Novel Surgical Technique for the Treatment of Female Stress Urinary Incontinence: Transobturator Vaginal Tape Inside-Out

• Published in: European urology Vol. 44; no. 6; pp. 724 - 730
• Main Author: de Leval, Jean
• Format: Journal Article Web Resource
• Language: English
• Published: Oxford Elsevier B.V 01.12.2003; Elsevier; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Equipment Design; Equipment Safety; Female; Follow-Up Studies; Human health sciences; Humans; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prosthesis Implantation - instrumentation; Prosthesis Implantation - methods; Prosthesis Implantation/instrumentation/methods; Risk Assessment; Sciences de la santé humaine; Severity of Illness Index; Stress urinary incontinence; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Surgical Instruments; Surgical Mesh; Suspension; Technique; Transobturator; Treatment Outcome; Urethra; Urinary Incontinence, Stress - diagnosis; Urinary Incontinence, Stress - surgery; Urinary Incontinence, Stress/diagnosis/surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics; Urologic Surgical Procedures - methods; Urologie & néphrologie; Urology & nephrology; Suspension; Transobturator; Stress urinary incontinence; Technique; Urethra; Performance evaluation; Urinary system disease; Treatment efficiency; Urinary tract disease; Voiding dysfunction; Surgical suspension; Vaginal route; Obturator foramen; Surgery; Cohort study; Instrument; Female; Surgical approach; Bladder disease; Female urethra; Urinary stress incontinence
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2003.09.003

Objectives: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. Methods: We have developed a novel surgical treatment of SUI, the transobturator inside-out tension-free urethral suspension, which uses specifically designed surgical tools, and in which a synthetic tape is passed from underneath the urethra, through the obturator foramens, towards the thigh folds, without entering the pelvic region at any time during the procedure. The tape is positioned without tension under the junction between mid and distal urethra. Results: The procedure was carried out in 107 consecutive patients (mean age: 62 years) using the same operative protocol in all case subjects, independently of the patient’s size and weight. Mean operative time was 14 min (range: 7–20) in case of isolated SUI treatment. No bladder or urethral injuries and no vascular (hematoma or bleeding) or neurological complications were encountered. Conclusions: The results of this study indicate that our novel transobturator inside-out surgical technique for treating SUI is feasible, accurate, and quick. This technique avoids damage to the urethra and bladder and, therefore, makes cystoscopy not necessary. Further prospective studies are currently ongoing to determine the efficacy of our new surgical approach for treating SUI.