PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II (PD37)1 Apr 2020PD37-12 URODYNAMIC PREDICTORS OF SURGICAL OUTCOMES FOLLOWING MALE SLING IMPLANTATION Bogdan Toia*, Lap Yan Leung, Raveen Saigal, Eskinder Solomon, Sachin Malde, Claire Taylor, Arun Sahai, Rizwan Hamid, Tamsin Greenwell, Jai Seth, Davendra Sharma, and Jeremy Ockrim Bogdan Toia*Bogdan Toia* More articles by this author , Lap Yan LeungLap Yan Leung More articles by this author , Raveen SaigalRaveen Saigal More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Sachin MaldeSachin Malde More articles by this author , Claire TaylorClaire Taylor More articles by this author , Arun SahaiArun Sahai More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , Jai SethJai Seth More articles by this author , Davendra SharmaDavendra Sharma More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000908.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical options for post prostatectomy incontinence are implantation of an artificial sphincter or male sling. Outcomes for artificial sphincters, and predictive values for good outcome have been documented. However, the criteria for patient selection and the likelihood of a good outcome for male slings are limited. Most authors have relied on pad number/weight as their primary parameter, despite poor correlation with success rates. It remains unclear whether pre-operative urodynamic parameters might better predict surgical outcomes and facilitate patient selection. METHODS: We performed a retrospective case notes and video-urodynamics review of men who underwent AdVanceXP male mid-urethral sling insertion in three London hospitals between 2012 and 2019. Collected data included demographics, postoperative continence and urodynamic parameters. Video-urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was only performed in one centre. Analysis was performed using chi-squared and independent t tests, with p<0.05 is considered significant. RESULTS: 114 men were identified. 89/114 (78%) patients were cured of their incontinence requiring 1 pad per day or less for reassurance (59/114 (52%) did not use any pads), whilst 25/114 (22%) patients remained significantly wet. Success by urodynamic parameters is shown in Figure 1. 43/114 (38%) had detrusor overactivity (DO) on preoperative urodynamics, with a mean pressure of 41cmH2O (range 15-78). The rate of DO demonstrated in the wet group was significantly higher than in dry group (60% vs 31%, p=0.009), but the peak DO pressure did not correlate with outcomes (p = 0.778). 31/114 (27%) had abnormal compliance, with higher incidence in the wet group (48% vs. 21%, p= 0.008). Having a bladder capacity less than 400ml was also associated with worse outcomes (p=0.001). Preoperative RLPP did not correlate with surgical outcomes (p=0.495), but was only was performed in 55 men (48%). CONCLUSIONS: Urodynamic parameters can be used to predict outcome for male sling. The predictors of significance are detrusor overactivity, reduced compliance and reduced bladder capacity (<400mls). Further study is required to accurately define urodynamic parameters that will differentiate outcomes and criteria for sling (and sphincter) selection. Source of Funding: No funding required © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e732-e733 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Toia* More articles by this author Lap Yan Leung More articles by this author Raveen Saigal More articles by this author Eskinder Solomon More articles by this author Sachin Malde More articles by this author Claire Taylor More articles by this author Arun Sahai More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Jai Seth More articles by this author Davendra Sharma More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement PDF downloadLoading ...