Abstract
PurposeTo investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection.MethodsWe performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre.ResultsSuccessful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1–6.5) for success vs 3.6 (range 1–10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25).ConclusionUrodynamic parameters related to bladder function—detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.
Highlights
The number of radical prostatectomies has more than doubled over the last 20 years, with 9844 performed in the United Kingdom in 2018–2019 [1]
The incidence of post-prostatectomy incontinence (PPI) in the robotic era has been reported as 5–20% at 12 months [2, 3]
We retrospectively reviewed data including surgical history, urodynamic findings, retrograde leak point pressure (RLPP) where available, complications, functional outcomes and the need for further surgery
Summary
The number of radical prostatectomies has more than doubled over the last 20 years, with 9844 performed in the United Kingdom in 2018–2019 [1]. Most prostatectomies are performed using robot-assisted laparoscopic techniques. The incidence of post-prostatectomy incontinence (PPI) in the robotic era has been reported as 5–20% at 12 months [2, 3]. This equates to an estimated 300–1300 new patients with persistent PPI every year. The AUS is effective in an estimated 80% of men [5] but requires manual dexterity and cognition to
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