Modified Distal Urethral Polypropylene Sling (Canal transobturator tape ) : Efficacy in Persistent Stress Urinary Incontinence after Conventional Midurethral Sling

다국어 초록 (Multilingual Abstract)

Introduction: Despite reports of persistent stress urinary incontinence (SUI) in patients following midurethral sling (MUS), there has not been a widely accepted definition and cause of the condition. Mesh implanted prior to MUS procedure has been found to have migrated proximally in many cases. The aim of this study is to evaluate the efficacy of the modified distal urethral polypropylene sling, canal transobturator tape (TOT), in persistent stress urinary incontinence after conventional MUS procedure on the assumption that persistent SUI after MUS procedure is due to the location of the sling.

Methods: From January 2008 to April 2012, 31 female patients with SUI patients who underwent the canal TOT procedure presented with incontinence or lower urinary tract symptoms (LUTS). We identified patients who had been operated upon using conventional MUS at other medical facilities and in whose Valsalva leak pressure point less(VLPP) than 120 cmH2O by urodynamic study (UDS), and who were also diagnosed with persistent SUI. If vaginal or urethral mesh exposure was concomitant with persistent SUI, the mesh was removed completely or in part. Surgical procedures for canal TOT were identical to that of original TOT procedures, except in the number and location of the vaginal incisions. Incontinence Impact Questionnaire-Short form (IIQ-7), Urogenital Distress Inventory-Short Form (UDI-6) and Quality of Life (QoL) scores were assessed preoperatively and at three months postoperatively.

Results: There were no intraoperative or postoperative complications after canal TOT. Twenty-eight (90.3%) patients showed improvement in incontinence or other LUTS. Postoperative scores of IIQ-7 (0.65±0.48), UDI-6 (3.48±2.28) and QoL (2.4±1.3) were significantly decreased compared to preoperative scores (1.26±0.58, 7.52±4.30 and 3.82±1.10) (p<0.05).

Conclusions: Our results demonstrate that canal TOT may be an alternative in the treatment of persistent SUI after conventional MUS procedure. However, more studies and long-term outcomes of this treatment are needed to define definitive outcome criteria and to delineate the etiology of persistent SUI.

목차 (Table of Contents)

• 국문초록
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