Klinischer Erfolg nach Implantation einer transobturatorischen suburethralen Schlingenplastik (TOT) bei weiblicher Belastungsinkontinenz- Langzeitergebnisse und Lebensqualität unter besonderer Berücksichtigung des Body-Mass-Index

Transobturator vaginal tape (TOT) is a new minimally invasive surgical technique to treat female stress urinary incontinence (SUI). In contrast to the tension-free vaginal tape (TVT) procedure there is no passage of the sling through the retropubic space so that the risk of serious complications, including vascular, bowel, peritoneum and bladder injuries, can be decreased. Aim of this study was to evaluate the long-term clinical outcome of the TOT operation as well as to analyze the BMI-specific outcome. The study included all women with SUI who underwent a TOT procedure at the Clinic for Urology, Philipps University Marburg, from January 2005 to July 2009. All study patients were preoperatively and postoperatively evaluated concerning medical history, Kings-Health-Questionnaire (KHQ), International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF), physical examination, pad-test, ultrasonography and urodynamics. The analysis of our data shows that the transobturator approach is a very successful treatment of female stress urinary incontinence. We found objective and subjective cure rates of 87% vs. 83% after a median follow-up of 17 months. These results are comparable to similar studies. The evaluation of the two questionnaires (KHQ and ICIQ-SF) showed also very convincing results: after the TOT-operation there was a significant improvement in quality of life in all areas of life (KHQ) and the severity of SUI could be definitely reduced (ICIQ-SF). Intraoperatively, there was no case of bladder or bowel injury. Vascular injury was encountered in one patient (1,45%), which shows that the transobturator approach is very safe with minimal long-term morbidity. 16% of the women developed denovo urgency, however they had a high mean age and therefore an increasing risk. Furthermore, our results demonstrate other late postoperative complications in 15 patients (22%), such as urinary retention or decreased maximum flow rates, without any clinical complains of the women. To evaluate the BMI-specific outcome, the patients were classified into three groups according to the WHO body mass index (<25 kg/m²; 25-29,99 kg/m²; ≥30 kg/m²). The objective and subjective cure rates, the complication rates as well as operation times are comparable in all groups. Although obesity represents a risk factor for SUI and is attended by higher operation and anaesthetic risks we did not find any significant differences between the three groups. Obese women even developed denovo urgency less frequently than patients with normal weight. From this follows that in overweight and obese patients the TOT procedure is as safe and effective compared to normal weighed females. Finally, we could demonstrate with this study that the transobturator approach is a successful treatment of female SUI. Our data show a very convincing long-term outcome after TOT as well as comparable cure rates and low morbidity for obese women. The TOT-operation is a good and sensible alternative to the retropubic access as the possibility to decrease the low complication rate once more. However, longer follow-up in larger population should follow this study to support our results.