Effect of Modified Mesh on Surgical Success in Transobturator Tape Surgery

This is a prospective, single-blind, randomized controlled trial evaluating the effect of mesh width on surgical outcomes in transobturator tape (TOT) procedures for women with stress urinary incontinence (SUI). A total of 106 participants will be randomized using a computer-generated allocation into two groups receiving either a 1.2 cm mesh (intervention group) or a 1.0 cm mesh (standard procedure).

The procedures will be conducted by a single experienced surgeon using a monofilament polypropylene mesh to ensure standardization. Surgical technique, anesthesia protocols, and perioperative management will be identical in both groups.

Primary outcome is objective cure, defined as negative stress test at 6 months. Secondary outcomes include symptom improvement (ICIQ-SF), mesh-related complications (erosion, infection, retention), and patient satisfaction assessed via structured Likert survey.

Follow-up visits are scheduled at 1 week, 1 month, and 1 year. Postoperative assessments will be conducted by a blinded evaluator. The study aims to evaluate whether wider mesh width provides superior anatomical support and reduces complication rates in comparison to standard mesh.

Inclusion criteria

• Female patients aged 18 years or older
• Clinical diagnosis of stress urinary incontinence (SUI), confirmed by:
• Positive stress test (urine leakage on coughing with a comfortably full bladder)
• Q-tip test showing urethral hypermobility (>30 degrees)
• Inadequate response to conservative therapy (e.g., pelvic floor muscle training, behavioral therapy)
• Eligible for transobturator tape (TOT) surgery
• Body mass index (BMI) less than 35 kg/m²
• Able to provide informed consent and follow postoperative instructions

Exclusion criteria

• History of prior midurethral sling surgery
• Mixed urinary incontinence or urge-dominant symptoms
• Pelvic organ prolapse stage > II according to the POP-Q system
• Neurological disorders affecting bladder function (e.g., multiple sclerosis, spinal cord injury)
• Active urinary tract infection or recurrent UTI (defined as ≥3 infections within the past 12 months)
• Pregnant or planning to become pregnant within the next 12 months
• Severe comorbid conditions (e.g., uncontrolled diabetes mellitus, active malignancy, pelvic radiotherapy)
• Use of medications that significantly affect bladder function (e.g., anticholinergics, diuretics)
• Inability or unwillingness to attend follow-up visits or comply with postoperative care plan