Transobturator Sling Improves Treatment of Female Stress Urinary Incontinence
Carl Klutke, MD
SAN FRANCISCO—A urethral sling placed via a transobturator approach improves objective incontinence measures as well as quality of life in women with stress urinary incontinence (SUI), investigators reported here at the 39th Annual Meeting of the International Continence Society.
Carl Klutke, MD, Professor of Surgery at Washington University in St. Louis, Mo., described results in 117 women in whom a sheathless, monofilament polypropylene, light weight, macroporous midurethral sling was implanted using the transobturator technique.
The patients were enrolled in two multicenter studies conducted at eight U.S. sites. They were 18 years of age or older at enrollment and had less than 150 mL post-void residual urine. About half of the women had undergone prior anti-incontinence surgery, including the use of bulking agents and bladder suspension. Women who underwent prior sling surgery were excluded.
Surgical procedures for female SUI typically involve slings, all of which “basically add resistance to the urethra,” Dr. Klutke pointed out. The transobturator sling differs from older slings in that it uses a material that does not require a plastic sheath, thereby allowing for more precise manipulation of the sling through the tissues to the urethra.
With a sheathless sling, an intra-operative cough test can be performed following placement of the sling without the risk of displacing the sling which may occur when the sheath is removed after a sheathed mesh sling has been implanted. “As a result, we are less likely to overcorrect which leads to voiding difficulty and undercorrect which causes continued leakage,” he said.
Before surgery, seven of 117 women (6%) tested negative on the cough stress test compared with 79 of 87 women (91%) at six months, and 90 of 92 women (98%) at 12 months.
Results also showed a significant improvement in quality of life at six and 12 months after surgery compared with pre-operative values as measured by two validated questionnaires: the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI)-6.
Specifically, IIQ-7 scores decreased from 42.3 points at enrollment to 7.6 points at six months and 6.3 points at 12 months. UDI-6 scores were reduced from 55.2 points at enrollment to 15.6 points at six months and 15.2 points at 12 months. In addition, nearly all patients experienced an improvement in their quality of life on a 7-point verbal scale, which was maintained one year after surgery.
Postoperative overactive bladder symptoms occurred in only two (1.7%) women. Seven patients had vaginal exposure of the sling, which was successfully treated in all cases by local excision.
SUI, Dr. Klutke noted, is highly prevalent in older women and is one of the most common reasons for surgical intervention in this population. “The only women who are ‘less than ideal' candidates for the transobturator sling rocedure are women with both stress and urge incontinence and women with a higher body mass index,” he said.
Dr. Klutke said that he hopes future studies will directly compare the transobturator sling with a sheathed mesh sling in women with SUI.