The document discusses stress urinary incontinence and trans obturator tape (TOT), a surgical procedure to treat it. It describes different types of incontinence and evaluations used to diagnose SUI, including urodynamics tests. TOT is presented as an alternative to trans vaginal tape (TVT) that avoids risks of injury from entering the retropubic space. The document outlines the TOT procedure and compares complications between TOT and TVT, noting lower risks of bladder injury, voiding dysfunction, and de novo urgency with TOT. Mini-slings are also mentioned as alternative options.

1. Live Surgery Workshop and Scientific Symposium | 2011
STRESS URINARY INCONTINENCE
TRANS OBTURATOR TAPE
K.LALITHA
Consultant Urologist & Urogynaecologist
Yashoda hospital
Somajiguda
Live Surgery Workshop and Scientific Symposium | 2011

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Types of Incontinence
• Stress
• Urge
• Mixed
• Overflow

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Classification of SUI
• Type I & II Anatomical
• Type III Int. Sphincter defect

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Evaluation of Patient
• History
• Examination
• Stress test - postural
• Bonney's test - false positive

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Urodynamics
• Uroflow
• Cystometry
FILLING/VOIDING
• Urethral Pr. profile
• EMG
Video - urodynamics
• Differentiate types of SUI

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Role of Urodynamics
• Is it essential in all patients ?
• Role of ALPP and UCP ?
• Prediction of post op voiding
dysfunction ?
• Effect on surgical outcome ?

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Grades of SUI
• I Severe stress
• II Minimal stress
• III Leakage thru out

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GYNECARE TVT Device

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Anesthesia
Abdomen

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Dissection of Anterior Wall

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TVT-O
(Obturator)
• Advantage over TVT
– Eliminates entry into retropubic space
– No risk of injury to bladder or bowel

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Complications
• Functional
– Voiding dysfunction
– Detrusor instability
• Technical
• Obturator nerve injury

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COMPLICATIONS OF TVT Vs TOT
• TVT TOT
• BLADDER INJURY 4% RARE
• VOIDING DYSFUN. 8% 2%
• De NOVO URGENCY 14% 6%

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COMPLICATIONS
EROSION
QUALITY OF MESH
HOST FACTOR
SURGICAL TECHNIQUE

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MINI SLINGS
• MINI-ARC
• TVT-ABBREVO

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