ABSTRACT

Introduction and hypothesis:

The study aims to evaluate the functional outcome of Trans-Obturator Tape (TOT) in the management of female Stress Urinary Incontinence (SUI) and its impact on patients’ quality of life (QOL) and symptom change by using the King’s Health Questionnaire (KHQ) pre- and post-operatively.

Methods:

Seventy-six female patients with SUI underwent a TOT operation, which used the outside-in technique. A prospective cohort analysis was conducted on 63 of the women with pure SUI who completed the KHQ before and after the TOT, at a 6-24 month interval post-operatively. The study was performed at the Charlotte Maxeke Academic Johannesburg Hospital in South Africa, from 1 January 2010 to 1 June 2013.

Results:

The mean follow up was 18 months. Thirteen out of 63 patients with pure SUI, after answering positively to the presence of urgency and/or urge symptoms, were placed into a separate group, SUI with the sensation of urgency. There was a general improvement in all areas of KHQ quality of life in both groups of patients postoperatively. Improvement in QOL for SUI (n=50) for both the SUI and the sensation of urgency (n=13) groups were 80% and 92%, respectively. Improvement in stress symptoms score for the SUI group was 91%, while a 100% improvement was noted in the urgency group. There were no cases of bladder perforation, urethral injury, or post-operative urinary retention. Post-operative complications during follow-up included one sling failure, two de novo Detrusor Instability (DI), two incidences of groin/thigh pain, and one urinary infection necessitating intravenous treatment.

Conclusion:

The TOT outside-in procedure is a safe and effective procedure in treating SUI, and conclusively improves the quality of life for women with this condition. The King’s Health Questionnaire is an easy and reliable instrument to assess symptoms of incontinence and the quality of life.