A modified technique for the implantation of the transobturator perineal male sling (TOMS) improves mild to moderate stress urinary incontinence (SUI) after radical prostatectomy (RP), according to French researchers.

Marc Galiano, MD, Cyrille Guillot-Tantay, MD, and colleagues from the Institute Mutualiste Montsouris in Paris, evaluated the success of the technique in 34 patients from their institution. All of the men (average age 65) had mild to moderate post-RP incontinence, defined as usage of 1-5 pads daily at 12 months after surgery. Three patients had radiotherapy and 2 underwent transurethral resection of the prostate (TURP) prior to RP. All patients had routine pelvic floor muscle training after surgery and evidence of a stable bladder.

Suburethral I-STOP TOMS is a monofilament polypropylene, nonextensible 4-arm sling (with 2 arms on each side). In the modified technique, after the perineal aponeurosis was incised, no muscle dissection was performed for sling insertion.

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Within a year of follow-up, 73.5% of patients experienced improvement of SUI, defined as a 50% reduction in the number of pads, according to results published online ahead of print in Urology. Approximately 53% of patients were continent and needed no protection with pads.

The procedure appeared to be well-tolerated with few complications (1 retention, 1 wound infection, and 5 ecchymosis without compression). Five patients had a second implantation of the same sling with the same procedure.

“The clinical implications of this study are that the superficial implantation of the I-Stop TOMS technique is an efficient, quick, and safe way to use the slings,” according to the investigators. The technique is reproducible and surgeons were able to double the distance from muscle to perineal skin. The results of superficial implantation appeared similar to classical implantation.

Future studies with larger numbers of patients, longer follow-up, and a comparison of procedures are still needed. One of the authors disclosed consultant fees from American Medical Systems and CL Medical.


  1. Superficial Implantation of the I-Stop TOMS ® Transobturator Sling in the Treatment of Post-Prostatectomy Urinary incontinence: Description of a Novel Technique and 1-Year Outcomes. Urology. doi: 10.1016/j.urology.2015.10.040.