196 Refining Male Sling Selectivity Improves Outcomes: Role of Standing Cough Test in Physical Demonstration of Mild Male Stress Urinary Incontinence

Abstract

We reviewed our 9-year surgical experience with male AdVance sling cases, determining clinical features associated with treatment success in an effort to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence (SUI) by standing cough test (SCT) improves patient selection for male transobturator sling surgery. A retrospective review of men undergoing primary AdVance sling surgery between 2008-2016 was performed. Patients without preoperative SCT were excluded. Treatment success was defined as ≤1 PPD postoperatively and no further intervention. SCT was performed during preoperative consultation and objectively graded using the Male Stress Incontinence Grading Scale (MSIGS). Of the 203 male sling patients with complete data, 80 (39%) failed during a median follow up of 63.5 months. From 2008-2016, the proportion of male transobturator slings performed as a surgical treatment modality for SUI declined from 66% to 13%. Increasing sling selectivity correlated with greater treatment success. Treatment success was greater among men without radiation (64% vs 41%; p=0.02), having a history (≤2 PPD; 77% vs 36%; p<0.0001) and physical findings of mild SUI (MSIGS grade 0-2 incontinence on SCT; 67% vs 26%; p<0.0001). In combination, non-radiated men with mild SUI and favorable SCT had an 81% treatment success rate. Incremental increases in PPD usage (OR 1.8 per pad; p<0.0001) and MSIGS grade (OR 1.7 per grade; p=0.005) were independently associated with treatment failure, while history of radiation trended towards significance (OR 2.2; p=0.09).