Assessment of Correction of Female Stress Urinary Incontinence with Trans Obturator Tape; Traditional versus Tailored

Abstract Background: Female genuine stress urinary incontinence (SUI) affects a great number of females, with important social and economic consequences. SUI is more frequent after several deliveries, after menopause as a result of changes in the urethral support or the sphincter mechanism. Aim of Study: To compare traditional tension free trans-obturator tape (TOT) and surgeon tailored mesh (STM) in treatment of female stress urinary incontinence as regard of safety, efficacy, side effects, cost, and follow-up. Patients and Method: Prospective randomized study was done on sixty three female patients were suffered SUI with determining of eligibility of the study as shown in COSORT flow chart Fig. (1) at Al Zahraa University Hospital, Al Azhar University from December 2016 to April 2019. All patients subjected to full history, general, and local examination (cases of cystocele, rectocele, or previous vaginal surgeries were excluded). Cystometrogram (CMG) was done for exclusion of uninhibited detrusor contractions, small bladder capacity (<250 CC), impaired bladder sensation, or impaired detrusor compliance. Patients with Significant Post voiding residual urine (>100 CC) assessed by ultrasonography were excluded from this study. All patients requested surgical treatment and provided informed written consent, and the study was approved by the ethical committee. With follow-up for six month post-operatively. Results: Depending on subjective criteria obtained from the Patric questionnaire, and objective criteria from physical examination.As regards traditional tape group, 13 patients (43.33%) were cured; two patients (6.67%) improved with no failed cases and STM group 14 patients (46.67%) were cured; one patient (3.33 %) improved with no failed cases (p-value 0.542, Pearson Chi-Square test). Conclusions: TOT (outside in technique) using both STM and traditional tape are minimally invasive techniques and are equally effective and safe in treatment of pure female SUI, with short hospital stay which reduces the cost of surgery. Both techniques could be used in treatment of pure SUI with good outcome. This technique is more economical due to the cheap ordinary polypropylene mesh. So, it should be considered as a low-cost alternative to the available commercial kits in the treatment of female SUI, mainly for public health systems with few financial resources.