Retropubic, transobturator and intraobturator tape procedures: how, when and why


Pelviperineology 2010;29(1):20-23

The tension-free vaginal tape (TVT) procedure for treatment of female stress incontinence is the first modern minimally invasive midurethra sling operation and the only one thus far with reports on cure rates with follow-up periods of 5 years or more. The TVT is a safe and effective treatment for stress urinary incontinence (SUI), offering the benefits of a minimally invasive technique with good longterm results . Reported complications of the procedure include bladder and vascular injuries and to lesser extent bowel perforations and mesh erosion. The transobturator approach (TOT) was developed as an alternative technique to minimise the risk of bladder and vascular injuries during the retro-pubic passage of the needle.

Reported cure rates of incontinence with the transobturator approach were similar to those observed with TVT; comparing retropubic and transobturator tapes, bladder perforations, pelvic haematoma and storage LUTS were significantly less common in the patients treated by transobturator tapes. Viceversa, the performances of retropubic and transobturator tapes were similar for all the other evaluable parameters (vaginal erosions, urinary tract infections, reoperation rates).

New minimally invasive procedures , like the novel TVT-SECUR (TVTs), were designed and introduced to overcome the peri-operative complications reported with use of TVT and TOT/TVT-O (bladder perforation, bowel, vessel and nerve injury, infection, thigh pain and bladder outlet obstruction) but their use needs again further evaluation with respect to efficacy and morbidity.

Keywords: Urinary incontinence; TOT; Transobturator procedures; TVT; Complications.