Transobturator male sling TOMS™ for the treatment of stress post-prostatectomy incontinence, initial experience and results with one year's experience

Abstract

Purpose: Post-prostatectomy incontinence remains a problem, even in minor or moderate degrees. In order to minimize surgical morbidity and costs, sling procedures have been proposed. The authors have developed a new transobturator male sling procedure and report their results after one-year experience. Materials and Methods: A prospective multicenter study was conducted in 50 patients with minor or moderate post-prostatectomy incontinence. Evaluation of TOMS TM two arms bulbar sling was based on clinical form assessment, The International Consultation on Incontinence Questionnaire (ICIQ) and short-form (SF) 36 questionnaire pre and postoperatively and at 3, 6, 9 and 12 months. Results: The surgical procedure was considered easy to perform and no post-surgery complication was reported except for one retention. The median number of pads per day decreased significantly from 2 pads before surgery (95% CI: 2 -3) to 1 during the follow-up period (95% CI: 0 -2 at 360 days), and at 3 months patients using none or one pad per day were 30% and 32% respectively. The SF 36 continence and quality of life score improved from a median of 100 (95% CI: 83 -133) to 300 (95% CI: 167 -375), and the median ICIQ incontinence and quality of life score decreased from 15 (95% CI: 14 -16) to 8 (95% CI: 5 -12) one year after surgery. Conclusion: The transobturator perineal male sling TOMS TM is an attractive simple sling technique for moderate or minor post-prostatectomy stress incontinence and offers an improvement in the quality of life.

Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review

“…Ten [13,17,18,20,21,23,24,26,27,32] of the 26 studies provided numerical data for patients treated with sling surgery in the daily pad use between patients before and after surgery and were included in the meta-analysis. There was evidence of heterogeneity among the 10 studies (Q statistic = 295.38, I 2 = 96.95, P < 0.001); therefore, a random-effects model of analysis was used.…”

“…The cure rate in the included studies ranged from 63% to 98% and the quality of life improved post sling surgery for all 4 studies. Retrourethral transobturator slings, such as the AdVance and I Stop TOM slings, have been extensively studied, and in fact, the majority of sling studies in our meta-analysis (n = 16) [12–14,16–21,26,27,29,31–33] investigated the efficacy of this type of sling. The cure rate for the included studies ranged from 9% to 85% and similar to the bone-anchored sling, use of the retrourethral transobturator slings improved the quality of life in all studies.…”

Single institution experience with the transobturator sling suspension system AdVance® in the treatment of male urinary incontinence: mid-term results

“…The mechanism of urinary retention is unclear; recent urodynamic studies after AdVance® sling placement did not show obstruction (5) and also our experience is that urethroscopy performed immediately after surgery does not show signs of obstruction. The TOMS two arms bulbar sling, however, seems to have a decreased likelihood for urinary retention in patients with minor or moderate post-prostatectomy incontinence (20).…”

Sphincter urinaire artificiel, bandelettes sous-urétrales et ballonnets. Choix de la stratégie thérapeutique chez l’homme non neurologique

“…Le mode de fixation de la bandelette est également un sujet de discussion. Deux modèles sont plus largement utilisés actuellement et comportent un passage transobturateur d'une bandelette en polypropylène, d'une part la bandelette I-Stop TOMS ® du laboratoire CL-Medical ® en situation postbulbaire [32], d'autre part la bandelette Advance ® du laboratoire AMS ® en situation bulbomembraneuse [33].…”