Transobturator tape (TOT) in outpatient surgery and under local anaesthesia: a retrospective study of 84 patients

摘要

abstract_textpObjective: To assess the insertion of a trans-obturator, suburethral sling under local anaesthesia and in outpatient surgery./ppMethod: Retrospective study of 84 patients having received outpatient treatment for stress urinary incontinence (SUI) with a suburethral sling (transobturator route) from June 2003 to February 2005. During this period, 91 patients were treated with a single, transobturator, suburethral sling; 7 (8.3) did not satisfy the initial criteria for outpatient treatment. The technique used was the insertion of a Monarc hammock sling (American Medical Systems). Local anaesthesia was administered along with sedation. Assessment of this treatment was carried out by reviewing medical records and performing a satisfaction survey by telephone./ppResults: Of the 84 patients initially scheduled for outpatient treatment, 75 were able to return home by the evening of the same day as the procedure (89.3). General anaesthesia was unnecessary in 80 cases (95 of the surgery was carried out under local anaesthesia). The causes of failure to maintain outpatient treatment are as follows: 2 cases of acute postoperative urine retention, 4 administrative incidents (treatment refusals by 2 patients on the day of the procedure and 2 patients who lived alone), 1 case of persistent nausea, 1 case of persistent pain, and 1 case of inclement weather. All these patients were discharged the day after the procedure. There were no peroperative complications to report, except for one case of low tolerance to the local anaesthetic, similar to vasovagal syncope and because of which general anaesthesia was administered. No rehospitalisation or early medical consultation was necessary. The assessment of the acceptance of this treatment was performed for 57 patients (69 of participants) using a telephone questionnaire. Of these patients, 89.47 were satisfied with the treatment, and 94.74 were satisfied with the local anaesthesia, only 1.9 of the group preferring general anaesthesia. In assessing the length of hospitalisation, 83.93 did not desire longer hospitalisation. Finally, 92.98 (N = 57) would recommend this procedure to others under the same conditions. Using the same method, an assessment of treatment effectiveness was carried out and agreed with the results of standard hospitalisation./ppConclusion: The treatment of stress urinary incontinence using a transobturator suburethral sling can be achieved on an outpatient basis and under local anaesthesia in 82.4 of the cases where indicated. Clinical management adapted specifically to the facility and close consultation with patients are crucial in limiting failures in outpatient care. Finally, the fees charged for these procedures must be adjusted to make it possible to establish this line of treatment./p/abstract_text