RETROPUBIC VERSUS TRANSOBTURATOR TENSION FREE PROCEDURES: A COMPARATIVE STUDY. Neurourology and

Midurethral tension-free procedures are considered the first-line surgical treatment for female stress urinary incontinence (SUI). Tension-free procedures were used, at the beginning, to treat stress urinary incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency. In this approach, a synthetic transvaginal suburethral sling is placed without using suspension sutures. The vaginal sling is held in place by the friction between the mesh and the tissue canals created by the needle pathway. Because the sling is not anchored with thread or staples it is called " tension-free." The tension-free vaginal tape (TVT) 1 had a high success rate, but there were concerns over its safety (risk of injury to the bladder or major blood vessels, and voiding dysfunction). To avoid complications, Leanza e coll.2 publishing in 2001 a new retropubic technique called Tension-free Incontinence Cystocele Treatment (TICT), developed the concepts of finger-guided method and adjustment: the former to avoid intra-operatory lesions and the latter to prevent urinary obstruction. Delorme,3chancing the route, introduced the transobturator tape (TOT), positioning the mesh through the obturator foramen. The transobturator approach was developed as an alternative mininvasive procedure to shun the retro-pubic passage of needle. The TICT consists on using a polypropylene T-shaped mesh made up by a central body (positioned under both urethra and bladder) and two wings which cross the Retzius (retropubic TICT or r-TICT) and the transobturator foramen (Transobturator TICT or t-TICT). The advantage of T-shaped mesh is to give a good support both on the mid-urethral complex (with tapes) and on the whole anterior compartment (with body of mesh). The target consists on treating the functional (incontinence) and the anatomical defect (cystocele). The aim of this study is to compare both efficacy and morbidity of retropubic versus transobturator tension-free incontinence cystocele treatment (TICT) procedures.