Résumé
To evaluate the one-year results of transobturator suburethral tape for the treatment of female stress urinary incontinence.OBJECTIVETo evaluate the one-year results of transobturator suburethral tape for the treatment of female stress urinary incontinence.Suburethral tape was implanted via the transobturator technique. UraTape non-woven, non-elastic polypropylene tape with a 15 mm wide central (suburethral) silicone-coated zone was inserted without tension in a horizontal plane underneath the middle of the urethra from one obturator foramen to the other. The lateral ends of the tape were tunnelled percutaneously with a tunnelling device. The retropubic space was preserved and cystoscopy was not required. From May 2000 to February 2002, 32 patients with a mean age of 64 years (range: 50 to 81 years), suffering from stress urinary incontinence without associated prolapse, were operated by the same surgeon (ED). All patients were evaluated before the operation by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closing pressure < 20 cmH2O); five patients presented recurrent urinary incontinence after Burch or TVT; 18 patients presented mixed incontinence and detrusor instability was demonstrated on cystometry in 6 of them. The results were evaluated by two independent doctors (clinical examination, uroflowmetry, cough test). Voiding disorders suggestive of bladder outflow obstruction were defined by the presence of the following two criteria: Qmax < 15 ml/s, residual volume > 20%.MATERIAL AND METHODSSuburethral tape was implanted via the transobturator technique. UraTape non-woven, non-elastic polypropylene tape with a 15 mm wide central (suburethral) silicone-coated zone was inserted without tension in a horizontal plane underneath the middle of the urethra from one obturator foramen to the other. The lateral ends of the tape were tunnelled percutaneously with a tunnelling device. The retropubic space was preserved and cystoscopy was not required. From May 2000 to February 2002, 32 patients with a mean age of 64 years (range: 50 to 81 years), suffering from stress urinary incontinence without associated prolapse, were operated by the same surgeon (ED). All patients were evaluated before the operation by clinical and urodynamic examination: 5 patients presented sphincter incompetence (maximum closing pressure < 20 cmH2O); five patients presented recurrent urinary incontinence after Burch or TVT; 18 patients presented mixed incontinence and detrusor instability was demonstrated on cystometry in 6 of them. The results were evaluated by two independent doctors (clinical examination, uroflowmetry, cough test). Voiding disorders suggestive of bladder outflow obstruction were defined by the presence of the following two criteria: Qmax < 15 ml/s, residual volume > 20%.The mean follow-up of the study was 17 months (range: 13 to 29 months). The mean operating time was 15 minutes. No intraoperative complication was observed. One patient presented complete postoperative bladder retention that resolved after 4 weeks of self-catheterization. 29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. No urethral erosions were observed. No residual pain and no functional impairment related to the tape was observed. 5/32 patients presented voiding disorders suggestive of bladder outflow obstruction. Two patients developed de novo urge incontinence.RESULTSThe mean follow-up of the study was 17 months (range: 13 to 29 months). The mean operating time was 15 minutes. No intraoperative complication was observed. One patient presented complete postoperative bladder retention that resolved after 4 weeks of self-catheterization. 29/32 patients (90.6%) were cured and 3/32 (9.4%) were improved. No urethral erosions were observed. No residual pain and no functional impairment related to the tape was observed. 5/32 patients presented voiding disorders suggestive of bladder outflow obstruction. Two patients developed de novo urge incontinence.Transobturator Uratape is a simple and effective procedure with a follow-up of one year for the treatment of female stress urinary incontinence. The transobturator approach avoids the risks of bladder, intestinal and vascular injuries. Evaluation of the results with a longer follow-up is necessary to validate this technique.CONCLUSIONSTransobturator Uratape is a simple and effective procedure with a follow-up of one year for the treatment of female stress urinary incontinence. The transobturator approach avoids the risks of bladder, intestinal and vascular injuries. Evaluation of the results with a longer follow-up is necessary to validate this technique.