HIP JOINT FUNCTION FOLLOWING MID-URETHRAL SLING SURGERY FOR THE TREATMENT OF STRESS URINARY INCONTINENCE

B. Sarhan¹, M. Hasan¹, N. Abreek²

¹Ben Gurion University of the Negev, Genocology, Soroka medical center- beer shevaa, Israel, ²Tel Aviv University, Physiotherapy, Tel Aviv, Israel

Background: Midurethral sling (MUS) placement is considered the gold standard surgical treatment for stress urinary incontinence (SUI). Transobturator tape (TOT), is a MUS where thesling is directed through the obturator foramen. To date, apart from pain, there is a paucity of data regarding the association between TOT and lower extremity function. We have aimed to evaluate the association between TOT and various indices of hip joint pain and function.

Purpose: To evaluate the association between TOT and various indices of hip joint pain and function.

Methods: In this prospective cohort study, we included 37 women who underwent TOT. Range of motion (ROM) and hip joint function were evaluated. In addition, muscle strength of the hip joint muscles was evaluated by 'Manual strength testing', walking function was evaluated by using the 'Time up and go' test and the '10 meters walk' test. We measured leg length and examined the subjective effect of surgery on patients' quality of life (QoL) using the UDI-6 questionnaire. In addition, the impact of urinary incontinence on daily activities, mental and physical QoL, and the ability of the patient to forget having a problem with a certain joint following surgery by using the IIQ-7, the SF-12 and the FJS questionnaires, respectively. All tests and questionnaires were examined before and after surgery. Paired data were compared using the paired sample t-test, after testing for normal distribution.

Results: Significant deterioration in ROM was observed in the majority of cardinal movements of the hip. An increase in leg length following the TOT was observed. An overall trend of decreased strength was noticed, and was found to be statistically significant for hip adduction. The IIQ-7 and UDI-6 questionnaires demonstrated a significant improvement in urinary function. No significant change was noted in gait function following surgery. Results of the FJS assessment revealed no difference in patient's awareness of their hip joint.

Conclusions: Our findings provide support for a yet underestimated association between TOT for the treatment of SUI and lower leg dysfunction. This study could be the basis for future longer-term studies aiming to investigate our findings and to investigate whether interventions such as physical therapy before of immediately after surgery may change the outcome.

Implications: Further studies are needed to examine the long- term effect of surgery on the range of motion and hip function as well as whether women can benefit from interventions such as physical therapy following surgery.

Funding acknowledgements: This study is dedicated for the memory of Dr. David Yohay R.I.P that passed away during this project.

Keywords:
Urinary incontinence
Transobturator tape
Midurethral sling

Topics:
Pelvic, sexual and reproductive health
Musculoskeletal: lower limb
Education: clinical

Did this work require ethics approval? Yes

Institution: Ben Gurion University of the Negev

Committee: Soroka medical center- beer shevaa

Ethics number: 12246