MP33-11 THE MALE TRANSOBTURATOR SLING HAS A HIGH REOPERATION RATE AND INCREASED COST IN MEN WITH A HISTORY OF RADIATION AFTER PROSTATECTOMY: A COST-BASED ANALYSIS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy I1 Apr 2014MP33-11 THE MALE TRANSOBTURATOR SLING HAS A HIGH REOPERATION RATE AND INCREASED COST IN MEN WITH A HISTORY OF RADIATION AFTER PROSTATECTOMY: A COST-BASED ANALYSIS Shubham Gupta, Aaron Lentz, Ngoc-Bich Le, George Webster, and Andrew Peterson Shubham GuptaShubham Gupta More articles by this author , Aaron LentzAaron Lentz More articles by this author , Ngoc-Bich LeNgoc-Bich Le More articles by this author , George WebsterGeorge Webster More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.962AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling (TOS) has diminished outcomes when used in patients who have undergone prior radiation therapy. We evaluated the need for additional treatment and associated procedural costs after placement of the TOS in men with post prostatectomy stress incontinence and a history of radiation. METHODS We conducted a retrospective review of post prostatectomy, post radiotherapy patients who had undergone surgical implantation of the TOS at a single institution. Patients were evaluated preoperatively with video-urodynamics, three day voiding diary, flexible cystourethroscopy, and 24-hour pad number and weight. Postoperatively, patients were evaluated at 6 weeks, 3 months, 6 months and yearly thereafter. Success was defined as cured (0 or 1 security pad use) or improved (>50% reduction in incontinence) and lack of any secondary incontinence operation. We performed bivariate statistical analysis in order to determine variables associated with success. The need for secondary operation for incontinence was evaluated, and cost data for the primary sling and secondary operations were analyzed. RESULTS Thirty patients were included in our analysis with a median follow-up of 12.38 months. Five patients (16.67 %) were cured, seven (23.33 %) improved, while 18(60%) failed the surgery. One patient (3.3%) had a complication referable to sling placement. 13 patients (43.3%) underwent one or more secondary procedures for continued incontinence (12 artificial urinary sphincters and 2 repeat slings). The mean direct cost per patient for sling implantation was $5,555 and for an artificial urinary sphincter (AUS) placement was $10,314. All of the patients undergoing a secondary AUS at our institute had cure of incontinence. For patients who had a secondary AUS placed after sling failure, the mean aggregate cost in order to achieve continence (direct sling cost + direct AUS cost) was $16,018. CONCLUSIONS The efficacy of the male TOS is decreased in patients who have undergone post-prostatectomy radiation therapy, and a large proportion of these patients will seek secondary intervention for continued incontinence. A secondary AUS placement is associated with cure of incontinence but increases the aggregate cost to achieve satisfactory results. Patients should be thoroughly counseled that the male sling is associated with low efficacy, a high rate of secondary procedures, and increased cost in the setting of prior radiation. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e342 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Shubham Gupta More articles by this author Aaron Lentz More articles by this author Ngoc-Bich Le More articles by this author George Webster More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...