MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI John Patrick Selph, Mustafa Bashir, Shubham Gupta, Michael J. Belsante, Timothy Brand, Timothy Tausch, Jessica Lloyd, Zachariah Goldsmith, and Andrew Peterson John Patrick SelphJohn Patrick Selph More articles by this author , Mustafa BashirMustafa Bashir More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Michael J. BelsanteMichael J. Belsante More articles by this author , Timothy BrandTimothy Brand More articles by this author , Timothy TauschTimothy Tausch More articles by this author , Jessica LloydJessica Lloyd More articles by this author , Zachariah GoldsmithZachariah Goldsmith More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The precise mechanism by which the AdVance(TM) transobturator sling (TOS) improves continence is unknown. Postulated mechanisms of action include changes in urethral mobility or an increase in functional membranous urethral length (FUL). Using dynamic MRI, we sought to determine how anatomic and functional relationships change in the male urethra after TOS surgery. METHODS We conducted a prospective study of males undergoing TOS from 2010 to 2014. Males with SUI after radical prostatectomy (RP) who were scheduled for TOS were enrolled. Patients underwent pad weight testing, voiding diary, urodynamics, and cystoscopy preoperatively. Dynamic MRI was performed before and after TOS. On matched pre- and post-operative sagittal T2 weighted images using a 3T MR system, the following measurements were obtained both at rest (R) and Valsalva (V): 1) distance from bladder neck BN to pubic symphysis (termed AP); 2) distance from BN to urethra at the pubococcygeal line (termed CC); and 3) distance from BN to urethra at the penile bulb (termed FUL). A group of patients who underwent RP with no SUI on pad weight testing underwent MRI post-RP and served as controls. RESULTS A total of 34 (20 cases, 14 controls) patients were enrolled in the study. All patients who underwent TOS had improvement in continence (12 used zero pads, 5 used 1 pad/day). Prior to TOS, there was a significant difference in rest and Valsalva CC but not AP distance when compared to non-leaking controls (mean case CC R 0.42cm and V 0.32cm vs. control CC R 1.06cm and V 1.09cm, resp, p < 0.05). Post-TOS, neither R and V AP nor R and V CC were different when compared to non-leaking controls. When comparing post-TOS to pre-TOS among the cases, there was a trend towards a difference in mean CC distance at rest and Valsalva (R pre 0.42cm vs post 0.63cm, p = 0.09; V pre 0.32cm vs post 0.54cm, p = 0.13). To assess urethral mobility, we looked at the rest to Valsalva change in AP and CC distance before and after TOS, and there was no significant difference in either measurement (mean difference in R-to-V AP pre 0.21cm vs post 0.3cm, mean difference in R-to-V CC pre 0.1cm vs post 0.09cm). However, the pre-sling cases had a shorter rest FUL when compared to controls (1.27 vs 1.92cm, p <0.05) and the post-TOS FUL increased significantly (1.27 vs 1.53 cm, p <0.05) and approximated the FUL found in dry controls. CONCLUSIONS The mechanism of action of the male TOS appears to be via an increase in functional urethral length rather than changes in urethral mobility. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1094 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Patrick Selph More articles by this author Mustafa Bashir More articles by this author Shubham Gupta More articles by this author Michael J. Belsante More articles by this author Timothy Brand More articles by this author Timothy Tausch More articles by this author Jessica Lloyd More articles by this author Zachariah Goldsmith More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...