Proper Mesh Placement Using the Outer Cylinder of a Ballpoint Pen in the Transobturator Adjustable Tape Sling Procedure for Female Stress Urinary Incontinence

PURPOSE The transobturator adjustable tape (TOA) sling operation is an effective procedure that allows for correction of postoperative incontinence or obstruction through adjustment of the mesh tension. During the operation, the outer cylinder of a ballpoint pen was used for proper mesh placement with less dissection. We evaluated the efficacy and safety of the TOA sling operation with the use of the outer cylinder of a ballpoint pen. MATERIALS AND METHODS A total of 127 consecutive women with stress urinary incontinence underwent the TOA sling operation with the use of the outer cylinder of a ballpoint pen. The preoperative evaluations included a stress cough test, urodynamic study, and questionnaires related to quality of life. The mesh tension was adjusted 1 day after the operation. Postoperative evaluation was done at 1 month and included a stress cough test, uroflowmetry, questionnaires, and asking about satisfaction. At 1 year, we evaluated the patients with a stress cough test and by asking about their satisfaction with the procedure. RESULTS The overall cure rate was 95.3% at 1 month and 96.8% at the 1-year follow-up. Postoperative adjustment of the mesh tension was done for 22 patients (17.3%). Eight patients needed increased tension for remaining stress urinary incontinence, and 14 patients needed reduced tension for urinary obstruction. The maximal flow rate was decreased significantly. However, the residual urine volume was not increased significantly. The total score on the questionnaires increased significantly. CONCLUSIONS Results were excellent compared with outcomes of the traditional TOA sling procedure. Proper mesh placement by use of the outer cylinder of a ballpoint pen with less dissection and tension adjustment could improve the success rate of the TOA sling operation.