Male Urethral Sling Research Articles

303 ‘Mini Male Urethral Sling’ and Inflatable Penile Prosthesis for the Treatment of Erectile Dysfunction with Climacturia

A ‘mini male sling’ (MMS) is a urethral sling designed to treat climacturia, urinary incontinence at the time of ejaculation. The MMS is composed of either human cadaveric pericardium or macroporous monofilament polypropylene mesh and is sutured to the ventral bilateral corpora cavernosa proximal to the corporotomies for inflatable penile prosthesis (IPP) placement at the level of the bulbar urethra. For men who experience erectile dysfunction and climacturia post prostatectomy, we hypothesized that placement of an IPP and a MMS would result in significant improvement in patient-reported climacturia and mild stress urinary incontinence as measured by pad use. A retrospective review was performed for all consecutive patients (n=20) who underwent IPP and MMS placement by a single surgeon between 2016-2017. Patient-reported climacturia and number of pads used daily for mild stress urinary incontinence were assessed pre-operatively and at each post-operative visit starting at 2 post-operative weeks for mild stress urinary incontinence and starting at 3 post-operative months for climacturia. Pre-operative to post-operative patient reported climacturia and pad use were compared for each patient using McNemar’s test with a statistical significance threshold of p<0.05.

Artificial urinary sphincter.

Although currently still the gold standard treatment for post-prostatectomy urinary incontinence, the artificial urinary sphincter (AUS) (AMS800) is an invasive procedure with associated risks factors. In this paper, we aim to outline what the scientific literature and what we personally believe are the factors that are useful and/or necessary to mitigate these risks, including both patient factors and surgeon factors. We also review special populations, including transcorporal (TC) AUS approach, AUS with inflatable penile prosthesis, AUS after male urethral sling, AUS erosion management, and AUS after orthotopic urinary diversion.

The Male Transobturator Sling for Stress Incontinence After the Treatment of Prostate Cancer

The purpose of this review is to describe the use of male transobturator slings for the treatment of post-prostatectomy urinary incontinence. We aim to cover available slings on the market and give some background history of transobturator sling development. Although there has been a paucity of new transobturator slings released on the market over the last 5 years, there has emerged new data on product variations of the transobturator sling, including the Argus T adjustable sling, the Virtue Quadratic sling, the ATOMS sling, and the AdVance XP sling. Evidence that radiotherapy worsens outcomes, urodynamic studies may play some role in patient selection with Valsalva leak point pressure (VLPP) <100 cm H20 showing improved success, and salvage of sling failures are more optimal with artificial urinary sphincter (AUS) as compared to repeat sling placement, highlights the recent technical findings for the use of transobturator male urethral slings for the treatment of post-prostatectomy urinary incontinence. Male transobturator slings and its variations are efficacious in the treatment of post-prostatectomy urinary incontinence given proper patient selection and appropriate device implantation practices. Patients with mild to moderate stress urinary incontinence that have had no prior radiotherapy and have some ability to coapt the external urethral sphincter have the highest success rates.

AdVance male urethral sling: medium-term results in an Australian cohort.

Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures. A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores. At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02). The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.

Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia.

Background:Erectile dysfunction is a prevalent disease affecting over 50% of men between the ages of 40 and 70 years. Penile prosthesis represents the end of the line treatment when other less invasive therapies fail or are contraindicated. Male stress urinary incontinence can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male stress incontinence. No data exist on the utilization of penile prosthesis or male incontinence surgical treatment in Saudi Arabia. Generally, urological prosthetic surgery is performed either in private hospitals or in government hospitals. Our aim was to assess the trend of penile prosthesis and male incontinence device utilization in Saudi Arabia.Materials and Methods:We utilized sales’ data of penile prosthetics, male slings, and AUS from the only two companies selling these devices in Saudi Arabia (AMS® and Coloplast®), from January 2013 to December 2016.Results:There were 2599 penile prosthesis implantation procedures done in the study period, with 67% of them performed in private institutions. There was a progressively increased use of penile prosthetics which nearly doubled from 2013 to 2016. The main type of prosthesis utilized was the semirigid type 70% versus 11% of the 2-piece inflatable and 17% of the 3-piece inflatable device. Only 10 slings and 31 AUS were inserted during the same study period.Conclusions:There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics’ use is very limited in Saudi Arabia.

The impact of prior urethral sling on artificial urinary sphincter outcomes.

We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS). We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Cox-regression analysis. There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy. AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

Post Prostatectomy Bladder Dysfunction: Where Are We Now?

During the prostate-specific antigen (PSA) era, the prevalence of male stress urinary incontinence (SUI) continues to rise as more prostatectomies are performed. Treatment of male SUI is a multifactorial decision depending not only on bladder and sphincteric function, but also patient choice. Due to the economic burden and strain on quality of life, procedures and devices have been developed to help patients alleviate their symptoms. Mainstays of treatment include conservative management with biofeedback and Kegel exercises, periurethral bulking agents, or surgical procedures such as the male urethral sling or the artificial urinary sphincter. A proper evaluation is important as bladder dysfunction in the form of detrusor overactivity, detrusor underactivity, and poor bladder compliance can occur independently or coexist with intrinsic sphincter deficiency. Thus, it is important to clearly define patient symptomatology to optimize outcomes.

