The Evaluation of Long-Term Outcomes of Outside-in Transobturator Tape Procedure in the Treatment of Stress Urinary Incontinence

INTRODUCTION: The objective of the study was to investigate the objective-subjective success rates and complications of outside-in transobturator tape (TOT) surgery with urinary distress inventory (UDI)-6 questionnaire and subjective assessment after 5 years follow-up.
METHODS: We analyzed 60 women with stress urinary incontinence who underwent outside-in TOT procedure by the same surgeon and mesh, and were followed up after 5 years. All patients’ gynecological examination findings, stress test, Q-tip test, pad test, residual urinary volume, UDI-6 questionnaire, and duration of operation and complications were recorded. 3 years and 5 years after surgery, all patients were evaluated for anatomic-functional outcomes and subjective patient satisfaction.
RESULTS: The mean age of the population was 51.92±7.31 years, and 50% of the women were postmenopausal. Two patients (3.3%) had intraoperative bladder injury. Among long-term complications, one patient had (1.6%) de novo urge incontinence. There was no mesh erosion in the 5 years follow-up. When we compared the pre-operative and 5-years post-operative Q-tip test angles, a significant decrease was observed (63.92±14.17; 25.08±9.68) (p=0.001). UDI-6 question 3,4 survey scores were also significantly lower in the 5th year follow-up (p=0.001) At the end of 5 years, we observed an objective success in 82.9% of the patients. The patients also reported a subjective improvement of 82.9%.
DISCUSSION AND CONCLUSION: If proper surgical technique is used, outside-in TOT procedure is an efficient and safe method with high objective and subjective cure rates and low complication rates after a 5 year follow-up.