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Low-cost transobturator vaginal tape inside-out procedure for the treatment of female stress urinary incontinence using ordinary polypropylene mesh

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Abstract

Introduction and hypothesis

The aim of this study is to describe the use of ordinary polypropylene mesh and our modified helical passers through a transobturator vaginal tape inside-out technique (TVT-O) as a low-cost alternative to available commercial kits in the treatment of stress urinary incontinence (SUI) with evaluation of its long-term safety and efficacy. This is important in developing countries due to limited health care resources.

Methods

Tailored (11 × 1.5 cm) polypropylene tape was inserted in 59 women from June 2006 to June 2009 at the Urology Department, Cairo University Hospitals as an open prospective study. SUI was diagnosed by positive cough stress test (CST) and abdominal leak point pressure (ALPP). Patients with post-void residual urine (PVRU) > 100 ml, bladder capacity < 300 ml, or neurological lesions were excluded. The Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), urodynamic parameters, and other variables were compared pre- versus postoperatively with paired t, Wilcoxon signed rank, McNemar, or chi-square tests.

Results

The mean age was 47.47 ± 8.52 years. Twenty-one (35.6 %) patients had intrinsic sphincter deficiency (ISD). The mean operative time was 21.22 ± 4.26 min (15–30). Procedures for prolapse were done in four (6 %) patients. Complications were vaginal discharge (6 %), dyspareunia (1 %), groin pain (20 %), urinary tract infection (3 %), obstructive symptoms (1 %), accidental cut of polypropylene suture (1 %) and felt subcutaneous polypropylene sutures (3 %). We had no cases of erosions or de novo urgency. SUIQQ indices improved significantly, while urodynamic parameters showed no significant difference postoperatively. Of the patients, 54 (91 %) were cured and 3 (5 %) improved, while failure was detected in 2 (3 %) patients.

Conclusions

Our technique is safe with excellent 5-year results. It should be considered as a low-cost alternative to available commercial kits in the treatment of SUI mainly for public health systems with few financial resources.

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Abbreviations

ALPP:

Abdominal leak point pressure

CST:

Cough stress test

DO:

Detrusor overactivity

ISD:

Intrinsic sphincter deficiency

MUCP:

Maximum urethral closure pressure

Pdet Qmax :

Detrusor pressure at maximum flow rate

PVRU:

Post-void residual urine

Qmax :

Maximum flow rate

QOL:

Quality of life

SUI:

Stress urinary incontinence

SUIQQ:

Stress and Urge Incontinence and Quality of Life Questionnaire

TOT:

Transobturator vaginal tape outside-in

TVT:

Tension-free vaginal tape

TVT-O:

Transobturator vaginal tape inside-out

US:

Abdominal and pelvic ultrasound

UUI:

Urgency urinary incontinence

RCT:

Randomized controlled trial

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Authors and Affiliations

  1. Urology Department, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt

    Mohammed S. ElSheemy, Ragheb Elsergany & Ahmed ElShenoufy

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  1. Mohammed S. ElSheemy
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  2. Ragheb Elsergany
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  3. Ahmed ElShenoufy
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Correspondence to Mohammed S. ElSheemy.

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ElSheemy, M.S., Elsergany, R. & ElShenoufy, A. Low-cost transobturator vaginal tape inside-out procedure for the treatment of female stress urinary incontinence using ordinary polypropylene mesh. Int Urogynecol J 26, 577–584 (2015). https://doi.org/10.1007/s00192-014-2552-1

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  • DOI: https://doi.org/10.1007/s00192-014-2552-1

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