INTRODUCTION : Stress Urinary incontinence (SUI) is defined as involuntary leakage of urine on effort or exertion, or sneezing or coughing in the absence of bladder contraction. Stress urinary incontinence is extremely
bothersome and can lead to significant interference in the quality of life in the female population. Stress urinary incontinence affects up to 40 % of women in the western world and 25% of women in India1. Women have a 4% risk of needing stress incontinence surgery during their lifetime, with nearly one third of surgeries performed due to recurrence. The tension free vaginal tape procedure described by Ulmsten has revolutionized the treatment of female stress urinary incontinence. This procedure had high cure rate when compared to Burch colposuspension. While these tapes have proved their long term efficacy, their insertion via an ascending or descending retropubic approach has been associated with number of intraoperative complications. The transobturator approach was first described by DeLorme in 2001 for placement of midurethral vaginal tape with the objective of avoiding retropubic area. It consists of insertion of the tape through a skin incision in the thigh into the obturator foramen towards the urethra.
Cadaveric dissections by various authors have proved this procedure is safer but complications like lower urinary tract injuries, vaginal tears and groin haematoma have been noted. AIMS AND OBJECTIVES : 1) To evaluate the efficacy of inside out transobturator tape in the treatment of female stress urinary incontinence. 2) To determine the influence of inside out transobturator tape on objective and subjective cure rate and quality of life in patients
with stress urinary incontinence. 3) To assess the postoperative complications and thus the safety of this procedure.
MATERIAL AND METHODS : A total of 25 patients with stress urinary incontinence in Government Stanley Hospital during the period November 2010 to January 2013 were asked to participate in this prospective study. All the women underwent a standardized preoperative evaluation including detailed incontinence history regarding duration and severity of stress urinary incontinence. All the patients underwent pelvic examination, a stress-test in upright position and a short term pad test. Study Design: Prospective study. Inclusion Criteria: 1) Patients in the age group between twenty five to eighty five years. 2) Clinical as well as urodynamic diagnosis of stress urinary incontinence. 3) Positive pad test, stress-test. Exclusion Criteria: 1) Detrusor overactivity or impaired bladder contractility. 2) Post void residual urine 100 ml or greater. 3) Pregnancy. 4) Neurological pathology. 5) Active urinary or vaginal infection. CONCLUSION : The inside out transobturator approach (TVT-O) is an effective
and safe technique for the treatment of female stress urinary incontinence. The anatomical and functional mechanism of continence is restored with this minimally invasive approach. The position of the transobturator tape is similar to that of the natural hammock supporting the urethra, respects the orientation of muscle fibres better than the tension free transvaginal tape operation, and the dissection is less extensive, making tape migration less likely to occur. The para-urethral subvaginal dissection is less extensive with the inside-out route and the learning curve of this approach appears to be quicker. There are several proven advantages concerning the feasibility of the inside out transobturator technique compared to the transvaginal tape procedure: the short duration of the operation; the low risk of urethral and bladder lesion, making cystoscopy redundant; the absence of risk of bowel lesion; the low risk of haemorrhage. Initial and long term results appear to suggest a cure rate similar to that of the transvaginal tape
procedure and outside in transobturator approach with decreased incidence of complications
