Surgery in Motion

The Inside-Out Trans-Obturator Sling: A Novel Surgical Technique for the Treatment of Male Urinary Incontinence eulogo1

By: Jean de Levallowast and David Waltregny

European Urology, Volume 54 Issue 5, November 2008, Pages 1051-1065

Published online: 01 November 2008

Keywords: Male incontinence, Radical prostatectomy, Sling, Surgery, Trans-obturator

Abstract Full Text Full Text PDF (2,2 MB)



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.


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.


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.


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.

Take Home Message

The inside-out trans-obturator sling procedure is a novel surgical technique for treating bothersome stress urinary incontinence after radical prostatectomy. Results of a prospective study at 6 mo postoperatively indicate that it is safe and efficient.

Keywords: Male incontinence, Radical prostatectomy, Sling, Surgery, Trans-obturator.


Department of Urology, University of Liège, Liège, Belgium

Corresponding author. Department of Urology, Central Building, Bat. B35, Level –1, CHU Sart Tilman Liège, B-4000 Liège, Belgium. Tel. +32 4 3667251; Fax: +32 4 3667258. Please visit to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

Place a comment

Your comment *

max length: 5000