Long-term outcome of transobturator tape (TOT) for treatment of stress urinary incontinence in females with neuropathic bladders

• Published in: Spinal cord 2015-07, Vol.53 (7), p.544-546
• Main Authors: Losco, G S, Burki, J R, Omar, Y A I, Shah, P J R, Hamid, R
• Format: Article
• Language: English
• Subjects: 692/699/2768/1337; 692/699/2768/587; Adult; Aged; Aged, 80 and over; Anatomy; Biomedical and Life Sciences; Biomedicine; Female; Follow-Up Studies; Human Physiology; Humans; Middle Aged; Neurochemistry; Neuropsychology; Neurosciences; original-article; Outcome Assessment (Health Care); Spinal Cord Injuries - complications; Suburethral Slings - adverse effects; Urinary Bladder, Neurogenic - complications; Urinary Bladder, Neurogenic - etiology; Urinary Incontinence, Stress - etiology; Urinary Incontinence, Stress - surgery; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - instrumentation; Urologic Surgical Procedures - methods
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sc.2015.70

Study design: Retrospective review of prospectively collected data. Objectives: Stress urinary incontinence (SUI) is a cause of significant distress in women with neurogenic bladder dysfunction (NBD) due to spinal cord injury (SCI). Transobturator tape (TOT) has not previously been studied in this select group for cure of SUI. We aim to determine the long-term safety and efficacy of TOT in SCI patients with NBD and SUI. Setting: London, the United Kingdom. Methods: All patients undergoing TOT between 2005 and 2013 were identified (27 patients). All patients had pre-operative videocystometrogram (VCMG) and all had VCMG-proven SUI. Mean follow-up was 5.2 years. Patient-reported leakage, satisfaction, change in bladder management, complications and de novo overactive bladder (OAB) were recorded. Results: Mean age was 56 years (range 30–82) with complete follow-up. Twenty-two patients (81.5%) reported complete dryness from SUI post surgery. One patient (3.7%) reported SUI only when her bladder was very full but was satisfied. Twenty-three patients (85.2%) were happy. Four patients (14.8%) remained wet. Twenty-five patients (92.6%) had no change in bladder management. Two out of five patients (40%) who voided by straining prior to surgery required clean intermittent self-catheterisation (CISC) post-operatively. Two patients (7.4%) developed de novo OAB. No bladder or vaginal injuries, tape erosions or urethral obstruction were seen. Three patients (11.1%) had transient thigh pain. Conclusion: In women with NBD and SUI, TOT should be considered safe and effective with very good medium/long-term outcomes. There may be an increased risk of CISC in women who void by straining pre-operatively.