1015 TREATMENT OF POST-PROSTATECTOMY INCONTINENCE WITH MALE SLINGS IN MEN WITH IMPAIRED DETRUSOR CONTRACTILITY AND/OR VALSALVA VOIDING ON URODYNAMICS

Abstract

INTRODUCTION AND OBJECTIVES: The use of male slings has emerged as a popular and efficacious treatment modality for men with post-prostatectomy incontinence (PPI). Traditionally, slings have been avoided in patients with impaired detrusor contractility because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with PPI who have impaired contractility and/or void with abdominal straining for urodynamics (UDS) can be safely treated with male slings. METHODS: A retrospective review of 123 consecutive patients with PPI who underwent a sling procedure between 1/04 and 1/10 was conducted at a single institution. Preoperative (preop) age, bladder capacity, post void residual (PVR), involuntary detrusor contractions (IDC), maximum flow rate (Qmax), detrusor pressure (Pdet), abdominal pressure (Pabd) and postoperative (postop) Patient Global Impression of Improvement (PGI-I), PVR and noninvasive uroflow were examined. Poor bladder contractility was defined as having bladder contractility index (BCI) 100. Valsalva voiding was defined as a change in Pabd at Qmax from baseline ( Pabd) 20. Exclusion criteria were lack of preop UDS and/or postop PVR or PGI-I. A total of 63 patients were analyzed. The variables were compared using Student’s t-test and chi-square test. RESULTS: No statistically significant difference was shown in postop PVR (mean 4 mos. postop) or urinary retention when comparing by BCI. Comparing by Pabd, a smaller PVR was seen with abdominal voiders, albeit likely clinically insignificant. Table 1 illustrates the preand postop outcomes compared by both BCI and Pabd. 31 patients (BCI 100, n 17 vs BCI 100, n 14) had postop uroflow available and there was no difference in postop Qmax (10.2 vs 13.1, p 0.22) or flow pattern. No patients excluded for incomplete data were treated for obstructive voiding or poor emptying. CONCLUSIONS: The results of this study indicate that men that may not have been traditionally offered a sling based on preop UDS findings can be safely treated with perineal sling. This may be a reflection of how contractility is measured in this population. Prospective studies comparing outcomes of men with impaired contractility that undergo various treatments may also be helpful. TABLE 1: Preand Postoperative Urodynamics Characterics of Male Sling Patients