Objective Cure Rates and Patient Satisfaction After the Transobturator Tape Procedure During 6.5-Year Follow-Up

Study Objective: To report the subjective and objective outcomes and patient satisfaction with the outside-in transobturator tape (TOT) procedure during long-term follow-up. Design: Clinical follow-up study (Canadian Task Force classification II-2). Setting: University hospital. Patients: One hundred ninety-one women who underwent the TOT procedure. Of these, 66% had stress urinary incontinence and 34% had mixed urinary incontinence, and 45% underwent concomitant surgery. Interventions: Patients underwent surgery between May 2003 and December 2004 using the TOT procedure. After a mean follow-up of 6.5 years, postal questionnaires and an invitation for a follow-up visit to the outpatient clinic were sent to the patients. Objective cure was defined as a negative result of a stress test and no repeat operation because of stress urinary incontinence during follow-up. Subjective outcome was evaluated using the following validated questionnaires: UISS (Urinary Incontinence Severity Score), DIS (Detrussor Instability Score), VAS (visual analog scale, 0-100), short versions of the IIQ-7 (Incontinence Impact Questionnaire-7) and UDI-6 (Urogenital Distress Inventory-6), and the EQ-5D and EQ-5D VAS. Patient satisfaction was evaluated using a self-tailored questionnaire. Measurements and Main Results: Of 191 patients, 139 (73%) were evaluated after a mean follow-up of 6.5 years. Objective and subjective cure rates were 89% and 83%, respectively. Of the patients with genuine stress urinary incontinence, 92% were completely or quite satisfied with the surgery, and 76% of the patients with mixed urinary incontinence were satisfied (p < .001). Patients with body mass index >30 had significantly higher scores on the IIQ-7, UDI-6 (p < .01 for both), VAS (p < .001), UISS (p < .01), and DIS (p < .001), thus indicating a less favorable outcome of the procedure. Conclusion: A high objective cure rate persisted after a mean follow-up of 6.5 years. Caution is advised when the TOT procedure is planned in patients with mixed urinary incontinence or severe obesity. Journal of Minimally Invasive Gynecology (2013) 20, 73-78 (c) 2013 AAGL. All rights reserved.