title: Male incontinence and the transobturator approach: An analysis of current outcomes.
abstract: OBJECTIVE
  To provide an analysis of the outcomes in patients who have a suburethral sling placed using the transobturator approach for the treatment of stress urinary incontinence after radical prostatectomy, because data in this specific area remain limited, and recent changes in male sling surgery might improve the efficacy in men with moderate or mild incontinence.
  
  
  METHODS
  We evaluated the results of transobturator non-adjustable and re-adjustable sling systems after reviewing previous reports identified using the Medline and PubMed databases for original articles, from 2002 to 2012, using the terms 'postoperative male incontinence', 'transobturator' and 'male sling'. Of a total of 31 articles, we reviewed the 22 related to the outcomes of the suburethral sling with positioning by the transobturator approach.
  
  
  RESULTS
  Currently the only results of the transobturator approach are those relating to the AdVance™ device (American Medical Systems, Minnetonka, MN, USA), for which the cure rate is ≈ 60% at 20 months. The remaining devices, although innovative, were assessed in studies for which the follow-up was too short to make a judgement.
  
  
  CONCLUSIONS
  It would be advisable to reserve the transobturator approach for patients with mild and moderate incontinence, and refer those with severe incontinence, with or without adjuvant radiotherapy after radical prostatectomy, for treatment with an artificial urinary sphincter. More results and a long-term follow-up are needed to evaluate the effectiveness of these devices.
authors.affiliation: Department of Urology, Trieste University, Ospedale di Cattinara, Via Strada di Fiume 447, 34100 Trieste, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.affiliation: Department of Urology, Trieste University, Ospedale di Cattinara, Via Strada di Fiume 447, 34100 Trieste, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Visalli
authors.affiliation: Department of Urology, Trieste University, Ospedale di Cattinara, Via Strada di Fiume 447, 34100 Trieste, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Toffoli
keywords: AUS, artificial urinary sphincter; Male; Postoperative incontinence; RP, radical prostatectomy; SUI, stress urinary incontinence; Transobturator sling