![]() ![]() We collected Variables including age, weight, height, menopausal status, hormonal replacement therapy, previous hysterectomy or genital prolapse surgery. This study was approved by the Institutional Ethics Committee of the Geneva University Hospitals. We included 233 consecutive women who had undergone transobturator sling procedure for pure stress or mixed urinary incontinence in the Department of Obstetrics and Gynecology, Geneva University Hospitals, from June 2003 to October 2006. One specific objective was to identify risk factors for erosions. The aim of this study was to describe the complications, and especially late ones, associated with the transobturator sling procedure. Data concerning safety are rare, follow-up is often less than two years, and risk factors for erosions are poorly described. Recently few articles reported high erosion rates, ischio rectal abcess as well as other complications. However, complications are probably underreported. Since its introduction numerous reports confirmed its effectiveness with an objective and a subjective cure rate up to 80% and 92% respectively and low morbidity. In a quest to find a minimally invasive sling associated with even less morbidity than the TVT, the transobturator tape (TOT) was created and a modified procedure (TVT-O) was reported by de Leval. The other category is related to voiding disorders such as dysuria, or de novo urgency. One category of complications is associated with the blind passage of the tape through the retropubic space causing bladder or bowel perforation, or vascular injuries. However patients can be exposed to several complications. In 1995, the tension-free-vaginal-tape (TVT) procedure was introduced and has revolutionized the surgical treatment of female stress urinary incontinence (SUI) due to its simplicity, efficiency and minimal invasiveness. The prevalence increases with age and reaches 45% at 60 years. In Europe, it is estimated to affect up to one third of women older than the age of 18 years. Urinary incontinence is a major public health problem. Choice of the safest sling material is crucial as it is a risk factor for erosion. ![]() Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris ®, Obtape ® and TVT-O ® respectively (P = 0.001). Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). ![]() There were few per operative complications. Follow-up information was available for 225 (96.6%) women. It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris ®, Obtape ®, TVT-O ®). The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. ![]()
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