Abstract
OBJECTIVES: To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure. DESIGN: Retrospective cohort study. SETTING: Tertiary referral urogynaecology centre. POPULATION: 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006. METHODS: Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test. MAIN OUTCOME MEASURES: Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques. RESULTS: 241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures. CONCLUSION: LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.
Original language | English |
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Pages (from-to) | 1377-1381 |
Number of pages | 5 |
Journal | BJOG-An International Journal of Obstetrics and Gynaecology |
Volume | 113 |
Issue number | 12 |
Early online date | 26 Oct 2006 |
DOIs | |
Publication status | Published - 1 Dec 2006 |
Keywords
- Adult
- Female
- Humans
- Middle Aged
- Retrospective Studies
- Suburethral Slings
- Urethra
- Urinary Bladder
- Urinary Incontinence, Stress
- Urologic Surgical Procedures