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Objectives: To compare the postoperative sexual function results of inside-out transobturator tape (TOT) and outside-in TOT in the treatment of stress urinary incontinence. Materials and Methods: The study included 54 women with stress incontinence between 2020 and 2022. Group 1 patients underwent the inside-out transobturator tape (TOT) procedure, while Group 2 patients underwent the outside-in TOT procedure. Female Sexual Function Index (FSFI), Female Sexual Distress Scale-R (FSDS-R), Golombok-Rust Sexual Satisfaction Scale, Quality of Sexual Experience Scale (QSES), and Patient Global Impression of Improvement (PGI-I) were applied to the patients preoperatively and 18 months postoperatively to compare the results of the 2 surgical procedures on sexual functions. Results: Postoperative results were statistically significantly higher in both groups. Group 1 was found to be more effective for FSDS, FSFI sexual desire, FSFI sexual arousal, FSFI lubrication, FSFI orgasm, FSFI pain, and FSFI total variables. When the p values of Golombok levels in Groups 1 and 2 were examined, it was concluded that there was a significant difference between the groups because the p values of communication, avoidance, satisfaction, and vaginusmus scales were <0.05. Conclusion: When the methods were compared with each other, it was observed that the increase in sexual functions was more significant in the group with inside-out TOT procedure. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) is a common problem in women, which accounts about 50% of all incontinent women and affects the quality of life. The mid-urethral sling is the mainstay of SUI treatment over the last years. Tension-free vaginal tape (TVT), has been used as minimally invasive procedure for SUI. Objective: To compare outcomes of sub-urethral minisling and transobturator tape (TOT) for treatment of female SUI, one year follow up regarding operative time, length of hospital stays, postoperative pain perception, general postoperative complications, surgical site infections and early recurrence. Patients and Methods: This comparative study has been conducted in Al-Hussein and Sayed Galal Hospitals; Al-Azhar University; Cairo; Egypt and it included 96 cases, 8 patients missed communication data, 9 refused to participate, 34 in minisling group and 45 in transobturator tape (TOT) group. This a retrospective study for follow up of operated cases during the period from July 2015 to June 2018 at the Urology Department, Al-Hussein, Sayed Galal University Hospitals; Cairo; Egypt. Results: In our study, the minisling operation was associated with nearly the same hospital stay of transobturator tape (TOT). We had early recurrence rate among minisling operation. Finally, the transobturator tape (TOT) operation was associated with less recurrence rate and recurrence time postoperatively compared to the minisling. Conclusion: Minisling when compared to transobturator tape (TOT) for treating SUI; transobturator tape (TOT) yielded better outcomes regarding the postoperative 1 year follow up compared to the minisling. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure’s effects on sexual functions and life quality. Materials and Methods: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. Results: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). Conclusions: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients.

Introduction: Transobturator tapes (TOT) are frequently used in the management of female stress urinary incontinence (SUI). We evaluated the effect of TOT on sexual function in Indian women with stress urinary incontinence. Materials and Methods: 34 sexually active women (mean age 42.38 years) with SUI were evaluated before TOT placement for sexual function using the NSF-9 sexual scoring system questionnaire. The evaluation was repeated at the 3 rd , 6 th and 12 th months post surgery and then yearly. Results: There was significant improvement in scores in all domains of sexual function post-surgery. The frequency improved in 24 (70.5%) patients, lubricacy improved in 12 (57.1%) patients, orgasm improved in 21 (67.1%) patients, pain improved in 14 (70%) patients and, in leaking patients, sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 26 (76.4%) of the patients before surgery; of them, 21 (80%) patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in one and two patients, respectively. Conclusions: The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI.

