Transobturator vaginal tape inside out for treatment of urethral sphincter mechanism incompetence

Urethral sphincter mechanism incompetence in dogs

Urethral sphincter mechanism incompetence (USMI) is the most common cause of acquired urinary incontinence in female dogs. Initial treatment is usually medical but surgery may be recommended if the animal does not respond to medical treatment or becomes refractory, if side effects develop, or if owners are reluctant to administer long term medication. Various surgical techniques have been described including colposuspension, urethropexy, prosthetic sphincters, cystourethropexy, and sling urethroplasty. Endoscopic injection of Teflon or collagen has also been reported.

Stress urinary incontinence in women

Stress urinary incontinence in women is divided into 2 entities: urethral hypermobility (loss of support of the urethra) and intrinsic sphincter deficiency. Many women are presented with a combination of those 2 primary mechanisms. Stress urinary incontinence in women is mainly treated surgically by minimally invasive procedures involving vaginal placement of sub-urethral slings. The goal of those procedures is to stabilize the mid-urethra at the time of an abdominal pressure increase (e.g., cough or exercise). Various techniques have been described including the retropubic TVT (Tension Free Vaginal Tape), the TOT (Transobturator Tape) outside-in, and the TVT-O (Transobturator Vaginal Tape) inside-out. TVT-O was described by de Leval in 2003 to reduce the complications encountered with other techniques.¹ This technique decreases the risk of perforation of the bladder or urethra, avoids vascular and neurological lesions as well as extended vaginal dissection. No perioperative complications were encountered and the 1-year success rate was 91 %.^1-3 In a recent study reporting the 10-year follow-up of the procedure, 97% of the 160 patients declared themselves cured and 92% were objectively cured at the 10-year evaluation.⁴ No patient required tape release or resection, and no vaginal, bladder or urethral erosions were registered.⁴ [...]