Transobturator-tape outside in (TVT-O) as saviour for female stress urinary incontince without available cystoscope for gynecologist: A case series

Abstract

SUI affects quality of life. Ulmsten and Petros reported mid urethral sling operations using Tension-free Vaginal Tape (TVT) and Delorme used Transobturator Tape (TOT). Cystoscopy is often used in retropubic sling procedures to identify lower urinary tract injury. Cystoscopy protects patients and accurately identifies iatrogenic injuries. The goal is to evaluate the efficacy of a standard Trans-Obturator (TOT-O) mid urethral sling for female Stress Urinary Incontinence (SUI) without intraoperative cystoscopy. A total of 120 female SUI patients from 2014 to 2019 were studied. Stress-related incontinence and diaper use were preoperative variables. Under spinal anesthesia, the procedure improved stress incontinence, sexual dysfunction, complications, and overall satisfaction. All patients improved after the procedure, and 116 (96.6%) completely resolved. Post-operative complications included urinary retention in 3 patients (2.5%), increased daytime urinary frequency in 3 (2.5%), urge incontinence in 4 (3.33%), groin/thigh pain in 2 (1.66%), and local mesh excision for mesh erosion in 1 (0.83%). Open EPI software calculated insignificant p values for clinical profile and satisfaction with symptom resolution. Brief Index of SF for Women was used to assess sexual function. At 6-month followup, all patients were satisfied with sexual function. TOT-O technique for female stress urinary incontinence is easy to learn and reproducible for beginners.

Keywords

• Stress urinary incontinence
• voiding dysfunction
• trans obturator-tape “outside in” (TOT-O)
• intraoperative cystoscopy