondary procedure. In contrast, both those with bladder injuries were undergoing primary continence surgery. The overall incidence of LUT injury in this series was 1%.LUT injury is an infrequent complication of TOT procedures. In the present series of nearly 400 women, LUT injuries occurred only when using the outside-in technique. Intraoperative cystoscopy should be considered in selected cases only, but postoperative problems such as hematuria call for immediate cystoscopy. GYNECOLOGY Volume 62, Number 3 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe inability of colposcopy to reliably rule out cervical intraepithelial neoplasia (CIN) 2 or more advanced changes has complicated the management of women diagnosed colposcopically as having human papillomavirus (HPV) or CIN 1. This study assessed the risk of CIN 3 or cancer in a group of women given a colposcopic diagnosis of CIN 1 or less. The participants, with no past history of CIN, underwent colposcopy to evaluate abnormal cervical cytology in the form of atypical Office Gynecology 173 174 Obstetrical and Gynecological Survey Office Gynecology 175 176 Obstetrical and Gynecological Survey ABSTRACTMore than 10% of epithelial ovarian neoplasms are borderline ovarian tumors (BOTS), also known as ovarian tumors of low malignant potential. About one-fourth of them are found in potentially fertile women. Once thought to be a precursor of epithelial ovarian cancer, the BOT now is viewed as a biologically distinct entity. Five-year survival rates exceeding 95% are reported. Among 101 women operated on for BOT in the years 1992-2001 were 22 who had a fertility-preserving procedure in which at l...

Laparoscopic transvesical removal of erosive mesh after transobturator tape procedure

“…In contrast, in the TOT procedure there is little risk of bladder injury and routine intraoperative cystoscopy is not necessary 1,2 . However, several patients have experienced urinary tract injury after TOT surgery, 3–6 which may be derived from needle injury or late onset tape erosion.…”

Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse

“…Some surgeons may argue that cystoscopy is not routinely required during transobturator tape procedures and so may not be required during anterior mesh insertion. However, we have shown previously that women with significant prolapse and those with previous pelvic floor surgery are at higher risk of bladder injury at the time of transobturator tape insertion and recommended cystoscopy to this subgroup 12 . It is important to note that sites of the trocar insertion are slightly different in anterior mesh repair devices with the superior trocars being inserted at the level of the urethral meatus rather than the level of the clitoris and therefore are closer to the bladder during insertion.…”

Trans‐obturator suburethral tape for female stress incontinence: a cohort of 254 women with 1‐year to 2‐year follow‐up

“…Bladder injury and urinary retention are the most commonly reported early postoperative complications. Bladder perforation occurs less frequently than in the TVT procedure (overall mean incidence of 5.4%) (12), ranging between 0% and B1% (15,21,24). The 8 cases of bladder perforation (3.1%) in our series occurred during the learning phase with the TOT procedure.…”