We aimed to determine the patients’ satisfaction and quality of life after trans-obturator tape (TOT) surgery for mixed type urinary incontinence patients in the mid-term follow up period

The patients who had undergone surgery of TOT for stress urinary incontinence dominant mixed urinary incontinence within last 5 years were included in the study after informed consents were taken. All patients had been performed urodynamics to confirm the diagnosis and rule out any other neurological issues preoperatively. The patients were asked to fill out  questionnaires of Incontinence Impact Questionnaire-7 ( IIQ-7) and Urogenital Distress Inventory-6 (UDI-6). They were also asked whether they were happy or not for havening been operated and were asked to  score their satisfaction level on a visual analog scale (VAS) of 0 to 10. The patients’ demographics and medical histories were noted. The patients’ QOL and satisfaction score were determined and analyzed to find any clinical correlations of scores with clinical parameters.

Thirty-three women were included in the study with a median age of 55 years. Their median follow-up period was 35 months. %73 had one or more co-morbid diseases. %46 of them were smokers. %39 of them had previous pelvic surgery related to gynecology. %88 of them were on antimuscarinic medication for urge incontinence. %9 was nullipara. Median numbers of live births were 3 with birth related complications in  %42 of them. Preoperative median bladder capacity was 400 ml. %6 of them had early operation failure and %6 had early postoperative postvoiding residual volume of 50 to 100 ml. None had urinary retention. None reported to have stress urinary incontinence as preoperatively. %60 of the patients reported themselves as happy/satisfied for having been operated with median VAS of 10  whereas other %40  reported as unhappy/unsatisfied with a VAS score of 1.  The UDI-6, IIQ-7 scores, BMI are shown in the table. No other clinical variable was distinct between two groups.

	                      SATISFIED 	UNSATISFIED 	p value
AGE (years)	                57               	52	                0.511*
BMI (kg/m2)	                31	                33.3	        0.108*
IIQ-7 SCORE	                 0	                15.5	       <0.001*
UDI-6 SCORE 	         3	                  11	                <0.001*
*: Mann-Whitney U Test

Present data related to the patient reported questionnaire form indicated a high rate of unsatisfaction for surgery of TOT for mixed urinary incontinence though seemingly successful surgery.  Ones unsatisfied had severely affected  quality of life compared to satisfied ones. This might be unmet preoperative over-expectations of patients like being dry with surgery for all components mixed urinary incontinence or failure of surgeons to inform well about the surgical outcomes.

Unsatisfaction rate is high for TOT perfomed for stress dominant mixed urinary incontince, though succesful surgery.