PD24-11 THE ARTIFICIAL URINARY SPHINCTER IS SUPERIOR TO A SECONDARY TRANSOBTURATOR MALE SLING IN CASES OF A PRIMARY SLING FAILURE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2015PD24-11 THE ARTIFICIAL URINARY SPHINCTER IS SUPERIOR TO A SECONDARY TRANSOBTURATOR MALE SLING IN CASES OF A PRIMARY SLING FAILURE Divya Ajay, John Selph, Michael Belsante, Ngoc-Bich Le, Aaron Lentz, George Webster, and Andrew Peterson Divya AjayDivya Ajay More articles by this author , John SelphJohn Selph More articles by this author , Michael BelsanteMichael Belsante More articles by this author , Ngoc-Bich LeNgoc-Bich Le More articles by this author , Aaron LentzAaron Lentz 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.2015.02.1466AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling (TOS) is a minimally invasive treatment for postprostatectomy stress urinary incontinence (PPSUI). Reported success rates for the male transobturator sling (TOS) are 41-76%. In the case of a failed primary sling, many surgeons offer a secondary sling; however, there is no literature describing the success of a secondary TOS placement in these situations. Our objective was to assess the success of secondary TOS in comparison to AUS for PPSUI patients who failed a primary TOS. METHODS We retrospectively reviewed all patients undergoing salvage procedures after failure of TOS from 2006 to 2012 at our institution. Demographic and follow-up data were extracted by chart review. Post-operative success was defined as the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g/day. Cox regression model and Kaplan-Meier survival analysis were performed. RESULTS 61 men were included. All had a TOS for PPSUI and presented with persistent incontinence after initial sling placement. 32 subsequently underwent placement of an AUS and 29 had a secondary TOS at a median of 10(IQR 6-29) and 14(IQR 7-19) months from primary TOS surgery, resp. The mean ages of the AUS and secondary TOS cohorts were not significantly different. 47% of the AUS cohort had received prior external beam radiation therapy versus 18.5% of the secondary TOS (p<0.01). Average pre-operative 24 hour pad weight was higher in the AUS cohort (517g) versus the TOS cohort (274g; p<0.01). The median follow-up for the AUS and TOS patients was 5 (IQR 4-16) and 4 (IQR1-5) months, resp. Treatment failure was seen in 55% (16/29) of secondary TOS versus 15% (5/32) of AUS patients with a hazard ratio of 2.9 (95%CI 1.1-8.3). 6 (21%) patients who failed a secondary TOS went on to receive an AUS. Figure 1 shows improved treatment success rates for TOS failures who received an AUS versus a secondary TOS (p=0.03). CONCLUSIONS In this cohort of patients with PPSUI who failed TOS, those who underwent a secondary TOS were 2.9 times as likely to have persistence incontinence in comparison to those who underwent AUS placement. This finding was noted despite the fact that there was a higher likelihood of radiation therapy in the AUS group. This data may be very useful in counseling patients and surgical planning. We currently recommend placement of an AUS for patients who have failed an initial TOS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e490 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Divya Ajay More articles by this author John Selph More articles by this author Michael Belsante More articles by this author Ngoc-Bich Le More articles by this author Aaron Lentz 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 ...