[90] Self-created transobturator tape (TOT) vs standard industrially created TOT in the treatment of stress urinary incontinence: Should we change the concept?

Objective

To compare the benefit and cost of tension-free self-created transobturator tape (SCTOT) with the standard industrially created TOT (ICTOT) in the treatment of stress urinary incontinence (SUI).

Methods

A prospective study of the treatment of SUI with SCTOT (98 patients) and ICTOT (77 patients) was performed. Two types of industrially created slings were used: the ‘T sling’ (Herniamesh, Torino, Italy), and the ‘TVT obturator’ (Johnson & Johnson, Somerville, NJ, USA). SCTOT (15 × 1 cm) was created from a polypropylene rectangular 30 × 30 cm macroporous polypropylene monofilament mesh weighing 48 g/m² (Pelvimesh®, Herniamesh) and monofilament sutures. Sutures (polydioxanone [PDS] 2–0) were passed through both ends of the mesh stripe to make a ‘composite’ sling consisting of monofilament suture-sling-monofilament suture (Video). The Urogenital Distress Inventory (UDI-6), the Incontinence Impact questionnaire (IIC-7) and the International Continence Impact questionnaire short form (ICIQ5-SF) were used to evaluate symptoms before and after surgery. The Overactive Bladder Symptom Score (OABSS >8) was used to identify patients with mixed UI (MUI).

Results

The follow-up period was 12 months. There was no statistically significant difference (P > 0.05) in objective cure between patients in the SCTOT group 84/98 (85.7%) and the ICTOT group 68/77 (88.3%). According to the IIC-7, UDI-6, ICIQ5-SF and OABSS symptom scores, significant improvement occurred in both groups, but it was better in the group with pure SUI than in the group with MUI, although it was not statistically significant. Symptom scores are shown in Tables 1 and 2. In all, 12 SCTOT were made from one polypropylene rectangular mesh priced at €60/piece. Compared to the price of the ICTOT (€400–700/piece) the SCTOT price is about 100-fold less.

Conclusion

The results of the treatment with SCTOT are not inferior to the results of the treatment with ICTOT but are less expensive.