Evaluation of transobturator tension-free vaginal tapes in the management of women with mixed urinary incontinence: one-year outcomes

• Published in: American journal of obstetrics and gynecology 2011-08, Vol.205 (2), p.150.e1-150.e6
• Main Authors: Abdel-fattah, Mohamed, MRCOG, Mostafa, Alyaa, MB BCh, Young, David, PhD, Ramsay, Ian, MRCOG
• Format: Article
• Language: English
• Subjects: Adult; Aged; ARIS; Confidence Intervals; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Middle Aged; midurethral slings; mixed urinary incontinence; Obstetrics and Gynecology; Odds Ratio; Patient Satisfaction - statistics & numerical data; Preoperative Care - methods; Prospective Studies; Quality of Life; Risk Assessment; Severity of Illness Index; Single-Blind Method; Suburethral Slings; Time Factors; Treatment Outcome; TVT-O; Urinary Incontinence - diagnosis; Urinary Incontinence - surgery; Urinary Incontinence, Stress - diagnosis; Urinary Incontinence, Stress - surgery; Urinary Incontinence, Urge - diagnosis; Urinary Incontinence, Urge - surgery; Urodynamics
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2011.03.018

Objective To assess the efficacy of transobturator tapes in the management of women with urodynamic mixed urinary incontinence (UI). Study Design A secondary analysis of a prospective randomized study; 83 women with mixed UI on urodynamics and predominant stress UI symptoms were recruited and randomly assigned to undergo “outside-in” or inside-out transobturator tapes. Preoperative assessment included urodynamic assessment and completion of validated symptom severity and quality of life (QoL) questionnaires. The primary outcome was patient-reported success rates at 1-year as assessed by the Patient Global Impression of Improvement (very much/much improved). Secondary outcomes included changes in preoperative urgency/urgency incontinence, changes in QoL scores and comparison between the 2 types of transobturator tapes. Results Seventy-seven women completed 1-year follow-up (outside-in [n = 42] vs inside-out [n = 35]). The patient-reported success rate and objective cure rate were 75% and 90%, respectively. At 1-year follow-up; 40 women (52%) and 31 women (57.4%) reported cure in their preoperative urgency and urgency incontinence, respectively. A total of 74% reported ≥10 point improvement in QoL scores. Conclusion In women with urodynamic mixed incontinence and predominant stress UI, transobturator tapes were associated with good patient-reported success rate at 1 year. Urgency/ urgency incontinence are cured in over 50% of women.