Aims The aim of this study was to assess medium-term outcomes of the single anterior vaginal wall incision technique with concomitant mid-urethral sling (MUS) procedure. Methods Patients suffering from stress urinary incontinence and who desired surgical correction for their incontinence were divided into two groups according to MUS surgery alone or MUS surgery with anterior vaginal wall surgery. Concomitant surgery was performed via single large anterior vaginal wall incision. Primary outcome was treatment success 12 months after surgery. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. Results Single incision anterior colporrhaphy with MUS was performed in 180 patients, 62 patients underwent only MUS procedure. Success rate was 87.1% in sling surgery alone and 83.9% in single incision concomitant surgery group ( P = 0.5). Detrusor overactivity (DO) was present on UDS in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test ( P < 0.05). Total continence rate in patients who underwent vaginal hysterectomy was 60.6% ( P < 0.001). Conclusion Concurrent cystocele repair with MUS operations through a single anterior wall incision is a safe and effective method for SUI. This study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse. Neurourol. Urodynam. 35:995-999, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Transobturator tape (TOT) and Burch colposuspension procedure's effects on sexual functions and life quality. Materials and Methods: A total of 81 patients who underwent TOT (n = 49) or Burch (n = 32) with stress incontinence were included in this prospective study. Preoperatively and at postoperative 6 month follow up pad and stress tests, physical examinations, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) questionnaires were performed. Patient Global Impression of Improvement (PGI-I) questionnare was added postoperatively. Results: According to stress test, success rate was found to be 69% and 45%, in the TOT and Burch groups respectively. Pad test decreased in both groups (p < 0.05). PGI-I scores was higher in the TOT group when compared to Burch group (p = 0.031). ICIQ-SF scores were improved in both TOT (p < 0.0001) and Burch groups (p < 0.012). IUDI-6 and IIQ-7 scores improved only in TOT group. Total FSFI scores did not change in both groups but only in TOT group sexual desire improved. Total FSFI scores did not change in patients that were successful and unsuccessful according to the stress test in both TOT and Burch groups (p < 0.05). Conclusions: TOT and Burch procedures have no effect on the sexual functions. However TOT improved life quality of patients. [ABSTRACT FROM AUTHOR]

Aim Despite a wide array of vaginal tapes to treat stress urinary incontinence (SUI), evidence suggesting that both patient characteristics and tape positioning influence outcomes, and differing tape insertion pathways (retropubic vs. transobturator), it remains unclear if the same incision location is effective for all tapes. The aim of the study was to compare outcomes using two different surgical incision locations when inserting a transobturator vaginal tape (TOT) to treat SUI. Methods We compared patient characteristics, tape positioning, and surgical outcomes in 123 women undergoing a TOT procedure who were randomly assigned to have the surgical incision begin at 1/3 of the sonographically-measured urethral length (similar to the traditional retropubic approach) or 1/2 of the urethral length. Results It was feasible to place the tape according to intention in 99.2% of the study cohort. The overall cure rate was higher when the incision site began at 1/2 the urethral length (83.6%) than 1/3 (62.9%) ( P = 0.01). In the subgroup analyses, only patients with normal urethral mobility had significantly different cure rates (85.7% vs. 55.2%, P = 0.02). No significant differences in cure rates were observed between the other mobility categories of the study groups-hypermobility was consistently associated with high cure rates and hypomobility with low cure rates. Conclusions When surgically treating SUI with a TOT, incision at the mid-urethra using the 1/2 rule is recommended as it leads to better outcomes for most patients, particularly those with normal urethral mobility. Neurourol. Urodynam. 34:741-746, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction: Transobturator tapes (TOT) are frequently used in the management of female stress urinary incontinence (SUI). We evaluated the effect of TOT on sexual function in Indian women with stress urinary incontinence. Materials and Methods: 34 sexually active women (mean age 42.38 years) with SUI were evaluated before TOT placement for sexual function using the NSF-9 sexual scoring system questionnaire. The evaluation was repeated at the 3rd, 6th and 12th months post surgery and then yearly. Results: There was significant improvement in scores in all domains of sexual function post-surgery. The frequency improved in 24 (70.5%) patients, lubricacy improved in 12 (57.1%) patients, orgasm improved in 21 (67.1%) patients, pain improved in 14 (70%) patients and, in leaking patients, sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 26 (76.4%) of the patients before surgery; of them, 21 (80%) patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in one and two patients, respectively. Conclusions: The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI. [ABSTRACT FROM AUTHOR]

Objective In this study, the effect of cystocele repair performed simultaneously with transobturator tape (TOT) on the results of operation was evaluated in patients with stress urinary incontinance (SUI) and pelvis organ prolapsus (POP). Materials and Methods The data of 103 patients who had SUI and cystocele between 2006 and 2012 were evaluated retrospectively. The patients who underwent only TOT was classified as group 1 and the patients who underwent cystocele repair simulatenously with TOT were classified as group 2. The patients in group 2 were divided as group 2a (low grade cystocele (grade 1 and 2)) and group 2b (high grade (grade 3) cystocele ). The age, number of normal deliveries, pad test, cystocele grade, post-operative complications and preop International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) forms were evaluated from the patient files. All patients were questioned by ICIQ-SF in terms of the final continence status. The groups were compared in terms of the above-mentioned parameters. Results It was observed that there was no significant difference between group 1 and group 2 in terms of preoperative ICIQ-SF scores (16.06±0.34 and 16.82±0.42, respectively) and demographic data at the baseline. It was observed that the postoperative ICIQ-SF scores decreased markedly in both groups (3.28±0.78 and 5.41±1.21, respectively, p<0.01). While there was no difference in preoperative ICIQ-SF values in the patients in group 2b in comparison with the patients in group 2a, the postoperative ICIQ-SF score was significantly lower. The mean ?ICIQ-SF score was found to be lower in the patients in group 2a compared to the patients in group 1 and group 2b (8.88±1.98,12.77±0.83, and 13.57±1.42, respectively, p<0.01). Conclusion Conclusively, cystocele repair performed simultaneously with TOT does not provide additional improvement in patients with low grade cystocele, whereas cystocele repair performed simultaneously with TOT provides a more prominent improvement in patients with high grade cystocele. [ABSTRACT FROM AUTHOR]

