Urethral slings placed by the transobturator approach: Evolution in the technique and review of the Literature

Abstract

Midurethral slings have proven to be efficacious in the surgical treatment of stress urinary incontinence (SUI) in women. A relatively new approach to the midurethral sling technique is the transobturator route for placement of the sling. This approach offers the theoretical safety advantage of avoiding the retroperitoneal space. The procedure has been pioneered in Europe and is now being practiced in the United States. In this article, we describe the theory behind urethral slings for SUI, the anatomy of the obturator canal, and early data on the safety and efficacy of transobturator urethral slings in the treatment of SUI.

Tension-free obturator tape (Monarc Subfascial Hammock) in patients with or without associated procedures

“…Anatomic studies rule out the theoretical risk of lesions to the obturator pedicle [2]. A recent review of the literature confirms the safety and efficacy of transobturator urethral slings in the treatment of stress urinary incontinence [16]. In our series, we were able to observe low surgical morbidity in 341 cases.…”

Advances in female stress urinary incontinence: mid‐urethral slings

“…In an attempt to obviate the need for the secondary incision to harvest fascia, many have evaluated the efficacy of cadaveric fascia, xenografts, and synthetic materials, e.g. Mersilene, Gortex, silicone, and polypropylene, as the sling material [2,3,7].…”

“…The efficacy, simplicity and minimal invasiveness of these procedures led to other mid‐urethral procedures, such as the transobturator tape (TOT) technique, and more recently the prepubic TVT. All of these procedures keep the same principles of mid‐urethral, tension‐free placement of a synthetic sling material [2,8–11].…”

“…Although retropubic mid‐urethral sling placement is very effective and well tolerated, several complications have been reported, mostly related to the blind passage of trocars through the retropubic space. The most common complication, bladder perforation, has a reported incidence of 1–23%[2,23]. Other complications include pelvic haematoma, infection, urinary retention requiring temporary catheterization or tape transaction, de novo detrusor overactivity, tape erosion into the urinary tract, and tape extrusion into vagina.…”

“…SUI can affect any age group, but is most often a disease of older, parous women. Vaginal delivery is a predisposing factor, as are age, obesity and the oestrogen‐deficient state of menopause [2,3].…”