Tot Fixation Using Customized Polypropylene Mesh - Safe and Effective Approach for SUI Repair

Abstract

Introduction: Stress urinary incontinence (SUI) is defined as involuntary loss of urine due to increased intraabdominal pressure and intravesical pressure, which exceeds the pressure that the urethral closure mechanism can withstand and urinary loss results. SUI prevalence increases with age and becoming popular day by day. The tot fixation in SUI repair is a common operation done in Gynaecology Department. Hence it is necessary to evaluate this technique in terms of safety and feasibility in our set up and also to evaluate the feasibility, simplicity, cost effectiveness of trans obturator fixation procedure using propylene mesh of adequate size was placed loose at midurethral level, extending from one paraurethral gutter to the other and was fixed with No.1-0 Vicryl on lateral sides in the management of female stress urinary incontinence (SUI). Aim and objectives: The objective was to assess safety, efficacy, complication and cost-effectiveness of polypropylene mesh in patients with SUI undergoing tot fixation and to analyze functional results. Materials and methods: This study included about 25 cases. All of them were examined and investigated after taking their informed consent. This was a retroprospective experimental study to see the outcome measures in patients of SUI treated with transobturator sling. It was an experimental design to assess safety, efficacy, complication, and cost-effectiveness of polypropylene mesh in patients with SUI undergoing tot fixation and study intra-operative parameters like mean operative time, intra- and postoperative complications like bladder injury postoperative urinary retention, and patient satisfaction. Results: 60% of women were in age group of 51 to 60 years and all were multigravida. Duration of procedure was significantly shorter in patients undergoing Tot fixation with polypropylene mesh for SUI repair. Conclusion: To conclude, the suburethral transobturator polypropylene mesh sling is a safe, efficient, reproducible and low cost technique for treating SUI. The polypropylene mesh commonly available in the markets with the proprietary brands is very costly and unaffordable for lower socioeconomic groups. Thus an attempt was made to design a technique to make this mesh economical in which we slit the mesh on both sides which prevents the rolling of the upper edge of the central portion of the mesh. The use of this custom-made polypropylene mesh in this way makes the procedure very cost-effective and affordable.