Effectiveness of transobturator tape in women with decreased urethral mobility.

OBJECTIVE

To determine whether preoperative urethral mobility is associated with success of the transobturator insertion of suburethral polypropylene slings.

STUDY

DESIGN

A cohort of women who underwent a transobturator insertion of a suburethral polypropylene sling for urodynamic stress incontinence between October 2003 and January 2005 was prospectively assessed.

RESULTS

Of the 134 women in the study cohort, 107 (80%) provided postoperative data at a median followup interval of 10 months. Postoperatively, 92 (86%) reported complete resolution of stress urinary incontinence on the Urogenital Distress Inventory-6 questionnaire, and 15 (14%) reported persistent incontinence. The median preoperative urethral mobility was significantly decreased among women who were incontinent postoperatively compared to those who were continent (40 degrees [10-60] vs. 50 degrees [10-90], p=0.0049). Women with preoperative urethral mobility < 45 degrees were at least 4 times more likely to report postoperative incontinence compared with women with preoperative urethral mobility > or = 45 degrees (29.4% vs. 6.9%, RR 4.29, 95% CI 1.59-11.60, p = 0.005). In addition, women with preoperative urethral straining angles < 45 degrees from the horizontal were at least 5 times more likely to report postoperative incontinence compared with women with preoperative urethral straining angles > or = 45 degrees (41.7% vs. 8.7%, RR 5.21, 95% CI 1.88-14.42, p = 0.006). Neither patient age nor the concomitant performance of an anterior colporrhaphy affected these results.

CONCLUSION

Women with preoperative urethral mobility or preoperative urethral straining angles < 45 degrees appear to be at higher risk for failure following a transobturator insertion of a suburethral polypropylene sling.