The Inside-Out Trans-Obturator Sling: A Novel Surgical Technique for the Treatment of Male Urinary Incontinence

• Published in: European urology Vol. 54; no. 5; pp. 1051 - 1065
• Main Authors: de Leval, Jean, Waltregny, David
• Format: Journal Article Web Resource
• Language: English
• Published: Oxford Elsevier B.V 01.11.2008; Elsevier; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Follow-Up Studies; Human health sciences; Humans; Male; Male incontinence; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Patient Satisfaction; Prospective Studies; Prosthesis Implantation - methods; Radical prostatectomy; Sciences de la santé humaine; Sling; Suburethral Slings; Surgery; Surveys and Questionnaires; Trans-obturator; Treatment Outcome; Urinary Incontinence - physiopathology; Urinary Incontinence - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics; Urologic Surgical Procedures, Male - methods; Urologie & néphrologie; Urology; Urology & nephrology; Trans-obturator; Male incontinence; Radical prostatectomy; Sling; Surgery; Nephrology; Urinary system disease; Sling operation; Male; Urinary tract disease; Urology; Urinary incontinence; Voiding dysfunction; Treatment; Prostatectomy; Bladder disease; Technique
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2007.11.025

Abstract Objectives To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. Methods The sling technique uses specific instruments and a polypropylene mesh with two arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Patients with detrusor overactivity were excluded. Baseline and follow-up evaluations included uroflowmetry and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d ≤2 and reduced by at least 50%. Complications were recorded. Results From April 2006 through February 2007, 20 consecutive patients suffering from post-RP SUI underwent the sling procedure using the same operative protocol. Preoperatively, 3 (15%), 11 (55%), and 6 (25%) patients were using 2, 3–5, and >5 pads/d, respectively. The procedure was preceded by an endoscopic urethrotomy in four patients. No perioperative complication was noted; three patients required suprapubic catheterization. At 6 mo, nine (45%) patients were cured and eight others (40%) were improved (1 pad/d). QoL was significantly enhanced and 80% of patients were moderately to completely satisfied with the procedure. Preoperative and postoperative maximum flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain, or neurologic complications were observed. Conclusions The inside-out trans-obturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long-term outcome.