1600 MID-TERM EVALUATION AND PROGNOSTIC FACTORS OF TRANSOBTURATOR RETROURETHRAL SLING FOR POST-PROSTATECTOMY INCONTINENCE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20101600 MID-TERM EVALUATION AND PROGNOSTIC FACTORS OF TRANSOBTURATOR RETROURETHRAL SLING FOR POST-PROSTATECTOMY INCONTINENCE Jean-Nicolas Cornu, Philippe Sèbe, Calin Ciofu, Laurence Peyrat, Bertrand Lukacs, Olivier Traxer, Olivier Cussenot, and Francois Haab Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , Philippe SèbePhilippe Sèbe More articles by this author , Calin CiofuCalin Ciofu More articles by this author , Laurence PeyratLaurence Peyrat More articles by this author , Bertrand LukacsBertrand Lukacs More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Olivier CussenotOlivier Cussenot More articles by this author , and Francois HaabFrancois Haab More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence is a challenging side effect of radical prostatectomy. Placement of a retrourethral male sling has proven high efficacy in short term studies for mild to moderate post-prostatectomy incontinence (PPI) management. However, long term evaluation and precise indications of this new device are unknown. Our aims were to assess mid-term outcome after this procedure and individualize preoperative parameters related to failure. METHODS A prospective study involved 146 patients treated for PPI by transobturator male sling by one surgeon. Mean age was 67±7.7 (54-84). Patients were preoperatively evaluated by complete medical history, ASA score, urodynamics, 24 hours pad test, urethrocystoscopy, and pad use. 27 patients were presenting detrusor overactivity treated by trospium chlorure, 20 patients had a history of surgical management of a urethral stricture and 24 patients had a history of radiation therapy. Patients were evaluated at 1, 3,6, 12 months and yearly thereafter by pad use, PGI-I scale and uroflowmetry. Cure was defined as no pad usage and improvement as reduction >50% of pad use. Statistical evaluation was made by univariate analysis. RESULTS Mean follow-up was 18.3 ±6.6 months [8-34]. 98% of patients were discharged the day after the procedure. At last follow-up 64% were cured, 17% improved and 19% not improved. The only complications noted were mild voiding difficulties in 13% of cases and moderate perineal pain in 10%, which both spontaneously resolved. PGI-I showed a high satisfaction rate. No retention, infection or erosion was noted during follow-up. Failure was diagnosed in 24 cases after 1 month and in only 3 cases as a further recurrence of urine leakage. Univariate analysis showed that a history of pelvic radiation (p=0.04), previous surgeries for urethral stricture (p=0.001) and preoperative pad-test > 200g/24h (p=0.02) were associated with a poorer outcome. Age, type of prostatic surgery, detrusor overactivity, anticoagulation therapy were not associated with failure. CONCLUSIONS Placement of a functional, retrourethral sling for PPI management is a safe procedure showing good and sustainable results in mid-term outcome, with a 81% success rate. However, severe incontinence (>200g/day), previous radiation therapy and surgical treatment of urethral strictures after radical prostatectomy are associated with a worse outcome. Patient evaluation is therefore critical before considering male sling placement instead of another surgical option. Paris, France© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e618 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jean-Nicolas Cornu More articles by this author Philippe Sèbe More articles by this author Calin Ciofu More articles by this author Laurence Peyrat More articles by this author Bertrand Lukacs More articles by this author Olivier Traxer More articles by this author Olivier Cussenot More articles by this author Francois Haab More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...