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1.4cm wide, and has a central part that is 2.8cm wide over the Pre- and post-surgery assessments included previous medical history,
urethra. The sling is attached at each end to a clip in order to connect physical examination, a clinical study questionnaire about urological
it to a specific needle. A hemet or helical needle is used according to symptoms and number of pads used per day, and urodynamics
surgeon preference. (uroflowmetry and post-void residual urine). The patients completed
the ICIQ-SF and the SF36 questionnaire and a VAS before and after
The surgical technique is performed under spinal or general surgery. The number of patients studied at follow-up visits at one,
anaesthesia, and a 16F Foley urethral catheter is inserted. The three and six months, respectively, was 93, 80 and 54.
patient is placed in the lithotomy position and a 6cm median
vertical perineal incision is made below the inferior border of the Changes in SF-36 and ICIQ were found not to follow an approximate
pubic symphysis to expose the bulbospongiosus muscle. The normal distribution. Accordingly, changes in these end-points were
perineal aponeurosis at the top of the triangular space is then analysed using Wilcoxon’s sign-rank test. Changes in flowmetry
delimited laterally by each ischiocavernous muscle and medial to more closely followed an approximate normal distribution and were
the bulbospongiosus. A short 2mm incision through the pelvic analysed using Student’s t-test. Both tests examined departures
fascia enables access to the obturator muscle just under the from the null hypothesis of no overall change from baseline. All
analyses were performed using the univariate procedure in SAS
v9.1. P-values of less than 0.05 were considered statistically
significant, and those less than 0.001 were considered to be highly
The patient is placed in the lithotomy
position and a 6cm median vertical
perineal incision is made below the
The surgery was considered by the surgeon to be easy to perform
in all cases. The median operative time for the procedure was 30
inferior border of the pubic symphysis to
minutes (25–45 minutes). No surgery complications were reported,
expose the bulbospongiosus muscle.
no significant intra-operative bleeding (>200ml) occurred and there
was no nerve, bowel or vascular injury. On the VAS, the median pain
value the day after surgery was 2, then decreased significantly to
ischiopubic ramus bone. A stab incision is made at the top of the 1.2 at one month and remained at 0.4 for all further visits. After
thigh, 4cm from the median line and 4cm below the major adductor urethral catheter removal, residual urine was less than 50ml for all
longus muscle. The transobturator puncture is preferentially patients. The maximal flow rate median value was 23ml/sec before
outside–inside with a Hemet needle. The end-point of the puncture surgery and 17.5ml/sec at one month, then 19ml/sec at three and
is the opening in the pelvic fascia. After the sling is attached to the six months. The change was significant one month post-surgery but
needle, pulling back the needle implants the two arms of the sling not for the three- and six-month follow-up period. Overall, median
in the same passage. The same procedure is repeated on the other pad use decreased significantly from two pads per day before
side. The sling is sutured to the bulbospongiosus muscle with non- surgery to one pad per day for all the visits thereafter. At one, three
absorbable sutures and then pulled firmly from each side in order and six months the number of pad-free patients was, respectively,
to obtain a 2mm visible mark on the bulbospongiosus muscle. The 60, 51 and 51%.
perineal body is not dissected, but in case of rolling of the inferior
edge of the sling on the bulb, the bulb is dissected just enough to Continence rate of use of no or one pad per day was, respectively, 74,
apply it under the sling, then sutured to the sling. No retrograde 82 and 83%. The SF-36 score of continence, measured on a scale ranging
urethral pressure adjustment is necessary. The incision is closed from 0 to 500, improved highly significantly (p<0.001) from a median
without drainage and the urethral catheter left for two days. Before score of 117 before the TOMS was inserted to 350 at one-month, 338 at
hospital discharge, a post-void residual and pelvic pain evaluation three-month and 308 at six-month follow-up. The ICIQ incontinence
on the visual analogue scale (VAS) should be obtained. median score decreased highly significantly (p<0.001) from 14 before
the TOMS was inserted to 5 at one- and three-month follow-up and to 6
Clinical Results with the Four-arm at six-month follow-up.
Transobturator Male Sling
A prospective multicentre study was conducted on 96 male Conclusion
patients suffering from mild or moderate post-prostatectomy The new four-arm TOMS is an attractive, simple and safe sling for
incontinence after a failure of physiotherapy and a minimum of one mild or moderate post-prostatectomy incontinence in non-radiated
year after surgery without radiation. The study received Ethical patients. Most of the patents are cured and have improved quality
Committee approval. of life. n
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