Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study

Mohamed Abdel-Fattah, I Ramsay, S Pringle

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68 Citations (Scopus)


OBJECTIVES: To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension-free vaginal tape (TOT) procedure. DESIGN: Retrospective cohort study. SETTING: Tertiary referral urogynaecology centre. POPULATION: 390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006. METHODS: Early cases were identified from theatre records and a case note review performed. From May 2005 (n = 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer's exact test. MAIN OUTCOME MEASURES: Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the 'outside-in' and 'inside-out' techniques. RESULTS: 241 women underwent TOT outside-in technique and 148 of them underwent inside-out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside-in group, although this difference did not reach significance (P = 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures. CONCLUSION: LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside-in technique. Intraoperative cystoscopy should be considered only in selected cases.
Original languageEnglish
Pages (from-to)1377-1381
Number of pages5
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Issue number12
Early online date26 Oct 2006
Publication statusPublished - 1 Dec 2006


  • Adult
  • Female
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Suburethral Slings
  • Urethra
  • Urinary Bladder
  • Urinary Incontinence, Stress
  • Urologic Surgical Procedures


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