From the Research
Vesicofixation after a TOT procedure is indicated in cases of de novo bladder outlet obstruction or voiding dysfunction that persists despite conservative management, with a reported incidence of urinary incontinence after TOT ranging from 5-15%. The main causes of post-TOT incontinence include insufficient tension of the tape, tape migration or displacement, intrinsic sphincter deficiency, and tissue integration failure 1. Other contributing factors include detrusor overactivity, mixed incontinence patterns, and anatomical factors such as severe prolapse or previous pelvic surgeries 2.
Indications for Vesicofixation
- De novo bladder outlet obstruction
- Voiding dysfunction that persists despite conservative management
- Urinary retention, incomplete bladder emptying, or significant post-void residual volumes
Causes of Urinary Incontinence after TOT
- Insufficient tension of the tape during initial placement
- Tape migration or displacement over time
- Intrinsic sphincter deficiency that was not adequately addressed by the TOT
- Tissue integration failure where the mesh doesn't properly incorporate into surrounding tissues
- Detrusor overactivity (urgency incontinence)
- Mixed incontinence patterns
- Anatomical factors such as severe prolapse or previous pelvic surgeries
Percentage of Urinary Incontinence after TOT
- Approximately 5-15% of patients experience persistent or recurrent stress urinary incontinence following the procedure 1
- Objective cure rates range from 80-90% at 1-year follow-up, with subjective cure rates ranging from 65-90% at 5-year follow-up 1
Management of Post-TOT Incontinence
- Pelvic floor physical therapy
- Medication
- Surgical revision, including vesicofixation or repeat mid-urethral sling placement 3