PURPOSE: To describe and evaluate a transobturator approach to urethral sling placement using autologous rectus fascia for the management of female stress urinary incontinence.
MATERIALS AND METHODS: We performed a feasibility study of ten autologous transobturator (ATO) mid-urethral sling placements for stress urinary incontinence. The procedure includes an anterior vaginal dissection, performed in the standard fashion for a mid-urethral sling, and harvest of a strip of rectus fascia. A trocar is passed through each obturator foramen and the fascial stay sutures are retracted through the skin incisions. The sling is then appropriately tensioned and the stay sutures tied. Patient outcomes were measured by 24-hour pad weight test and ICIQ-FLUTS score.
RESULTS: Median patient age was 57 (IQR 48; 69.5) with a median body mass index of 30.3 kg/m2 (IQR 25.2; 32.4). Median follow-up was 4 months (range 3-5). All patients demonstrated reduction of leakage, with 80% being completely dry (zero grams on 24-hr pad test and not wearing pads). Overall, there was significant improvement in pre- versus postoperative 24-hour pad weight (p=0.02). Likewise, all subscores of the ICIQ-FLUTS were significantly improved following surgery: frequency (p=0.006), voiding (p=0.04), and incontinence (p=0.002). Six of the nine eligible cases (67%) were performed on an outpatient basis. One patient performed intermittent self-catheterization for 24 hours following sling placement. No patients suffered severe (Clavien III-V) postoperative complications or required urethrolysis.
CONCLUSIONS: Autologous transobturator urethral sling placement (ATO) appears technically feasible with excellent short term outcomes. Longer follow up and larger series are needed for validation.
Written by:
Linder BJ, Elliott DS. Are you the author?
Department of Urology, Mayo Clinic, Rochester, MN.
Reference: J Urol. 2014 Oct 19. pii: S0022-5347(14)04765-X.
doi: 10.1016/j.juro.2014.08.125
PubMed Abstract
PMID: 25444955