Sivabalan, J (2010) A prospective study on outcome of Tension Free Trans Obturator Tape for Female Stress Urinary Incontinence. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Stress Urinary Incontinence is defined as the involuntary loss of urine from the urethra during physical activities that increase the intra abdominal pressure in the absence of detrusor activity. It is the major proportion of cause of urinary incontinence. SUI can develop through two mechanisms; hyper mobility - significant displacement of the urethra and bladder neck during exertion and intrinsic sphincter deficiency (ISD). These two conditions can coexist in women. As stated by the American Urologic Association consensus statement in 2001, there are only 2 procedures that are proven to have effective long-term cure rates for the treatment of stress urinary incontinence (SUI). These procedures are the abdominal Burch Colposuspension and the sling procedure that is completed vaginally. However, in the past, the sling procedure was far from standardized. There have been multiple different descriptions using different materials for the sling (fascia from the patient, cadaveric fascia or dermis from humans or animals, synthetics, etc), different anchoring points, and different methods to adjust the tension of the sling. In many cases patients had to undergo general anesthesia, were in the hospital for several days, required a catheter to drain the bladder and many patients suffered high rates of voiding dysfunction following these slings. AIM OF STUDY: 1. To study the efficacy of TOT in Stress Urinary Incontinence. 2. To analyse immediate and late complications. 3. Compare the results. MATERIALS AND METHODS: All female patients with SUI who underwent TOT procedure from September 2007 to March 2009 were included .The study was prospective study, conducted in Department of Urology, GRH and KMCH. Total number of patients included in this study were 60. All patients were evaluated with history including bladder diary pre operative. International Consulation on continence Questionnaire and Urogenital Distress Inventory. physical examination including pelvic examination, urinalysis, urodynamic studies. RESULTS: 50 patients under spinal anaesthesia 10 patients under IV Sedation. The mean operative time was 12 min (6–30) in cases of isolated SUI treatment. The catheterisation time was 0.9 day (0–2). No significant blood loss occurred in any cases. At one month, 93% of patients (56/60) were cured and 3.5% (2/60) of persistent voiding dysfunction with de novo urgency or urge incontinence who needed simple follow up. Perineal pain was observed in 1 patient (2.5%) – Lasted for 3 months. Post operative leg pain in 4 patients (7%) - Lasted for 2 to 6 months. No vaginal erosion was observed at this point. No perioperative complications noted. 2 urinary retention after removal of the catheter on post-operative day 1, one for 15 days and the other one not recovered, patient advised splitting of the tape under mid urethra..Patient was not willing, hence self catheterisation was taught. Two lower urinary tract infections were observed in the immediate post-operative period. At one year, 48 of 60 patients (80%) were clinically cured from their stress incontinence and an additional 12% were also improved. CONCLUSION: Trans obturator tape is a simple, effective and safe procedure for the treatment of female stress urinary incontinence confirmed after 1 year of follow-up. • It offers increased safety. • The post-operative morbidities associated with this technique are minimal and manageable. • Evaluation of the results after a longer follow-up period is needed. • The learning curve is simple and easy.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Tension Free Trans Obturator Tape, Female Stress Urinary Incontinence. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Feb 2020 04:04 |
| Last Modified: | 18 Feb 2020 15:32 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11946 |
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