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UROSCAN
Year : 2005  |  Volume : 21  |  Issue : 2  |  Page : 127-128
 

Stress urinary incontinence: TVT or TOT?


Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
J Chandra Singh
Department of Urology, Christian Medical College,Vellore – 632 004, Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Chandra Singh J, Kekre NS. Stress urinary incontinence: TVT or TOT?. Indian J Urol 2005;21:127-8

How to cite this URL:
Chandra Singh J, Kekre NS. Stress urinary incontinence: TVT or TOT?. Indian J Urol [serial online] 2005 [cited 2019 Oct 17];21:127-8. Available from: http://www.indianjurol.com/text.asp?2005/21/2/127/19640


Peri-operative complications and pain after the suburethral sling procedure for urinary stress incontinence:

A French Prospective Randomised Multicentre Study comparing the retropubic and transobturator routes ((TOR).

Emmanuel David-Montefiore, Jean-Louis Frobert, Marielle Grisard-Anaf, Jean Lienhart, Karine Bonnet, Christophe Poncelet and Emile Daraο.


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This prospective, randomized, multicentric trial[1] compared the perioperative complications, pain, and the immediate functional results of the sub-urethral sling procedure for urinary stress incontinence by the retropublic and TORs. A 86 patients from three gynecology units and two urology units were included in the study from March 2004 to May 2005. Preoperative workup included urodynamic evaluation and validated questionnaires measuring quality of life. The retropubic route (RPR) and the TOR were used in 42 and 46 cases, respectively. A macroporous nonelastic monofilament polypropylene mesh (I-STOP®) was used in both procedures. A sample size of 40 in each arm was arrived at permitting a b error of 0.2 and an assumption that with TOT, the incidence of de novo urge incontinence and postoperative voiding dysfunction would be less than by half than with RPR. The baseline characteristics of the women in both groups were not significantly different. The mean operating times were 21 ± 9.5 (10-50) and 17 ± 6.6 (8-40), mean ± SD (range) for RPR and TOR groups, respectively ( P = 0.03). There were four bladder injuries in the RPR group but none in the TOR group. Conversely, there were five vaginal injuries in the TOR group and none in the RPR group. The mean hospital stay was not significantly different and both groups had significant postoperative improvement in quality of life measured using validated questionnaires. The overall morbidity was not significantly different between the groups ( P = 0.28). Postoperative pain, as measured by numerical rating scale (NRS) was significantly less severe in the TOR group than in the RPR group ( P = 0.0008).

Transobturator routes placement was shown to be successful in the treatment of stress incontinence by Delorme.[2] This is a well designed study to compare the outcome of retropubic and transobturator sling procedures. Only the immediate postoperative follow up is reported in this study. No immediate postoperative retention occurred in either groups. The authors believe that this is likely to be due to the nonelastic nature of the slings. The authors are of the opinion that routine cystoscopy is not required with TOT as they did not encounter any bladder injury. However, bladder perforation, though uncommon, has been reported with TOR[3],[4] sling placement. Another randomized study comparing transobturator sling (Monarc) with suprapubic arc sling (Sparc) has documented the need for cystoscopy.[5] Till the results are reproduced in larger series, it may be safe to perform cystoscopy to rule out bladder injury. Though no significant bleeding complications were encountered in the TOR study group, there have been a few recent case reports.[6],[7] Measurement of postoperative pain with NRS is highly subjective. It is not documented if the person obtaining the NRS was blinded to the procedure performed. Documentation of objective parameters like doses of analgesic required would have minimized possibility of bias. It is not mentioned if the trend of postprocedural pain was monitored using NRS in the follow up.

To conclude, this study has demonstrated comparable efficacy of TOR and RPR routes in the immediate postoperative period. Postoperative complications were minimal in both groups and postoperative pain was lesser in the TOR group than in the RPR group.

 
   References Top

1.David-Montefiore E, Frobert JL, Grisard-Anaf M, Lienhart J, Bonnet K, Poncelet C, Darai E.Peri-Operative Complications and Pain After the Suburethral Sling Procedure for Urinary Stress Incontinence: A French Prospective Randomised Multicentre Study Comparing the Retropubic and Transobturator Routes. Eur Urol 2006;149:133-8.  Back to cited text no. 1    
2.Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306-13.  Back to cited text no. 2  [PUBMED]  
3.Abouassaly R, Steinberg JR, Lemieux M, Marois C, Gilchrist LI, Bourque JL, Tu le M, Corcos J. Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU Int 2004;94:110-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Minaglia S, Ozel B, Klutke C, Ballard C, Klutke J. Bladder injury during transobturator sling. Urology 2004;64:376-7.  Back to cited text no. 4    
5.Wang AC, Lin YH, Tseng LH, Chih SY, Lee CJ. Prospective randomized comparison of transobturator suburethral sling (Monarc) vs suprapubic arc (Sparc) sling procedures for female urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2005;3:1-5.[Epub ahead of print]  Back to cited text no. 5    
6.Rajan S, Kohli N. Retropubic Hematoma After Transobturator Sling Procedure. Obstet Gynecol 2005;106:1199-202.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Richards SR, Balaloski SP. Vulvar hematoma following a transobturator sling (TVT-O). Int Urogynecol J Pelvic Floor Dysfunct. 2005;23:1-2.[Epub ahead of print].  Back to cited text no. 7    




 

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