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Case Reports
. 2023 May;34(5):1017-1023.
doi: 10.1007/s00192-022-05299-y. Epub 2022 Jul 26.

Total trans-obturator tape (TOT) removal; a case series including pain and urinary continence outcomes

Sami Shawer  1 , Vijna Boodhoo  2 , Oliver Licari  3 , Stewart Pringle  3 , Veenu Tyagi  3 , Vladimir Revicky  3 , Karen Guerrero  3
Affiliations
Case Reports

Total trans-obturator tape (TOT) removal; a case series including pain and urinary continence outcomes

Sami Shawer et al. Int Urogynecol J. 2023 May.

Abstract

Introduction and hypothesis: For many years, mid-urethral mesh tape (MUT) was the gold-standard procedure for management of stress urinary incontinence (SUI). However, significant concerns were raised over its safety. We present a case series of total trans-obturator tape (TOT) removals, performed in a tertiary unit over a 3-year period. We aim to evaluate improvement of pain and change in urinary continence symptoms following mesh explantation.

Methods: This is a retrospective case series of the outcomes of total TOT removal. Primary outcome is the change in pain scores following total removal, assessed preoperatively, at discharge and follow-up. Secondary outcomes were perioperative complications, including return to theatre, re-admission rates and incidence of worsening SUI and overactive bladder symptoms (OAB) postoperatively. Statistical analyses were performed using SPSS 27.0 package (IBM, Chicago, IL) and the GraphPad Prism 9 statistical packages.

Results: Nineteen women were identified. Mean age was 52 years and mean BMI was 31. Indications for mesh removal were: chronic pain (95%), vaginal exposure (37%) and pelvic sepsis (5%). No patients had return to theatre. Median intraoperative blood loss was 200 ml (interquartile range [IQR]: 150-288). Mean length of mesh excised was 22 cm. Mean postoperative hospital stay was 2 days. At follow-up, most patients (72%) reported "improvement" of their mesh-related pain at follow-up, while 6% reported "worsening" of pain. Eighty-three per cent of patients reported worsening SUI, and 50% reported worsening OAB symptoms.

Conclusions: In the absence of sepsis, significant intraoperative complications are rare during total TOT removals. While 72% of patients reported improvement of their mesh-related pain, 6% still reported worsening pain after total mesh excision.

Keywords: Mesh complications; Mesh excision; Mesh removal; Pain; Stress urinary incontinence.

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Conflict of interest statement

Sami Shawer (SS), Vijna Boodhoo (VB), Oliver Licari (OL) and Stewart Pringle (SP): no conflict of interest for any of the authors.

Veenu Tyagi (VT): Executive member and/or member of the British Society of Urogynaecology (BSUG), the UK Continence Society (UKCS) and the Scottish Pelvic Floor Network (SPFN).

Vladimir Revicky (VR): Member of the British Society of Urogynaecology (BSUG) and the UK Continence Society (UKCS)

Karen Guerrero (KG): Executive member of the British Society of Urogynaecology (BSUG) and the UK Continence Society (UKCS). Chair of the RCOG sub-speciality training committee.

Figures

Fig. 1
Fig. 1
Removed TOT mesh photographed in line with our nationally agreed protocol, with a measurement tape
Fig. 2
Fig. 2
Mean VAS pain scores pre- and postoperatively and at follow-up. The patients’ VAS pain scores were shown to be significantly reduced postoperatively and at follow-up compared to the preoperative (pre-op) pain scores. ***P ≤ 0.05
See this image and copyright information in PMC

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