Inside-Out Transobturator Suspension with Pubic Fixation for the Treatment of Male Urinary Incontinence

Objectives To describe a novel sling technique for the treatment of urinary incontinence after radical prostatectomy and to provide a preliminary evaluation of its safety and efficacy. Methods The technique employs purpose-designed instruments and a polypropylene mesh that is passed from inside to outside through both obturator foramina and tensioned so as to elevate and compress the bulbar urethra. Each arm of the mesh is then returned through a subcutaneous tunnel and fixed to the pubic aponeurosis. Clinical data of patients treated between September 2022 and September 2024 were collected. The primary outcome measures were the daily pad count and the 24-h pad test before and after treatment; the secondary outcome measures were the corresponding incontinence scores and the responses to surgery-related questionnaires. Complications were also recorded. Cure was defined as the use of no pads, and improvement as a pad count of ≤1 per day together with a reduction of at least 50%. Results Fifty-eight patients with urinary incontinence underwent the sling procedure according to an identical operative protocol and were followed for 6–12 months. Preoperatively, 32 (55%), 18 (31%), and 8 (14%) patients used 2, 3–5, and >5 pads/day, respectively, and the mean urine loss on the 24-h pad test was 187 g. At 6 months, 44 patients (76%) were cured and 11 (19%) were improved (1 pad/day), and the mean urine loss had decreased significantly to 16 g. The International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) score decreased from 18.2 ± 2.1 preoperatively to 4.6 ± 1.3 at 6 months (P < 0.05); the Incontinence Quality of Life (I-QOL) score increased from 33.6 ± 14.7 to 91.5 ± 8.7 (P < 0.05); and the Patient Satisfaction Questionnaire (PSQ) score increased from 1.7 ± 1.3 to 8.9 ± 0.8 (P < 0.05). The responses to the surgery-related questionnaires were likewise favorable. No serious perioperative complication occurred; two patients required indwelling catheterization because of postoperative voiding difficulty. Sling infection, urethral erosion, and persistent pain were not observed in any patient. Conclusions Inside-out transobturator suspension with pubic fixation appears to be a safe and effective treatment for male urinary incontinence and is associated with few complications. Larger randomized studies with longer follow-up are nevertheless required to establish long-term outcomes.