Abstract
ABSTRACTObjective:To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery.Materials and Methods:We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent.Results:Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm.Conclusions:SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.
Highlights
Retrourethral transobturator sling (RTS) is a functional, non-compressive and nonobstructive minimally invasive treatment for stress urinary incontinence (SUI)
The key mechanism to RTS surgery seems to be a dynamic support of the urinary sphincter during stress by increasing ibju | Sphincter pressure under contraction seems to be a way for optimizing the sphincter evaluation prior to male sling surgery the coaptive zone in the sphincter part of the urethra and the ideal candidates for sling placement seem to be those with good residual urinary sphincter function [5]
It is not largely used in pre-operative evaluation to male sling surgery and is more used to measure the sphincter pressure at rest (SPAR) than the sphincter pressure under contraction (SPUC) [9]
Summary
Retrourethral transobturator sling (RTS) is a functional, non-compressive and nonobstructive minimally invasive treatment for stress urinary incontinence (SUI). It is our belief that a possible factor influencing the outcome of the RT could be its interpretation This is a subjective, non-numeric test, and depends largely on surgeon experience with the test. Urethral pressure profilometry (UPP) was first described by Brown-Wickham in 1969 and was the first method used for evaluating urethral function (including sphincter pressure) [8]. It is not largely used in pre-operative evaluation to male sling surgery and is more used to measure the sphincter pressure at rest (SPAR) than the sphincter pressure under contraction (SPUC) [9]
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