Background Only limited data are available on the outcome of tension-free obturator tape (TOT) procedures in overweight and obese women. We would like to verify the objective and subjective outcomes of TOT in women with a higher body mass index (BMI). Methods We evaluated the records of 116 patients who had undergone TOT, stratifying by BMI into normal weight (n = 31), overweight (n = 56), and obese (n = 29) groups. We compared preand postoperative evaluations, including subjective and objective outcome of TOT, complications, and quality of life assessed by validated questionnaires (ICIQ-SF and KHQ). Results The median follow-up was 21 months. There were no significant differences between different groups in terms of objective cure rate and subjective success, quality of life scores and postoperative complications. Conclusions Our data demonstrate that TOT procedure is safe and effective. BMI did not influence the outcome of TOT procedures at a median of 21 months after surgery and represents no contraindication for continence surgery. The success of the outcome of TOT procedure in females and the occurrence of complications are not negatively affected by obesity. [ABSTRACT FROM AUTHOR]

Purpose: We report our experience with the diagnosis and treatment of refractory synthetic sling complications in women. Materials and Methods: This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7. Results: A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct sling complications. Original sling composition was type 1 mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy and urinary diversion, and enterocystoplasty. Median followup was 2 years (range 0.25 to 12, mean 3). Overall a successful outcome was achieved in 34 of 47 patients (72%) after the first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 patients with treatment failure 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion and cystectomy (1), partial cystectomy and augmentation cystoplasty (1), biological sling and sinus tract excision (1), and vaginal mesh excision (1). Conclusions: Success after the initial failure of mesh sling complications repair is possible but multiple surgeries may be required. Each symptom should be addressed separately. [Copyright &y& Elsevier]

Abstract: Introduction: Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. Methods: For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both ’index patients’ (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. Results: Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. Conclusion: MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and are dependent on technique. [Copyright &y& Elsevier]

The objective of this study was to assess the impact of body mass index (BMI) on transobturator tape (TOT) success rates, patient acceptability and complications 1 year following surgery. The medical records of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) patients who underwent the TOT operation were retrospectively reviewed. The patients were divided into non-obese (BMI < 25) and obese (BMI ≥ 30) groups. Baseline and 1 year post-surgical outcomes were assessed by including multichannel urodynamics, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores and cure, failure and success rates. There were no significant differences between groups in terms of urodynamic parameters, objective cure rate and subjective success, quality of life scores, or postoperative complications. Both obese and non-obese patients had cure and/or improvement of their symptoms and had better quality-of-life in the postoperative period. As a conclusion, BMI does not affect the clinical effectiveness of TOT operation in the treatment of female SUI or MUI. [ABSTRACT FROM AUTHOR]

Sling procedures are a widely proven treatment for stress urinary incontinence. The aim of this prospective study was to evaluate the effect of the transobturator tape on female sexual functioning. Fifty-four women treated for stress urinary incontinence with transobturator tape filled out self-administered questionnaires on quality of life, urinary incontinence, and sexual function prior to surgery and 6 weeks and 12 months postoperatively. Preoperatively, 40 women (78%) were sexually active. There were no significant postoperative changes regarding frequency of sexual activity, sexual desire, and problems with lubrication or orgasm. Preoperatively, 55% reported urinary leakage during sexual activity and after surgery 6.5%. Sexual satisfaction was significantly improved 6 weeks ( p = 0.05) and 12 months ( p = 0.03) postoperatively. Pain during or after sexual activity was declined, only one patient reported worsening of pain. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. It seems to improve the overall sexual satisfaction. Further research is warranted to support these preliminary findings. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to discuss our approach to the failure cases whose primary surgery was Burch colposuspension. Methods: Total cases who underwent Burch colposuspension was 298, however, 36 cases lost follow-up therefore the study population was 262 cases. Forty-two patients having recurrent stress urinary incontinence (16.0%) after Burch procedure enrolled for the study. Twenty-nine of the recurrent cases were treated with mid-urethral slings tension-free vaginal tape or transobturator tape (TOT) as a secondary procedure, whereas thirteen of the recurrent cases preferred to take medical therapy. Seven of the failed patients after the repeat surgery accepted TOT as a tertiary procedure. Results: The cumulative cure rates after the secondary and tertiary interventions were 62.1 and 57.1%, respectively. No complications were noticed during the secondary and tertiary surgical interventions. Conclusion: Our study showed that suburethral sling surgery can be an effective choice for the treatment of recurrent cases after Burch colposuspension. [ABSTRACT FROM AUTHOR]

