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Two cases illustrating a potential difference between transobturator and retropubic slings
Moses Mukai1, Ramzi Aboujaoude, Patrick J Culligan
1Division of Urogynecology and Pelvic Reconstructive Surgery, Atlantic Health System, 95 Madison Ave., Suite 204, Morristown, NJ 07962, USA. HarleyMukai@yahoo.com
International Urogynecology Journal and Pelvic Floor Dysfunction
|December 16, 2006
Summary
Transobturator slings for stress incontinence can fail even when tightened. Retropubic slings were successful in these cases, suggesting the retropubic approach may be more reliable for certain patients.
Area of Science:
- Urology
- Female Pelvic Medicine and Reconstructive Surgery
Background:
- The transobturator (TOT) sling procedure is a surgical option for stress urinary incontinence (SUI).
- Its functional differences and failure rates compared to the traditional retropubic (RP) sling are not fully understood.
Observation:
- Two cases of failed TOT slings are presented, both performed under local anesthesia with intraoperative cough stress testing.
- Despite apparent adequate tensioning, the TOT slings failed to resolve SUI in both patients.
Findings:
- The failed TOT slings were subsequently replaced with RP slings.
- The RP sling procedures successfully resolved SUI in both previously reported cases.
- This suggests that some cases of SUI amenable to RP slings may not be effectively treated with TOT slings, even with aggressive tensioning.
Implications:
- The retropubic sling approach may offer superior efficacy for certain SUI patients compared to the transobturator approach.
- The cough stress test may help identify cases where a TOT sling is likely to fail preoperatively.
- Further research is warranted to elucidate the specific factors influencing the success rates of different mid-urethral sling procedures.
