Skip to main content
Top
Published in: International Urogynecology Journal 8/2011

01-08-2011 | Original Article

An anatomic comparison of the original versus a modified inside-out transobturator procedure

Authors: Piet Hinoul, Pierre Bonnet, Ladislav Krofta, David Waltregny, Jean de Leval

Published in: International Urogynecology Journal | Issue 8/2011

Login to get access

Abstract

Introduction and hypothesis

The objective of this study was to evaluate the modification of a shortened tape and reduced dissection of the inside-out transobturator procedure on the tape’s relationship to the relevant anatomical structures.

Methods

In ten fresh frozen cadavers, relevant distances between the two different tapes and anatomical structures were recorded.

Results

The shorter tape traversed less muscular structures, but consistently traversed the obturator membrane. The median distance from the tape to the obturator canal measured 2.0 versus 1.9 cm, to the anterior obturator nerve 3.0 versus 2.7 cm, and to the posterior obturator nerve 2.2 versus 2.0 cm [modified versus original procedure, respectively (p > 0.05)]. Significantly, less mesh was inserted in the modified procedure on each side of the body (6.1 versus 9.9 cm, p < 0.05).

Conclusions

The shorter, inside-out transobturator tape traverses less muscular structures than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal.
Literature
1.
go back to reference Herzog AR, Fultz NH (1990) Prevalence and incidence of urinary incontinence in community dwelling populations. J Amer Geriatr Soc 38:273–281 Herzog AR, Fultz NH (1990) Prevalence and incidence of urinary incontinence in community dwelling populations. J Amer Geriatr Soc 38:273–281
2.
go back to reference Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trøndelag. J Clin Epidemiol 53(11):1150–1157PubMedCrossRef Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trøndelag. J Clin Epidemiol 53(11):1150–1157PubMedCrossRef
3.
go back to reference Van Geelen JM, Hunskaar S (2005) The epidemiology of female urinary incontinence. Eur Clin Obstet Gynecol 1:3–11CrossRef Van Geelen JM, Hunskaar S (2005) The epidemiology of female urinary incontinence. Eur Clin Obstet Gynecol 1:3–11CrossRef
4.
go back to reference Latthe PM, Singh P, Foon R, Toozs-Hobson P (2010) Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int 106(1):68–76PubMedCrossRef Latthe PM, Singh P, Foon R, Toozs-Hobson P (2010) Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int 106(1):68–76PubMedCrossRef
5.
go back to reference Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006375. doi:10.1002/14651858.CD006375.pub2. Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006375. doi:10.​1002/​14651858.​CD006375.​pub2.​
6.
go back to reference Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, Nilsson CG (2007) Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol 109(1):4–11PubMedCrossRef Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, Nilsson CG (2007) Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol 109(1):4–11PubMedCrossRef
7.
go back to reference Lee KS, Han DH, Choi YS, Yum SH, Song SH, Doo CK, Choo MS (2007) A prospective trial comparing tension-free vaginal tape and transobturator vaginal tape inside-out for the surgical treatment of female stress urinary incontinence: 1-year followup. J Urol 177(1):214–218PubMedCrossRef Lee KS, Han DH, Choi YS, Yum SH, Song SH, Doo CK, Choo MS (2007) A prospective trial comparing tension-free vaginal tape and transobturator vaginal tape inside-out for the surgical treatment of female stress urinary incontinence: 1-year followup. J Urol 177(1):214–218PubMedCrossRef
8.
go back to reference Araco F, Gravante G, Sorge R, Overton J, De Vita D, Sesti F, Piccione E (2008) TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(7):917–926PubMedCrossRef Araco F, Gravante G, Sorge R, Overton J, De Vita D, Sesti F, Piccione E (2008) TVT-O vs TVT: a randomized trial in patients with different degrees of urinary stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(7):917–926PubMedCrossRef
9.
go back to reference Lee KS, Choo MS, Lee YS, Han JY, Kim JY, Jung BJ, Han DH (2008) Prospective comparison of the ‘inside-out’ and ‘outside-in’ transobturator-tape procedures for the treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(4):577–582PubMedCrossRef Lee KS, Choo MS, Lee YS, Han JY, Kim JY, Jung BJ, Han DH (2008) Prospective comparison of the ‘inside-out’ and ‘outside-in’ transobturator-tape procedures for the treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(4):577–582PubMedCrossRef
10.
go back to reference But I, Faganelj M (2008) Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct 19(6):857–861PubMedCrossRef But I, Faganelj M (2008) Complications and short-term results of two different transobturator techniques for surgical treatment of women with urinary incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct 19(6):857–861PubMedCrossRef
11.
go back to reference Liapis A, Bakas P, Creatsas G (2008) Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct 19(2):185–190PubMedCrossRef Liapis A, Bakas P, Creatsas G (2008) Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct 19(2):185–190PubMedCrossRef
12.
