Transobturator crossover readjustable sling for severe female incontinence: technique and preliminary results

We present a technique that provides circumferential coaptation of the urethra as a salvage procedure for severe subset of patients. We prospectively evaluated 16 patients who had a transobturator crossover sling. Adjustable hybrid slings were used, and silicone washers were used over the anchoring columns to keep them in place and to facilitate any posterior readjustment. Mean age was 58 years and mean follow-up was 12 months. At presentation, patients had undergone at least two anti-incontinence procedures and wore a mean of six pads daily. There was a mean 93.7% overall cure in symptoms. There was one intraoperative complication (urethra perforation) that was resolved by closing the urethral wall. De novo urge incontinence developed in 2/16 patients. All patients (3/16) who had preoperative urge incontinence achieved resolution after the procedure. The transobturator crossover sling is an effective salvage procedure that may be considered in a selected subset of female patients with a nonfunctional urethra.