"Inside-out" transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair.

Objectives: To assess the safety and effectiveness of the "inside-out" transobturator tension-free vaginal tape procedure for the management of occult stress urinary incontinence (SUI) in clinically continent women undergoing prolapse repair.

Methods: A total of 117 consecutive continent women (mean age and parity 66.8 ± 9.9 years and 3.2 ± 1.5, respectively) with significant pelvic organ prolapse and urodynamically confirmed occult SUI were enrolled in the present study. Surgical intervention included transvaginal prolapse repair and concomitant prophylactic transobturator tension-free vaginal tape. The main outcome measures were procedure-related complications, early and late postoperative morbidity, postoperative urodynamic SUI, persistent or de novo overactive bladder, and bladder outlet obstruction.

Results: No cases of significant blood loss, hematoma formation, or bladder injury occurred. Of the 117 patients, 6 (5.1%) had immediate postoperative voiding difficulties necessitating catheterization for >2 days. Late postoperative morbidity was assessed in 110 patients with ≥3 months of follow-up (mean 27.2 ± 17.7). Of these 110 patients, 7 (6.4%) had protracted postoperative thigh pain with spontaneous resolution within 1-3 months, and 7 (6.4%) had developed recurrent urinary tract infections. No cases of vaginal erosion developed. The functional outcome analysis was restricted to 92 patients with ≥12 months of follow-up (mean 31 ± 16). Of the 92 patients, 13 (14%) were found to have urodynamic SUI. However only 2 patients (2.2%) were symptomatic for a subjective and objective cure rate of 97.8% and 86%, respectively. Of the 34 patients who had had overactive bladder preoperatively, 22 (64.7%) had persisting symptoms postoperatively. An additional 4 patients (6.9%) had developed de novo overactive bladder symptoms, and 1 patient had bladder outlet obstruction.

Conclusions: The prophylactic transobturator tension-free vaginal tape procedure is both effective and safe in patients with occult SUI undergoing prolapse repair.