Postoperative Complications in Women Submitted to a Transobturator Tape Sling: An 11-Year Retrospective Cohort.

Abstract

<h4>Introduction and hypothesis</h4>Urinary incontinence (UI) is a common condition that impacts society. A transobturator tape (TOT) sling is one of the most widely used surgical options in the treatment of stress incontinence. This study aimed to investigate the incidence and types of postoperative complications, as well as the reoperation rate, in women undergoing TOT sling surgery.<h4>Methods</h4>A retrospective cohort study was conducted involving 194 women submitted to a TOT sling between 2010 and 2020 at São José do Rio Preto Base Hospital, a university hospital in the state of São Paulo, Brazil. Demographic characteristics, type of UI, preoperative urodynamic data, postoperative complications, and the need for reoperation were collected. The data were entered into a spreadsheet in MS Excel. IBM SPSS Statistics for Windows, version 23.0 (released 2014, IBM Corp., Armonk, NY) and GraphPad Instat (version 3.10, released 2009, GraphPad, California, USA) programs were used for the statistical analysis.<h4>Results</h4>The mean patient age was 56.4 years, and 68% of the sample had stress UI alone. The success rate was 77%, whereas 31% had clinical or surgical complications, such as de novo urgency and postoperative stress UI, mesh extrusion, urinary obstruction, and acute urinary retention. Only four patients (2%) required reoperation.<h4>Discussion</h4>The epidemiological findings (average age and prevalence of comorbidities, such as hypertension (36.6%) and diabetes (14.4%)) match the expected profile for women with UI. The overall complication rate was compatible with rates described in the literature, with a predominance of conservatively manageable clinical complications. Although 7.8% of the patients required intervention for surgical complications, the procedure proved safe and effective, even in a teaching environment.<h4>Conclusions</h4>TOT sling proved to be a safe, effective option for the treatment of stress UI, even in a training scenario. Most postoperative complications were managed clinically, and the reoperation rate was low. Despite the proven efficacy of the procedure, the monitoring of clinical complications is necessary to minimize the impact on the quality of life of patients.