Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery

Published:September 23, 2020DOI:


      To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications.

      Materials and Methods

      Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire.


      The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P = .001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P = .998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P = .664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P = .028 and P = .032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P = .043, P = .048,P = .034, and P = .039, respectively).


      The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.
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        • Muller-Arteaga C
        • Martin Martinez A
        • Padilla-Fernandez B
        • et al.
        Position of the Ibero-American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence.
        Neurourol Urodyn. 2020; 39: 464-469
        • Ford AA
        • Rogerson L
        • Cody JD
        • Ogah J
        Mid-urethral sling operations for stress urinary incontinence in women.
        Cochrane Database Syst Rev. 2015; (CD006375)
        • Ford AA
        • Rogerson L
        • Cody JD
        • Aluko P
        • Ogah JA
        Mid-urethral sling operations for stress urinary incontinence in women.
        Cochrane Database Syst Rev. 2017; 7 (CD006375)
        • Chughtai B
        • Barber MD
        • Mao J
        • Forde JC
        • Normand ST
        • Sedrakyan A
        Association between the amount of vaginal mesh used with mesh erosions and repeated surgery after repairing pelvic organ prolapse and stress urinary incontinence.
        JAMA Surg. 2017; 152: 257-263
      1. United States Food and Drug Administration: Considerations about surgical mesh for SUI. ImplantsandProsthetics/UroGynSurgicalMesh/ucm345219.htm (01.2018).

        • Linder BJ
        • Elliott DS.
        Autologous transobturator urethral sling placement for female stress urinary incontinence: short-term outcomes.
        Urology. 2016; 93: 55-59
        • Osman NI
        • Hillary CJ
        • Mangera A
        • Aldamanhoori R
        • Inman RD
        • Chapple CR
        The midurethral fascial "Sling on a String": an alternative to midurethral synthetic tapes in the era of mesh complications.
        Eur Urol. 2018; 74: 191-196
        • El-Gamal O
        • Soliman M
        • Tawfik A
        • Abdel Raheem A
        Use of autologous rectus fascia in a new transobturator hybrid sling for treatment of female stress urinary incontinence: a pilot study.
        Scand J Urol. 2013; 47: 57-62
        • Cubuk A
        • Yanaral F
        • Savun M
        • et al.
        Modified autologous transobturator tape surgery - evaluation of short term results.
        Ginekol Pol. 2020; 91: 51-56
        • Laufer J
        • Scasso S
        • Bentancor V
        • Bertoche C
        • Sosa CG
        • Elliott DS
        Autologous transobturator sling as an alternative therapy for stress urinary incontinence.
        Int J Gynaecol Obstet. 2019; 145: 300-305
        • Walsh LP
        • Zimmern PE
        • Pope N
        • Shariat SF
        • Urinary Incontinence Treatment N
        Comparison of the Q-tip test and voiding cystourethrogram to assess urethral hypermobility among women enrolled in a randomized clinical trial of surgery for stress urinary incontinence.
        J Urol. 2006; 176 (discussion 650): 646-649
        • Haylen BT
        • de Ridder D
        • Freeman RM
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.
        Int Urogynecol J. 2010; 21: 5-26
        • Cubuk A
        • Erbin A
        • Savun M
        • et al.
        Autologous transobturator midurethral sling.
        Turk J Urol. 2019; 45: 230-232
        • Delorme E.
        Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women.
        Prog Urol. 2001; 11: 1306-1313
        • Rac G
        • Younger A
        • Clemens JQ
        • et al.
        Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications.
        Neurourol Urodyn. 2017; 36: 1155-1160
        • Palmerola R
        • Peyronnet B
        • Rebolos M
        • et al.
        Trends in stress urinary incontinence surgery at a tertiary center: midurethral sling use following the AUGS/SUFU position statement.
        Urology. 2019; 131: 71-76
        • Zacche MM
        • Mukhopadhyay S
        • Giarenis I
        Changing surgical trends for female stress urinary incontinence in England.
        Int Urogynecol J. 2019; 30: 203-209
        • Braga A
        • Caccia G
        • Sorice P
        • et al.
        Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 17-year follow-up.
        BJU Int. 2018; 122: 113-117
        • Woodruff AJ
        • Cole EE
        • Dmochowski RR
        • Scarpero HM
        • Beckman EN
        • Winters JC
        Histologic comparison of pubovaginal sling graft materials: a comparative study.
        Urology. 2008; 72: 85-89
        • Dora CD
        • Dimarco DS
        • Zobitz ME
        • Elliott DS
        Time dependent variations in biomechanical properties of cadaveric fascia, porcine dermis, porcine small intestine submucosa, polypropylene mesh and autologous fascia in the rabbit model: implications for sling surgery.
        J Urol. 2004; 171: 1970-1973
        • Fusco F
        • Abdel-Fattah M
        • Chapple CR
        • et al.
        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. 2017; 72: 567-591
        • Blaivas JG
        • Simma-Chiang V
        • Gul Z
        • Dayan L
        • Kalkan S
        • Daniel M
        Surgery for stress urinary incontinence: autologous fascial sling.
        Urol Clin North Am. 2019; 46: 41-52
        • Brubaker L
        • Norton PA
        • Albo ME
        • et al.
        Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study.
        Am J Obstet Gynecol. 2011; 205 (e491-496): 498
        • Rice NT
        • Hu Y
        • Slaughter JC
        • Ward RM
        Pelvic mesh complications in women before and after the 2011 FDA public health notification.
        Female Pelvic Med Reconstr Surg. 2013; 19: 333-338
        • Abraham N
        • Vasavada S.
        Urgency after a sling: review of the management.
        Curr Urol Rep. 2014; 15: 400