Functional and anatomic assessments for transobturator vaginal tape inside-out operation for urodynamic stress incontinence

Aim: The aim of the present study was to assess by urodynamic study and chain urethrocystography the functional and anatomic changes before and after transobturator vaginal tape inside-out (TVT-O) operation. Methods: From January 2005 to February 2006, 35 women were enrolled who had urodynamic stress incontinence, with or without intrinsic sphincter deficiency, and had undergone TVT-O with regular follow-up. Investigations, including pelvic examination, pad test, urodynamic study, chain urethrocystography and questionnaire with short forms of Urogenital Distress Inventory and Incontinence Impact Questionnaire, were performed pre- and postoperatively. Results: The mean follow-up period was 12.8 months. The subjective and objective cure rates were 80 and 71.4%, respectively. The maximal urethral pressure was significantly decreased (from 67.0 to 58.9 cmH(2)O) after surgery and bladder neck mobility was reduced. Quality of life assessment revealed significant improvement after TVT-O. Conclusion: TVT-O is an effective operation for female urodynamic stress incontinence. Improved postoperative bladder neck mobility showed anatomic correction, indicating a hammock effect. The decreased maximal urethral pressure may reflect neurogenic damage during surgery; thus, minimal dissection and avoidance of unnecessary dissection to prevent periurethral damage are advised.