Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study

Abstract

Objectives To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure.Design Retrospective cohort study.Setting Tertiary referral urogynaecology centre.Population 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006.Methods Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test.Main outcome measures Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques.Results 241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures.Conclusion LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.Keywords Bladder injuries, lower urinary tract injury, transobturator tension-free vaginal tapes, urethral injuries, urodynamic stress incontinence.Please cite this paper as: Abdel-Fattah M, Ramsay I, Pringle S. Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study.

Unrecognized bladder perforation with mid‐urethral slings

“…In a meta-analysis of complications reported in 1854 patients, bladder perforation was most common, occurring in 3.5% of retropubic sling insertions and in 0.2% of procedures using the transobturator route [3], although incidences as high as 24% have been reported [4]. Although it has been stated that bladder perforation only occurs during the 'outside-in' technique [2,5], there is at least one report to the contrary [6] and it appears likely that complications are under reported [7].…”

“…However, bladder perforations are encountered with the transobturator route, despite anatomical studies suggesting that this route does not traverse the pelvis so that bladder perforation should be impossible [12]. Authors reporting on cases of missed or eroded intravesical sling material propose that cystoscopy should be anything from 'considered in selected cases' [5] to 'mandatory' citing the negligible additional morbidity associated with cystoscopy [13,14].…”

Transobturator tape for female stress incontinence: follow-up after 24 months

“…After performing 390 cases of TOT by different routes, Abdel-Fattah and colleagues found that lower urinary tract injury only occurred with the outside-in technique. 10 Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures 10 In a recent literature review by Sivanesan and colleagues, several cases of bladder injury were reported; they recommend cystoscopy in cases of associated pelvic surgery or presence of prolapse, previous retropubic surgery or in cases where it is difficult to insert the tapes. 11 In our practice we are considering abandoning the cystoscopic examination, except in cases of pelvic prolapsed.…”

Perforación de la uretra proximal durante TVT-O, en paciente con desviación uretral secundaria a cirugía de Burch fallida

“…Una publicación de Abdel-Fattah y colaboradores 10 , durante el 2006, evidenció que las únicas 2 perforaciones uretrales ocurridas durante una serie de 390 operaciones de TOT, ocurrieron en pacientes con antecedente de cirugía previa. El presente caso parece aportar a la idea, de la necesidad de realizar una cistoscopia en las operaciones de TOT o TVT-O realizadas en paciente previamente intervenidas, por existir un pequeño riesgo de perforación uretral.…”