Objectives

1. One Year study evaluating symptomatic relief of patients undergoing trans-obturator tape procedure Dr SumairaArain, specialist trainee O&G; Dr Suzanne Robinson, FY2; Dr Kathryn Fishwick, consultant O&G Dewsbury District Hospital NHS Trust, West Yorkshire, UK. OPTIONALLOGO HERE OPTIONALLOGO HERE Methods Results Objectives Conclusions • Background and aims of study • The study aimed to evaluate the effectiveness of the Trans-Obturator Tape (TOT) procedure in treating urinary stress incontinence. • What is the Trans-Obturator Tape? • Trans-Obturator tape is a type of polypropylene tension free sling which is used to treat stress urinary incontinence caused by urethral hypermobility and intrinsic sphincter deficiency. • How does the tape work? • The tape supports the urethra, helping it to close more tightly during activities which raise abdominal pressure such as coughing and exercise. Once fitted, the tape stays in place permanently. • How is the trans-obturator tape fitted? • The procedure takes place under a general or spinal anaesthetic. A small incision (about 2 cm) is made in the vagina just below the opening of the urethra. A polypropylene tape is passed outwards through small (0.5 cm) incisions made in the inner thigh on either side • The tape is positioned without /tension under the urethra and acts as a ‘backboard’ to support the urethral continence mechanism (sphincter) when coughing. The incisions are the closed with dissolvable stitches which disappear within 2-3 weeks of surgery. The TVT-O procedure takes about 30 minutes. • Advantages of Trans-obturator Approach • Safer, faster, more efficient • Decreased risk of: bowel Injury, bladder injury, major bleeding • No Retro-pubic Needle Passage • No Abdominal Incisions • More Anatomic Position of Tape • The risk of bowel or bladder injury as well as the risk of major bleeding are significantly reduced compared to retropubic approaches • Risks and complications • Risks and complications are rare, however include the same risks associated with any tension-free mesh sling including: • Bleeding • Infection • Voiding dysfunction, • Urinary retention • Mesh erosion (in the vagina or urethra), pain in the vagina or groins. A one year retrospective study of 67 patients, presenting with urinary stress incontinence, was conducted in a urogynaecology clinic at Dewsbury District Hospital NHS Trust. West Yorkshire. The study was conducted between the period of August 2009 to July 2010. Data collection Data was obtained from patients’ urogynaecology out-patient clinic and operative procedure notes. Inclusion criteria. All patients demonstrating urinary stress incontinence on urodynamic studies and who agreed to undergo the Trans-Obturator Tape procedure were included in the study. Some of these patients underwent other procedures in the past for urodynamic stress incontinence with no improvement in their urinary incontinence symptoms. Post-procedure evaluation Following the Trans-Obturator Tape procedure, a post operative evaluation of all 67 patients was conducted. Patients were directly questioned in the urogynaecology out patient clinic. Evaluations were also made using a symptom diary and pad test when followed up six weeks post-operatively in the outpatient clinic. Data Collection Data was collected using a proforma with the following parameters 1.Age 2.Date of operation 3.Type of operation 4.Urodynamics prior to operation 5.Pad test prior to operation 6.Other surgical procedures prior to TOT 7.Perioperative complications 8.Post operative voiding difficulties 9.Follow up and results • The age of patients included in the study ranged from 30 to 80 years, with most patients falling between 50-60 years of age. • All TOT procedures were carried out by the same surgical team, essentially using the same surgical technique and same quality of tension free tape. • 13 patients had other procedures done at the time of the TOT procedure. Of these 5 patients had anterior repairs carried out. • Prior to the TOT procedure, all patients had urodynamic studies performed. • All patients had a post-operative cystoscopy/ urethroscopy, with none showing any injuries to the bladder or urethra. • The patients who had a single procedure i.e. TOT insertion were discharged home on the same day. The discharge of other patients was on the third post-operative day. One patients with multiple co-morbidities was discharged after 10 days. • Based upon the 6 week post operative evaluation and results obtained from the proforma questionnaire, 95% of patients reported improvements in their urinary stress incontinence symptoms and were happy with the results of the operation. • The study proved Trans-Obturator Tape procedure is effective treatment for urinary stress incontinence with excellent results and patient satisfaction. • Further, similar studies, with larger patient cohorts and better exclusion criteria, such as previous surgeries and co-morbidities, need to be done. • To show the true, long term improvements of symptoms in the patients included in this study, a future one year, five year and ten year follow up should be carried out. References 1) NICE Clinical guideline 40 (2006) Urinary incontinence The management of urinary incontinence in women 2) Delorme E. Droupy S. de Tayrac R. Delmas V. (2004) TransobturatorTape (Uratape): A New Minimally-Invasive Procedure to Treat Female Urinary Incontinence. European Urology 45 203–207 3) Hermieu JF. Messas A. Delmas V. (2003) Bladder injury after TVT transobturator. Prog. Urol. 13 :15-7 4) Abrams P. Cardozo L. Fall M. (2002) The standardisation of the terminology of lower urinart tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstret Gynecol. 187: 116-26