NEUROUROLOGY & FEMALE UROLOGY

Objective and Subjective Cure Rates after Trans-obturator Tape (OBTAPE) Treatment of Female Urinary Incontinence
Deval B, Ferchaux J, Berry R, Gambino S, Ciofu C, Rafii A, Haab F
Service de Gynecologie, Hopital Beaujon, Assistance Publique - Hopitaux de Paris (AP-HP), Universite Paris VII, Clichy, France
Eur Urol. 2006; 49: 373-7

• Objective: To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence.
• Methods: Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire.
• Results: Mean follow-up was 17.2 +/- 4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2 +/- 2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence.
• Conclusions: Our results suggest that the OBTAPE is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.
  
  
• Editorial Comment
  The authors reviewed the effectiveness of the transobturator procedure using the OBtape® material. The authors found overall cure rates that were very competitive with other suburethral sling procedures but noted a relatively high erosion rate.
  This publication evaluated a fairly young patient population (average age 57.1) and followed the patients for a minimum of six months. Objective cure of stress incontinence was judged on fairly strict criteria: both clinical and urodynamic examinations were utilized though it is unclear when the urodynamic examinations were performed postoperatively. In addition to the objection evaluation, the patients were asked to judge their surgical result on a subjective basis. Performance of the operation was very efficient with a mean operating time being a little less than 10 minutes. Objective cure rates were approximately 90% with subjective cure rates being somewhat less at 78%. Of interest is that two-thirds of the patients had resolution of their preoperative urge symptoms while one-third has persistence of same. This mirrors closely that reported for other surgical procedures (1). That this operation usually necessitates less vaginal dissection opposes the argument that the urge component may be lessened by incidental neural ablation occurring during the vaginal dissection (2). This high erosion rate using the OBtape® has been reported by other surgeons leading to the discontinuation of use of this material; in response, there has been a progression to new tapes such as ArisÔ that is knitted and has a larger pore size of 550 x 170 microns. Other authors have stated that erosion may be material based and not really a technical problem (3). This paper does reinforce the ease and efficacy of this procedure.

References
1. McGuire EJ, Savastano JA: Stress incontinence and detrusor instability/urge incontinence. Neurourol Urodyn. 1985; 4: 313-316.
2. Fulford SCV, Flynn R, Barrington J, Appanna T, Stephenson TP: An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome. J Urol. 1999; 162: 135-137.
3. Domingo S, Alama P, Ruiz N, Perales A, Pellicer A: Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005; 173: 1627-30.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA