research day - University of Toronto Department of Obstetrics and ...

41
ABSTRACT #P-A1
TRANSOBTURATOR TAPE FOR THE TREATMENT OF STRESS URINARY
INCONTINENCE: EFFECTIVENESS AND PREDICTORS OF OUTCOME
Maria Augusta T. Bortolini[F], Victor Miranda, Raed S. Ahmed, Andrea Lischka, Heng R.
Wang, May Alarab, Danny Lovatsis, Harold P. Drutz
Urogynaecology Division, Department of Obstetrics & Gynaecology, Mount Sinai Hospital.
Objective: The objective of the study was to determine the success rate and predictors of failure of
transobturator tape (TOT) for the surgical treatment of stress urinary incontinence (SUI) in women.
Methods: Retrospective data collection was performed for 250 women who had undergone TOT in
Mount Sinai Hospital, Toronto, between February 2005 and August 2008. Preoperative and
postoperative assessment included history, physical examination, uroflowmetry and multichannel
urodynamic testing. Postoperative follow-up took place at 6 weeks, 6 months and then annually.
Multichannel urodynamic testing was repeated at 1 year follow-up. Subjective success was defined
as lack of stress urinary incontinence symptoms and objective success was defined as a negative
cough test during physical exam. Statistical analysis was performed using simple descriptive
techniques. Multivariable Cox regression analysis was used to evaluate predictors of failure. Local
ethics board approval was obtained.
Results: During the study period, 265 TOT were performed; however, 15 cases were excluded
because of inaccessible records. This study therefore included 250 cases of whom 237 (94.8%)
primary cases of SUI. The mean age was 56.59, BMI was 27, parity was 2.42, 44.5% had estrogen
therapy replacement, 65% had associated overactive bladder symptoms and 110 (44%) patients had
concomitant surgeries (11% had hysterectomy, 42% had anterior and/or posterior repair, and 16%
had sacrospinous vault suspension or laparoscopic colposacropexy). The mean follow-up time was
8.5 months (range 1.5 – 36 months). Objective success rate was 84.6% and subjective success rate
was 78% in 6 months, and 92.6% and 86.6%, respectively, at the end of 1 year. Variables as age,
BMI > 30, smoking, vaginal delivery, menopause status, HRT and previous gynecology surgery
were not predictors of failure. Menopause, previous hysterectomy and BMI > 30 increased the
chances of failure in 1.7, 3 and 2.3 times, respectively, but were not statistically significant.
Conclusions: We concluded that TOT procedure is effective with a success rate of 90% at one year
follow up. Age, BMI > 30, smoking, vaginal delivery, menopause status, HRT and previous
gynecology surgery were not predictors of failure.