Effectiveness of transobturator tape in women with decreased urethral mobility.

Objective: To determine whether preoperative urethral mobility is associated with success of the transobturator insertion of suburethral polypropylene slings.

Study Design: A cohort of women who underwent a transobturator insertion of a suburethral polypropylene sling for urodynamic stress incontinence between October 2003 and January 2005 was prospectively assessed.

Results: Of the 134 women in the study cohort, 107 (80%) provided postoperative data at a median followup interval of 10 months. Postoperatively, 92 (86%) reported complete resolution of stress urinary incontinence on the Urogenital Distress Inventory-6 questionnaire, and 15 (14%) reported persistent incontinence. The median preoperative urethral mobility was significantly decreased among women who were incontinent postoperatively compared to those who were continent (40 degrees [10-60] vs. 50 degrees [10-90], p=0.0049). Women with preoperative urethral mobility < 45 degrees were at least 4 times more likely to report postoperative incontinence compared with women with preoperative urethral mobility > or = 45 degrees (29.4% vs. 6.9%, RR 4.29, 95% CI 1.59-11.60, p = 0.005). In addition, women with preoperative urethral straining angles < 45 degrees from the horizontal were at least 5 times more likely to report postoperative incontinence compared with women with preoperative urethral straining angles > or = 45 degrees (41.7% vs. 8.7%, RR 5.21, 95% CI 1.88-14.42, p = 0.006). Neither patient age nor the concomitant performance of an anterior colporrhaphy affected these results.

Conclusion: Women with preoperative urethral mobility or preoperative urethral straining angles < 45 degrees appear to be at higher risk for failure following a transobturator insertion of a suburethral polypropylene sling.