Effect of transobturator tape procedure on proximal urethral mobility.

Objectives: To assess prospectively the degree of urethral mobility in the preoperative and postoperative periods after the transobturator tape procedure and correlate the findings with surgical outcome.

Methods: Thirty-six consecutive patients with stress urinary incontinence underwent the transobturator tape procedure. A cotton-swab test was performed before the procedure and at the 6-week postoperative follow-up visit to evaluate proximal urethral mobility. Cure was defined as the absence of leak during cough stress testing at cystometric capacity.

Results: Of the 36 patients, 26 were available for the complete follow-up evaluation. The mean preoperative and postoperative resting cotton-swab test values were 11.7 degrees and 13.6 degrees, respectively (P = 0.347). The mean preoperative and postoperative straining cotton-swab test values were 57.3 degrees and 48.4 degrees, respectively (P = 0.047). Of the 36 patients, 21 had a straining cotton-swab test result of 30 degrees or greater after surgery, and 19 (90.4%) of these 21 patients were objectively cured by the procedure. Overall, 21 patients (84%) were objectively cured of stress urinary incontinence. Four patients had urinary leakage during stress testing at cystometric capacity. Three of these patients reported subjective cure and one noted improvement. Of the 5 patients with a negative cotton-swab test after surgery, 2 were cured (50%), 2 were not cured, and 1 did not undergo cough stress testing at cystometric capacity because of urgency at 200-mL limiting bladder filling.

Conclusions: The cure of urodynamic stress incontinence using the transobturator tape procedure does not require the correction of proximal urethral mobility.