Abstract
Purpose
To determine the association between changes in lumbar lordosis (LL) and/or pelvic inlet (PI) orientation and the outcome of a transobturator tape (TOT) sling procedure.
Methods
The study population consisted of 70 patients who underwent the TOT sling procedure for stress urinary incontinence, and were evaluated by a stress test at the sixth month after the surgery. The women were defined as continent on the absence of both subjective complaint of leakage and objective leakage as a result of the test. Cases that failed, even though improvement may have been observed, were considered incontinent. With the use of a standardized protocol, lateral lumbosacral spine/pelvic X-rays were taken with the participants standing in their usual upright posture with hands kept at chest level. From these X-rays, the angle of LL and PI were measured.
Results
Of the 70 cases, 42 were continent and 28 were incontinent according to the evaluation done during the sixth month after the TOT procedure. There were no significant differences with respect to age, body mass index, gravidity, vaginal parity, pelvic organ prolapse and comorbid diseases between the continent and incontinent groups. The mean angle of PI in the continent group (34°, range 20–50) was significantly lower than in the incontinent group (37°, range 28–60) (p = 0.012). There was no significant difference in the median angle of LL (32°, range 15–50 in continent group, 34.5°, range 21–56 in incontinent group, p = 0.13) between the two groups.
Conclusions
Women with continence after the TOT sling procedure have lower angle of PI than women with incontinence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AZ (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506
Hilton P, Dolan LM (2004) Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG 111(Suppl 1):5–9
Mayne CJ, Assassa RP (2004) Epidemiology of incontinence and prolapse. BJOG 111:2–4
Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT (2000) Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 11:301–319
Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L et al (2007) Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol 52:1481–1490
Amaye-Obu FA, Drutz HP (1999) Surgical management of recurrent stress urinary incontinence: a 12-year experience. Am J Obstet Gynecol 181:1296–1307
Nguyen JK, Lind LR, Choe JY, McKindsey F, Sinow R, Bhatia NN (2000) Lumbosacral spine and pelvic inlet changes associated with pelvic organ prolapse. Obstet Gynecol 95(3):332–336
Stav K, Alcalay M, Peleg S, Lindner A, Gayer G, Hershkovitz I (2007) Pelvis architecture and urinary incontinence in women. Eur Urol 52:239–244
Delorme E (2001) Transobturator urethral suspension: miniinvasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11:1306–1313
Wiltse LL, Winter RB (1983) Terminology and measurement of spondylolithesis. J Bone Joint Surg 65-A:768–772
Smith ARB, Hosker GL, Warrell DW (1989) The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine: a neurophysiological study. Br J Obstet Gynaecol 96:24–28
Merlin T, Arnold E, Petros P et al (2001) A systematic review of tension-free urethropexy for stress urinary incontinence: intravaginal slingplasty and the tension-free vaginal tape procedures. BJU Int 88:871
Lo TS (2004) Tension-free vaginal tape procedures in women with stress urinary incontinence with and without co-existing genital prolapse. Curr Opin Obstet Gynecol 16:399
Nilsson CG, Falconer C, Rezapour M (2004) Seven year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 104:1259
Novara G, Ficarra V, Boscolo-Berto R, Secco S, Cavalleri S, Artibani W (2007) Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol 52:663–679
Novara G, Galfano A, Boscolo-Berto R et al (2008) Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol 53:288–309
Novara G et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. doi:10.1016/j.eururo.2010.04.022)
Fischer A, Fink T, Zachmann S, Eickenbusch U (2005) Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol 48:799–804
Guerette NL, Bena JF, Davila GW (2008) Transobturator slings for stress incontinence: using urodynamic parameters to predict outcomes. Int Urogynecol J 19:97–102
Miller JJ, Botros SM, Akl MN et al (2006) Is transobturator tape as effective as tension-free vaginal tape in patients with borderline maximum urethral closure pressure? Am J Obstet Gynecol 95:1799–1804
Hsiao SM, Chang TC, Chen CH et al (2008) Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator tape procedures. World J Urol 26:643–648
DeLancey JO (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–1720
Hsiao SM, Sheu BC, Lin HH (2008) Sequential assessment of urodynamic findings before and after transobturator tape procedure for female urodynamic stress incontinence. Int Urogynecol J 19:627–632
Hsiao SM, Chang TC, Lin HH (2009) Risk factors affecting cure after mid-urethral tape procedure for female urodynamic stress incontinence: comparison of retropubic and transobturator routes. Urology 73(5):981–986
Smith MD, Coppieters MW, Hodges PW (2007) Postural response of the pelvic floor and abdominal muscles in women with and without incontinence. Neurourol Urodyn 26:377–385
Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Chao F et al (2010) Repeat synthetic mid urethral sling procedure for women with recurrent stress urinary incontinence. J Urol 183:241–246
Lee KS, Doo CK, Han DH et al (2007) Outcomes following repeat mid urethral synthetic sling after failure of the initial sling procedure: rediscovery of the tension-free vaginal tape procedure. J Urol 178:1370
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sahinkanat, T., Arıkan, D.C., Turgut, E. et al. Effects of lumbar lordosis and pelvic inlet orientation on the outcome of the transobturator tape sling operation in women. Arch Gynecol Obstet 284, 125–130 (2011). https://doi.org/10.1007/s00404-010-1619-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-010-1619-6