Transobturator Sling Suspension for Male Urinary Incontinence Including Post-Radical Prostatectomy

ObjectiveTo study the anatomical effects of placing a transobturator tape (TOT) in cadavers as well as determining the clinical outcome in men with urinary incontinence.MethodsThe study was a two stage study. The first phase was a cadaver study to examine the placement of the sling. The second part involved the placement of the sling in 20 men with incontinence, which occurred post-radical prostatectomy in 15 men. All patients had pre-operative and post-operative videourodynamics, maximum flow rate (Qmax) and residual urine measurement. Urethral pressure profiles and membranous urethral length were measured in five patients pre- and postoperatively. Incontinence was assessed on the basis of pad usage. Patients’ satisfaction was recorded using a non-validated patient questionnaire at 6 weeks post-operatively.ResultsThe cadaver study revealed that a leak point pressure of 60 cmH2O was achieved on tensioning of the tape. In the clinical series, the mean (range) urethral closure pressure improved from 13.2 (8–22) to 86.4 (70–100) cmH2O following placement of the TOT. The membranous urethral length increased from a mean (range) of 3 (0–7) to 17.2 (10–22) mm following tensioning of the tape. No significant differences in Qmax pre- and postoperatively were observed. Incontinence cure rate (no pad usage) was 40% and improved rate (1–2 pads per day) was 30%. The majority of patients (12/20) were very satisfied with the procedure.ConclusionsThe TOT, a novel procedure for treatment of post-radical prostatectomy incontinence, was shown to be effective and well accepted by patients.