The Inside-Out Transobturator Sling for the surgical treatment of post-radical prostatectomy urinary incontinence: Results of a prospective study after a minimum of 6 months

Introduction and Objective: To prospectively evaluate the short-term safety and efficacy of a new transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence (SUI). Methods: The sling technique uses specific instruments and a polypropylene mesh with 2 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. Inclusion criteria were clinically and urodynamically demonstrated SUI, positive bulbar compression test, and signed informed consent. Patients with detrusor overactivity were excluded. Baseline and followup 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 04/2006 through 10/2008, 70 consecutive patients who fulfilled inclusion and exclusion criteria underwent the sling procedure using the same operative protocol. As of October 2008, 55 and 35 patients who consecutively underwent the sling procedure were expected to have a minimum followup of 6 months and 1 year, respectively. Preoperatively, 13 (24%), 25 (45%), and 17 (31%) patients were using 2, 3 to 5, and >5 pads/d, respectively. Nine and 6 patients had undergone prior surgery for SUI and/or previous pelvic irradiation, respectively. The sling procedure was preceded by an endoscopic urethrotomy in 5 (9%) patients. No perioperative complication was noted. Seven (13%) patients required suprapubic catheterization; normal voiding resumed in all 7 patients except 1 who underwent urinary diversion for radiation-induced complete anastomotic stricture. Six-month and 1-year minimum followup was available on 51 (93%) and 33 (94%) patients, respectively (Table 1). Of note, at 6 months, among the 17 patients with preoperative severe incontinence (> 5 pads/day), 9 (53%) patients were cured and 6 others (35%) were improved (1 pad/d). Overall, QoL was significantly enhanced and 85% patients were moderately to completely satisfied with the procedure. Preoperative and postoperative max flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain or neurological complication was observed. No sling was withdrawn or cut. Conclusions: The inside-out transobturator sling procedure appears to be safe and efficient at short term