الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Stress urinary incontinence is the most common type of incontinence in women, with 86% of incontinent women presenting with the symptom of SUI in either pure (50%) or mixed (36%) forms. Incontinent women have SUI when they complain of involuntary leakage on effort, exertion., sneezing or coughing (Cardozo, 2004).
Many surgical procedures for relieving SUI have been introduced and most stabilize the bladder neck and or urethra. In 1996 Ulmsten proposed a new surgical technique called tension-free vaginal tape (TVT) for treatment of SUI (Ulmsten et aI., 1996). Pioneered by Delorme (2001), the trans-obturator tape approach (TOT) was developed with the aim to reduce side effects of this retropubic sling procedure by not entering the space beyond the endopelvic fascia (Delorme, 2001). The mechanism of action of these sling procedures differs from that of conventional slings that usually were placed beneath the bladder neck to elevate this area according to pressure transmission theory (Boustead, 2002). Using tension-free or low tension slings the bladder neck is not displaced backwards into the abdomino-pelvic pressure zone but the defective pubo-urethral ligament is replaced. In addition the defective connection between the urethra and vagina is restored and thereby the sub-urethral hammock reinforced or restored (Boustead, 2002).
In this study we prospectively evaluate using TOT procedures in treatment of female SUI as regards safety and efficacy. A total of30 patients were randomly assigned to TVT-O( inside-out) 15 patients and TOT(outside-in) 15 patients during the period from October 2007 to December 2009. All patients were assessed before surgery by history, clinical examination, urine analysis, abdomino-pelvic ultrasonography, ascending cystourethrography and urodynamic examination. The preoperative criteria (age, menopausal state, previous deliveries, type, cause and grade of SUI, presence of cystocele and presence of previous
Summary
pelvic surgery) were assessed in the 2 groups. The surgical outcome results were classified into cured, improved and failed.
All patients were operated upon under spinal anesthesia. The mean operative time of TVT -0 was significantly shorter than that of TOT. No intra-operative bleeding requiring blood transfusion was observed in both groups. Bladder injury did not occur in any patient.
The mean hospital stay was one day for both groups and the mean follow-up was 9.4 Months. Out of the 30 patients included in this study 96-6% were cured and 3.3% improved while 0% had failure. There was no significant difference between TVT -0 and TOT as regards the rates of cure.
There were no cases recorded with postoperative urinary retention. Only one patient of the TOT group developed transient postoperative voiding outflow obstruction. The mean uroflowmetry Q max did not show any significant changes during the follow-up period in both groups. De-novo urgency was noticed in 13.3% of patients in group 1 and 20% in group 2. those patients had no obstructive symptoms or significant residual urine. In group 1 (TVT -0) 26% of patients had moderate pain in the lower limbs in the early postoperative period and 33.3% had moderate pain or discomfort in the groin folds. While in group 2(TOT), 73.3% of patients developed lower limb pain and 20% had groin pain which persisted for few days.