go back to reference Tamussino K, Hanzal E, Kölle D, Tammaa A, Preyer O, Umek W, Bjelic-Radisic V, Enzelsberger H, Lang PF, Ralph G, Riss P, Austrian Urogynecology Working Group (2007) Transobturator tapes for stress urinary incontinence: results of the Austrian registry. Am J Obstet Gynecol 197(6):634, e1-5PubMedCrossRef Tamussino K, Hanzal E, Kölle D, Tammaa A, Preyer O, Umek W, Bjelic-Radisic V, Enzelsberger H, Lang PF, Ralph G, Riss P, Austrian Urogynecology Working Group (2007) Transobturator tapes for stress urinary incontinence: results of the Austrian registry. Am J Obstet Gynecol 197(6):634, e1-5PubMedCrossRef
13.
go back to reference Houwert RM, Roovers JP, Venema PL, Bruinse HW, Dijkgraaf MG, Vervest HA (2010) Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices. Am J Obstet Gynecol 202(1):75, e1-7PubMedCrossRef Houwert RM, Roovers JP, Venema PL, Bruinse HW, Dijkgraaf MG, Vervest HA (2010) Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices. Am J Obstet Gynecol 202(1):75, e1-7PubMedCrossRef
14.
go back to reference Debodinance P (2006) Trans-obturator urethral sling for surgical correction of female stress urinary incontinence: outside-in (Monarc) versus inside-out (TVT-O). Are both ways safe? J Gynecol Obstet Biol Reprod (Paris) 35(6):571–577 Debodinance P (2006) Trans-obturator urethral sling for surgical correction of female stress urinary incontinence: outside-in (Monarc) versus inside-out (TVT-O). Are both ways safe? J Gynecol Obstet Biol Reprod (Paris) 35(6):571–577
15.
go back to reference Bonnet P, Waltregny D, Reul O, de Leval J (2005) Transobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations. J Urol 173(4):1223–1228PubMedCrossRef Bonnet P, Waltregny D, Reul O, de Leval J (2005) Transobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations. J Urol 173(4):1223–1228PubMedCrossRef
16.
go back to reference de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730PubMedCrossRef de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730PubMedCrossRef
17.
go back to reference de Leval J, Thomas A, Waltregny D (2010) The original versus a modified inside-out transobturator procedure: 1-year results of a prospective randomized trial. Int Urogynecol J Pelvic Floor Dysfunct 22(2):145–156 de Leval J, Thomas A, Waltregny D (2010) The original versus a modified inside-out transobturator procedure: 1-year results of a prospective randomized trial. Int Urogynecol J Pelvic Floor Dysfunct 22(2):145–156
18.
go back to reference Hinoul P, Vanormelingen L, Roovers JP, de Jonge E, Smajda S (2007) Anatomical variability in the trajectory of the inside-out transobturator vaginal tape technique (TVT-O). Int Urogynecol J Pelvic Floor Dysfunct 18(10):1201–1206PubMedCrossRef Hinoul P, Vanormelingen L, Roovers JP, de Jonge E, Smajda S (2007) Anatomical variability in the trajectory of the inside-out transobturator vaginal tape technique (TVT-O). Int Urogynecol J Pelvic Floor Dysfunct 18(10):1201–1206PubMedCrossRef
19.
go back to reference Spinosa JP, Dubuis PY, Riederer BM (2007) Transobturator surgery for female stress incontinence: a comparative anatomical study of outside-in vs inside-out techniques. BJU Int 100(5):1097–1102PubMed Spinosa JP, Dubuis PY, Riederer BM (2007) Transobturator surgery for female stress incontinence: a comparative anatomical study of outside-in vs inside-out techniques. BJU Int 100(5):1097–1102PubMed
20.
go back to reference Reisenauer C, Kirschniak A, Drews U, Wallwiener D (2006) Transobturator vaginal tape inside-out. A minimally invasive treatment of stress urinary incontinence: surgical procedure and anatomical conditions. Eur J Obstet Gynecol Reprod Biol 127(1):123–129PubMedCrossRef Reisenauer C, Kirschniak A, Drews U, Wallwiener D (2006) Transobturator vaginal tape inside-out. A minimally invasive treatment of stress urinary incontinence: surgical procedure and anatomical conditions. Eur J Obstet Gynecol Reprod Biol 127(1):123–129PubMedCrossRef
21.
go back to reference Waltregny D, de Leval J (2009) The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update. Int Urogynecol J Pelvic Floor Dysfunct 20(3):337–348PubMedCrossRef Waltregny D, de Leval J (2009) The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update. Int Urogynecol J Pelvic Floor Dysfunct 20(3):337–348PubMedCrossRef
22.
go back to reference Ridgeway BM, Arias BE, Barber MD (2008) Variation of the obturator foramen and pubic arch of the female bony pelvis. Am J Obstet Gynecol 198:546, e1-546.e4PubMedCrossRef Ridgeway BM, Arias BE, Barber MD (2008) Variation of the obturator foramen and pubic arch of the female bony pelvis. Am J Obstet Gynecol 198:546, e1-546.e4PubMedCrossRef
23.
go back to reference Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, Dwyer PL (2006) Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct 17(4):330–334PubMedCrossRef Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, Dwyer PL (2006) Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct 17(4):330–334PubMedCrossRef
24.
go back to reference Zahn CM, Siddique S, Hernandez S, Lockrow EG (2007) Anatomic comparison of two transobturator tape procedures. Obstet Gynecol 109(3):701–706PubMedCrossRef Zahn CM, Siddique S, Hernandez S, Lockrow EG (2007) Anatomic comparison of two transobturator tape procedures. Obstet Gynecol 109(3):701–706PubMedCrossRef
Metadata
Title
An anatomic comparison of the original versus a modified inside-out transobturator procedure
Authors
Piet Hinoul
Pierre Bonnet
Ladislav Krofta
David Waltregny
Jean de Leval
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 8/2011
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-011-1415-2

Other articles of this Issue 8/2011

International Urogynecology Journal 8/2011 Go to the issue