The Effectiveness And Complications of Transobturator Tape Operation: Analysis of 120 cases

Abstract

Amaç: Bu çalışmanın amacı; minimal-invazif bir teknik olarak tanımlanan transobturator tape (TOT) operasyonunun etkinliğinin ve komplikasyonlarının değerlendirilmesidir. Yöntemler: 2011-2012 yılları arasında saf stres üriner inkontinans (SÜİ) veya mikst üriner inkontinans (MÜİ) nedeniyle subüretral gergisiz vajinal TOT operasyonu yapılan 120 hasta çalışmaya alındı. Tüm operasyonlar dıştan-içe Obtryx™ (Boston Scientific, Natick, MA, USA) marka kit ile gerçekleştirildi. Hastalar postoperatif 1. ve 3. aylarda kontrollere çağrılarak ürojinekolojik muayeneleri yapıldı, operasyon başarısı ve perioperatif komplikasyonları değerlendirildi. Bulgular: Olguların tamamı multipardı ve yaş ortalaması 49,6±11,3 idi. Hastaların 47 (%39,2) tanesi postmenopozal, 73 (%60,8) tanesi ise premenopozal idi. Transobturator tape operasyonu olan olgulardan 36 (%30) tanesi ek cerrahi operasyon geçirdi. Olguların objektif kür oranı %91,7 ve subjektif kür oranı %88,3 idi. Tedavi başarısızlığı %8,3 olarak bulundu. Transobturator tape operasyonuna bağlı kan transfüzyonu gereksinimi sadece 1 hastada gerekli oldu. İntraoperatif 200ml üzerinde kanama 4 hastada izlendi. Vajinal forniks perforasyonu sadece 3 vakada izlendi. Perineal ağrı 2 olguda mevcuttu. De novo urge inkontinans postoperatif 5 hastada izlendi ve antikolinerjikler ile tedavi edildi. Vajinal erozyon görülen 4 hastada mesh eksize edildi ve vajen mukozası tekrar sütüre edildi. Sonuç: Stres üriner inkontinans cerrahi tedavisinde minimalinvazif, komplikasyon oranı düşük ve kür oranı yüksek bir yöntem olan transobturator tape operasyonu diğer tekniklere üstünlük sağlamıştır. Cerrahi tecrübe arttıkça komplikasyon oranları azalmakta ve bunların yönetimi kolaylaşmakta-dır.Objective: The aim of this study is to evaluate the effectiveness and complications of TOT (trans-obturator tape) operation which is a minimally-invasive technique. Methods: 120 patients who had suburethral tension-free vaginal TOT operation due to pure stress urinary incontinence (SUI) or mixt urinary incontinence (MUI) between 2011-2012 were reviewed. All of the operations were performed outside to inside with the Obtryx™ (Boston Scientific, Natick, MA, USA) trademark kit. Postoperatively patients were called at 1st and 3rd months; urogynecologic examinations were done, the success and perioperative complications of the operations were evaluated Results: All of the patients were multiparaous and median age was 49,6±11,3 years. Forty-seven (%39.2) patients were postmenaupausal and thirty-six patients (%30) who had TOT operation had extra surgery. Objective cure rates of the patients were %91.7 and subjective cure rates of the patients were %88.3. Treatment failure was %8.3. Only one patient had blood transfusion requirement due to TOT operation. Intraoperatively, 4 patients had bleeding more than 200 ml. Three patients had vaginal fornix perforation. Two patients had perineal pain. De novo urge incontinence was seen in 5 patients postoperatively and was treated with anticholinergic drugs. Mesh excisions were done...

Early complications of the transobturator tape and mini sling procedure

“…De novo urge incontinence effects the life quality negatively and de novo urge incontinence rate was low (4,2 %) in the TOT group in the study of Afflar et al and this rate was similar with the literature (12,16,17) .…”

“…None of the cases in the mini sling group developed hemorrhage over 200 ml. Afflar et al reported that only one patient required transfusion and haematoma didn't occur in this case (12) . They reported the rate of hemorrhage over 200 ml as 3,3 % and this rate overlaps Early complications of the transobturator tape and mini sling procedure with the findings of Abdel-Fattah et.al (13) .…”

“…Afflar et al reported that 3,3 % of the patients who underwent the TOT operation, developed early vaginal erosion complication (12) . Our early vaginal erosion rates were 4,6% (6 cases) and 11,9 % (18 cases) in the TOT and mini sling groups, respectively.…”

“…During learning process complication rates decreases and the management of the complications become easier with surgical experience (12) . In our study, all the operations were performed by the same surgeon and by the help of different assistants under the supervision of the aforementioned surgeon.…”

Transvaginal repair of unrecognized bladder injury after transobturator tape surgery

“…[2] Though it is a minimally invasive method, complications such as vaginal perforation, de novo incontinence, perineal pain, and vaginal erosion can be seen. [3] Bladder injuries is one of the rarely reported challenging complications that might occur after TOT. [4] Case presentation Our case presentation was written after approval of the patient was obtained.…”