TEMPLATE DESIGN © Loo CY, S. Balakrishnan, M. Rouse, Department of O&G, Penang Hospital, Penang 1.Bemelmans BL, Chapple CR. Are slings now the gold standard treatment for the management of female urinary stress incontinence and if so which technique? Curr Opin Urol Jul;13(4): Royal College of Obstetrician and Gynaecologists. Surgical Treatment of Urodynamic Stress Incontinence. Green-Top Guideline No. 35. London: RCOG, October The current gold standard of managing Urinary Stress Incontinence (USI) is using a suburethral sling 1. This can be done via retropubic, transobturator tape (TOT) or even minislings. The transobturator tape is currently the most favoured approach. It can be performed either from the outside-in or the inside-out method. We would like to show that the TOT using outside-in approach is safe and effective in treating USI. This is a prospective review of 129 patients undergoing transobturator slings using the outside-in approach for the management of USI from January 2007 till November There were 3 types of tapes used (Monarc Subfascial Hammock TM, from AMS, Benesta and Desara Sling system TM from Caldera Medical). The patients underwent detailed preoperative assessment including urodynamic assessment to exclude other concomitant bladder disorders. This review showed comparable rate of complications and success rate as in the literature 2. Therefore, we conclude that the Transobturator method with outside-in approach is effective and save in treating USI without any significant short or long term complications. Mostly, patients were able to be discharged within 48 hours after surgery. This review showed a subjective continence rate of 93.8%, with objective cure of 81.4% on urodynamics study. 3 (2.3%) patients developed recurrent USI after the third year. 19 (14.7%) patients had urinary tract infection postoperatively which was treated with only 1 (0.8%) patient had recurrent episode. 17 (14.7%) patient experienced urgency which had resolved. 5 (3.8%) patients had de novo overactive bladder which responded to oral anticholinergics. Subsequent reviews showed no evidence of erosions or other complaints. Figure 1 Intraoperative complications and blood loss were documented. Patients had intraoperative cystoscopy to rule out bladder or urethral injury. Postoperatively, patients were reviewed at two weeks, six weeks, three months and then six monthly. All patients had urodynamic assessment at three month postoperatively. Preoperative urodynamic confirmed the USI and there were no other abnormalities. 92 patients (70%) had associated prolapses requiring concomitant pelvic floor repairs and vaginal hysterectomy. There were no intraoperative complications such as bladder or urethral injury. The average blood loss for the sling procedure is less than 50mls. The follow up were from 1 to 57 months. 33 (25.5%) patients experienced voiding dysfunction immediately postoperatively. However it resolved within the first 12 days with only 1 (0.8%) patient who failed trial of void, requiring sling division 4 weeks later after which she remained continent. Picture 1: Helical TrocarPicture 2: Tape positioned