Superficial Implantation of the I-Stop TOMS Transobturator Sling in the Treatment of Postprostatectomy Urinary Incontinence: Description of a Novel Technique and 1-Year Outcomes

Introduction To describe a new technique for superficial implantation of the I-Stop TOMS transobturator sling and present the clinical outcomes on patients treated for mild to moderate urinary incontinence after radical prostatectomy. Technical Considerations We evaluated the four-arm sub urethral sling I-Stop TOMS performed in our institution between March 2012 and March 2015 using a superficial implantation technique. After a small incision, the perineal aponeurosis was incised but no muscle dissection was performed. Inclusion criteria for sling procedure used in the study was mild (1-2 pads/day) to moderate (3-5 pads/day) postprostatectomy incontinence and at least 12 months after radical prostatectomy. Improvement was defined as the patient having 50% reduction in the number of pads and success as patient either not wearing pads or using one security pad. The primary objective was to evaluate the proportion of patients achieving continence after the modified sling implantation technique at 12 months after surgery. Fifty-two patients underwent our new technique and 34 had completed 12 months follow-up. The procedure was successful for 28 patients (82.4%). There was an improvement in 25 patients (73.5%). Pad use at 12 months had decreased significantly compared with baseline (mean 0.7 vs 2.2, P  <  .00001). The complications were rare and the procedure was well tolerated as shown by median visual analogic scale of 1.5 (interquartile range, 2 to 1). Conclusion This novel approach for insertion of the transobturator I-Stop TOMS male sling is a quick, simple, and well-tolerated procedure with low complication rate, allowing a significant improvement in postprostatectomy incontinence.