ABSTRACT
Since the inception of the retropubic MUS, several modifications have been proposed in an attempt to decrease the incidence of adverse side effects while maintaining efficacy. Currently, there are prepubic and mini-sling approaches; however, it is the transobturator (TO) approach which has the longest follow-up and has been most often compared to the retropubic MUS (1) . Placement through the obturator foramen avoids entry into the space of Retzius, thus eliminating the more serious trocar complications ( Fig. 67.1 ). There are currently two approaches to TO sling placement: ( i ) through the obturator foramen and out of the vagina (outside-in), and ( ii ) through the vagina and out of the obturator foramen (inside-out). The goals of this chapter are to describe the technique of TO sling surgery and to review the outcomes and complications associated with these procedures.
