Complications Associated With Transobturator Sling Procedures
Complications Associated With Transobturator Sling Procedures
Backround: The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.
Methods: It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris, Obtape, TVT-O). Follow-up information was available for 225 (96.6%) women.
Results: There were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris, Obtape and TVT-O respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05–0.38, P < 0.001).
Conclusion: Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
Urinary incontinence is a major public health problem. In Europe, it is estimated to affect up to one third of women older than the age of 18 years. The prevalence increases with age and reaches 45% at 60 years. In 1995, the tension-free-vaginal-tape (TVT) procedure was introduced and has revolutionized the surgical treatment of female stress urinary incontinence (SUI) due to its simplicity, efficiency and minimal invasiveness. However patients can be exposed to several complications. One category of complications is associated with the blind passage of the tape through the retropubic space causing bladder or bowel perforation, or vascular injuries. The other category is related to voiding disorders such as dysuria, or de novo urgency. In a quest to find a minimally invasive sling associated with even less morbidity than the TVT, the transobturator tape (TOT) was created and a modified procedure (TVT-O) was reported by de Leval. Since its introduction numerous reports confirmed its effectiveness with an objective and a subjective cure rate up to 80% and 92% respectively and low morbidity. However, complications are probably underreported. Recently few articles reported high erosion rates, ischio rectal abcess as well as other complications. Data concerning safety are rare, follow-up is often less than two years, and risk factors for erosions are poorly described.
The aim of this study was to describe the complications, and especially late ones, associated with the transobturator sling procedure. One specific objective was to identify risk factors for erosions.
Abstract and Background
Abstract
Backround: The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions.
Methods: It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris, Obtape, TVT-O). Follow-up information was available for 225 (96.6%) women.
Results: There were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris, Obtape and TVT-O respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05–0.38, P < 0.001).
Conclusion: Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
Background
Urinary incontinence is a major public health problem. In Europe, it is estimated to affect up to one third of women older than the age of 18 years. The prevalence increases with age and reaches 45% at 60 years. In 1995, the tension-free-vaginal-tape (TVT) procedure was introduced and has revolutionized the surgical treatment of female stress urinary incontinence (SUI) due to its simplicity, efficiency and minimal invasiveness. However patients can be exposed to several complications. One category of complications is associated with the blind passage of the tape through the retropubic space causing bladder or bowel perforation, or vascular injuries. The other category is related to voiding disorders such as dysuria, or de novo urgency. In a quest to find a minimally invasive sling associated with even less morbidity than the TVT, the transobturator tape (TOT) was created and a modified procedure (TVT-O) was reported by de Leval. Since its introduction numerous reports confirmed its effectiveness with an objective and a subjective cure rate up to 80% and 92% respectively and low morbidity. However, complications are probably underreported. Recently few articles reported high erosion rates, ischio rectal abcess as well as other complications. Data concerning safety are rare, follow-up is often less than two years, and risk factors for erosions are poorly described.
The aim of this study was to describe the complications, and especially late ones, associated with the transobturator sling procedure. One specific objective was to identify risk factors for erosions.
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