الفهرس 
Anatomy of the female pelvisOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
Stress urinary incontinence is the involuntary leakage of urine during exercise or movements such as coughing, sneezing and laughing.
Normal continence in females results from a delicate balance of several factors including:
1. Closing urethral pressure.
2. Clinical functional and anatomical length of the urethra.
3. Ability of the pelvic floor muscles to increase the urethral closing pressure at the time of stress.
4. Proper anatomical location of urethral sphincter.
SUI in females is caused either by anatomic malposition of the urethra and bladder or caused by ISD.
The initial evaluation of the female with SUI should begin with a through history, bladder diary and laboratory investigations.
First-line treatment of SUI is conservative and includes pelvic floor muscle training, electrical stimulation, biofeedback and mechanical devices. If the condition does not improve, surgical alternatives in women may include colposuspension, tension-free vaginal tape (TVT), traditional suburethral slings, and injectable agents. Of these four types of operation, TVT is currently the most common procedure performed either as stand alone or along with concomitant pelvic floor or abdominal surgery. Transobturator tape (TOT) is similar to TVT, but a different technique is used to insert the tape.
TOT procedure is safe, simple, effective and inexpensive, minimally invasive technique for correction of female stress urinary incontinence.
In this study, results from twenty published randomized trials were combined in collaborative meta-analysis of 3069 patients with stress urinary incontinence (SUI) with a mean follow up of 1 year. All these patients underwent transobturator approach of suburethral sling Procedures.
Meta-analysis has shown that outside method had a slightly shorter operative time compared to inside-out. It has shown as well that outside-in method had less frequency of vaginal erosion in comparison to inside-out method. Other complications are of no significant importance such as infection, bladder perforation, abnormal bleeding, and pain in the thigh fold, incontinence and dysuria.
Outside-in method had better outcome regarding improved and cured cases with little failed cases in comparison to inside-out method. Lastly, outside method had better outcome rate of satisfied cases in comparison to inside method.