الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Urinary incontinence is a common problem through the world, although it is not life threatening, it is very disturbing to the lives of the individuals and can have devastating effects, both socially and psychologically.In the UK. Alone, it has been estimated that there are more than 3.5 million sufferers (Abrams et al., 2002).
According to the International continence society, Urinary incontinence defined ”A condition in which involuntary loss of urine is a social or hygienic problem and objectively demonstrable” (Ranee et al., 2000, Abrams et al., 2003).
Stress urinary incontinence (SUI) has an observedprevalence of between 4% and 35% (Karl et al., 2004).
In genuine stress incontinence, the assumption is that the intrinsic structuresphincter itself is intact and normal. However, it loses efficiency because of excessive mobilityand loss of support. Thus the anatomic feature of genuine SUI is consistently that ofhypermobility or lowering of the position of the vesicourethral segment or a combination of twofactors. Numerous risk factors for SUI have been identified. Aging, obesity, and smoking appearto have consistent causal relationships with the condition, whereas the roles of pregnancy andchildbirth remain controversial (Karl et al., 2004).
Although few young women report daily leakage, 10% of middle-aged women report dailyor severe incontinence and one third report leakage at least weekly. In epidemiologic studies, incontinence peaks in old age. In women with incontinence, the rate of stress incontinence peaks between 45 and 49 years at about 65% and then slowly drifts downward.(Hannestad et al., 2000).
It is not clear whether this is related to lower activity levels inolder women or whether the increased rate of urge incontinence in older women makes stress incontinence symptoms harder to isolate. Approximately 1 in 4 women with urinary incontinence consult a health care professional for this condition; not surprisingly, as incontinence becomes more severe, women are more likely toseek advice (Hannestad et al., 2000).
Treatment of SUI consists of conservative, pelvic floor muscle training (PFMT), pharmacologic treatment (Imipramine, Duloxetine, Estrogens). The principal treatment of SUI is proper suspension and support of the vesico-urethral segment in a normal position. There were numerous approaches in the past to restore the normal position and providing adequate support, some vaginal and some supra-pubic. Then can tension free vaginal tape (TVT) in mid to late 1990s. But TVT was associated with vascular injuries and bowel perforations (Delorime et al., 2001).
In 2001, Delorime et al. advocated the use of the trans-obturator route in order to avoid the complications associated with the retropubic route (Delorimeet al., 2001)Insertion through the obturator and puborectalis muscles reproduces the natural suspension fascia of the urethra while preserving theretropubic space.
This approach has a theoretical advantage of less obstruction and postoperative voiding dysfunction, as well as avoiding some of the complications, such as bladder perforation and bowel perforation. Subsequently, deTayrac reported a 1-year cure rate of 84% with the TOT procedure (deTayrac et al., 2004).
Reports indicate that TOT provides high short-term cure rates, similar to those achieved with TVT (Delorimeet al., 2004).
There were few post operative complications following TOT including de novo or worsening of preexisting urgencies, perineal pain, de novo dyspareunia, and vaginal erosion (Isabelle et al., 2009).
A recent review revealed the total reported complication rates ranging from 10.5% to 31.3% for TOT. (Daneshgari et al., 2008).
A study published by International Journal of Health Sciences stated that TOT Sling procedure is currently the Gold Standard for management of female SUI (Farhat et al., 2008) and many studies are being held to asses.
The aim of this study is to assess the long term Efficacyof Trans-Obturator Tape (TOT) For Treatment of Stress Urinary Incontinence.
Sixty women underwent Transobturator tape (TOT) for treatment of SUI at least 3 years ago were assessed both subjectively and objectively post operatively
Results showed that T.O.T. is a quite safe and effective procedure ,longterm complications like mesh erosion , dysparunea&denovo urge incontinence are are not common while the patient satisfaction with the outcome in great.