Synthetic sub-urethral sling has become the most widely used technique for the surgical management of stress urinary incontinence. Despite a higher success rate, complications like migration, encrustation, and stone formation have been reported by a mid-urethral sling (MUS). Among mid-urethral sling procedures, mini vaginal tape (MVT) is very popular. As periurethral stone formation and urethrovaginal fistula are very uncommon after MVT, case report on this issue is sparse. The current case report features a 55-year female presented with lower abdominal pain and continuous urinary incontinence, 10 years after the MVT. She was diagnosed as a case of periurethral stone with urinary incontinence due to urethro-vaginal fistula. Our surgical team successfully removed the stone formed by the encrustation of the displaced tape and repaired the fistula. Following the MVT, a high degree of suspicion and long-term follow-up is mandatory for the diagnosis and management of these rare complications. • Mini vaginal tape (MVT), a form of synthetic mid-urethral sling is popular for treating stress urinary incontinence. • There are limited reports on periurethral stone formation and urethrovaginal fistula by MVT as it is rare. • This study presents a case of periurethral stone in the MVT with urinary incontinence due to urethrovaginal fistula. • Although rare, a high degree of suspicion is mandatory for the diagnosis and management of these rare complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate by voluntary and anonymous declaration the current surgical practice for female stress urinary incontinence (SUI) in France. Population and methods: A postal survey, anonymous, sealed, and validated by the Scientific Committee of the Société de chirurgie gynécologie et pelvienne (SCGP), was conducted among all members. The questionnaire was also available online, on the SCGP website. Results: One hundred and three (18%) members responded. The respondents (87%; n =90) were performing less than 10 incontinence procedures in a month. Suburethral slings represent the choice technique for SUI, prior by transobturator approach (87%; n =90). Other practices are exceptional. Urodynamics study was routinely performed prior to surgery in 69% of cases. Surgical treatment was performed using prior regional anaesthesia in retropubic approach (58%; n =40 in 68 respondents); either loco-regional (47%; n =48 in 102 respondents) or general anaesthesia (50%; n =51 in 102 respondents) were used in transobturator approach. No transobturator route was privileged. The postoperative urethral catheter was being left for 24h or less in case of retropubic or transobturator approach (70%; n =37 in 53 respondents and 68%; n =52 in 76 respondents, respectively). The patient''s hospital stay was one night (83%; n =54 in 65 respondents and 85%; n =87 in 102 respondents, respectively). A postoperative audit was not done by 19% of respondents. Discussion and conclusion: Suburethral tape placement is nowadays the main surgical treatment for female stress urinary incontinence amongst members of SCGP. The transobturator approach is preferred. [Copyright &y& Elsevier]

Objectives: Suburethral sling is the gold standard treatment for stress urinary incontinence (SUI). Short-term cure rates are high, but only few studies are available for longer assessment after transobturator tape procedure. The objectives of this study were to assess mid-term functional outcome for Monarc(®) transobturator tape after initial success, and to identify risk factors for recurrence., Material and Methods: We conducted a single centre retrospective study (2004-2013) on consecutive women with SUI who underwent Monarc(®) transobturator tape procedure and were initially cured at the postoperative medical consultation. Pre- and postoperative data (age, weight, height, body mass index, hormonal status, surgical history, associated organ prolapse [Baden and Walker], associated urinary symptoms, postoperative complications [Clavien-Dindo]) were extracted from the electronic medical record. Subjective cure was defined by a score of zero from the ICIQ-SF questionnaire, no second intervention for recurrent SUI and no need for pads at latest news. Statistical analysis was performed using SAS(®) v9.3 (P<0.05)., Results: One hundred and thirty-three consecutive women underwent TOT Monarc(®) procedure, and 125 women were cured in the short-term. Among these women, 103 (82%) were available for mid-term evaluation. Sixty-four women (62%) had pure stress urinary incontinence. The mean follow-up period was 51 months [2-119]. At last follow-up, cure rate was 61%. Seventy-eight percent of women with recurrent urinary incontinence had SUI. Other women had mixed urinary incontinence (3/40), or de novo urgency (6/40). In univariate analysis, we could not identify pejorative prognostic factors for mid-term failure., Conclusion: In our experience, mid-term functional outcome after Monarc(®) transobturator tape procedure seems to deteriorate. After 4 years of follow-up, 61% of the women who were initially cured were still free from any leakage., Level of Evidence: 4., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)