MP87-16 PERINEAL FIXATION IS INFERIOR TO PURELY TRANSOBTURATOR PLACEMENT OF MALE SLING: MULTICENTER STUDY OF SURGICAL ESCALATION.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-16 PERINEAL FIXATION IS INFERIOR TO PURELY TRANSOBTURATOR PLACEMENT OF MALE SLING: MULTICENTER STUDY OF SURGICAL ESCALATION. Ryan Terlecki, Kurt McCammon, Jack Zuckerman, Brian Flynn, Joshua Broghammer, Gopal Badlani, and Marc Colaco Ryan TerleckiRyan Terlecki More articles by this author , Kurt McCammonKurt McCammon More articles by this author , Jack ZuckermanJack Zuckerman More articles by this author , Brian FlynnBrian Flynn More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Marc ColacoMarc Colaco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male urethral sling is an attractive option for select cases of stress urinary incontinence (SUI). At present, two commercially available male slings are marketed in the United States, AdVanceTM (American Medical Systems, Minnetonka MN) and Virtue® (Coloplast, Minneapolis MN). AdVanceTM is a purely transobturator sling, while Virtue® involves transobturator and prepubic mesh tunneling. Proposed technical modification of Virtue® placement, however, includes suture fixation to the periosteum of the pubic rami, theoretically mimicking the earlier InVance® sling, but without bone anchors. Numerous definitions exist for success and failure after SUI surgery, but it is generally accepted that surgical escalation to an artificial urinary sphincter (AUS) following sling surgery constitutes sling failure. We sought to compare outcomes of perineal fixation versus transobturator elevation by analyzing rates of surgical escalation after AdVanceTM versus InVance®. METHODS A retrospective cohort analysis was performed to compare outcomes of AdVanceTM and InVance® procedures. AdVanceTM data was drawn from the prospectively collected experience of four academic centers with high volume implanters. All cases of AdVanceTM sling placement were included for this analysis, excluding only those with incomplete data. For the InVance® cohort, data was queried from the AMS Patient Information Form (PIF) database. All cases of AdVanceTM and InVance® sling placement were cross-referenced with the PIF database to determine cases of subsequent AUS placement. Overall rates and time to escalation were determined, with a rate comparison performed via chi square analysis. RESULTS 345 patients undergoing AdVanceTM (mean age 67.5 yrs) and 5417 receiving InVance® (mean age 68.3 yrs) were included. Mean follow-up for cases not requiring escalation was 5.6 yrs and 11.2 yrs, respectively. The rate of surgical escalation to AUS was significantly higher for InVance® than AdVanceTM (17.1% vs 11.3%, p = 0.005), with a mean time to escalation of 3.0 yrs and 1.7 yrs, respectively. CONCLUSIONS Based on this multi-institutional study, and in view of historical data, surgical escalation to AUS is significantly less common with a purely transobturator sling than with perineal fixation. This data may have relevance to training on surgical technique and product selection. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1120-e1121 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ryan Terlecki More articles by this author Kurt McCammon More articles by this author Jack Zuckerman More articles by this author Brian Flynn More articles by this author Joshua Broghammer More articles by this author Gopal Badlani More articles by this author Marc Colaco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy.

To analyze the rates of incontinence procedures after radical prostatectomy, and define the variables associated with them. We conducted an IRB approved retrospective review of patients with prostate cancer who underwent radical prostatectomy at a single institute from January 1998 to December 2012. Logistic regression and time to event analyses were performed to ascertain variables associated with receipt of incontinence procedure after prostatectomy. Four thousand four hundred one men underwent radical prostatectomy (69.8% open, 30.1% laparoscopic or robotic) of whom 74.3% were white Caucasian and 22.1% were African-American. Overall, 165 (3.7%) patients underwent a total of 191 procedures for male urethral sling or artificial urinary sphincter placement. African-American men received fewer incontinence procedures than white Caucasian men (2.1% versus 4.3%, P = 0.001); and with a longer delay after prostatectomy than white Caucasian men (28.3 months versus 19.9 months, P = 0.029). Men who had a laparoscopic or robotic prostatectomy received an incontinence procedure earlier than men who had an open prostatectomy (17.6 months versus 24.4 months, P = 0.0001). On multivariate analysis, age at prostatectomy, diagnosis of incontinence, and race were independently associated with receiving an incontinence procedure. The overall rate of incontinence surgery after radical prostatectomy is low at 3.7%. African-American men receive incontinence procedures at a lower rate and with a longer delay after prostatectomy than white Caucasian men. Further studies are needed to define the reasons for this racial disparity in urinary incontinence surgery in the prostate cancer survivor. Neurourol. Urodynam. 35:733-737, 2016. © 2015 Wiley Periodicals, Inc.

MP38-19 THE UTILIZATION OF INCONTINENCE PROCEDURES VARIES BY RACE IN PROSTATE CANCER SURVIVORS

INTRODUCTION AND OBJECTIVES: Voiding dysfunction and urinary incontinence after radical prostatectomy has been reported to range from 3% to as high as 90%. In addition, little is known about racial differences in post prostatectomy incontinence and the utilization of anti-incontinence procedures. We analyzed the rates of anti-incontinence procedures after radical prostatectomy with respect to race at a single institute. METHODS: We conducted an IRB approved retrospective review of the billing data of patients with prostate cancer who underwent radical prostatectomy (open, laparoscopic, or robotic) at a single institute over a 10-year period. Demographic data including race and ethnicity, marital status, age at treatment and surgical therapy for urinary incontinence with either a male sling or artificial urinary sphincter (AUS) were reviewed. RESULTS: 4401 men underwent radical prostatectomy over the study period. 30% of the patients underwent laparoscopic or robotic prostatectomy, 8.5% underwent perineal prostatectomy, and 60% underwent retropubic radical prostatectomy. 74.3% of the patients were Caucasian (mean age of 62.7 years at treatment), and 22.1% were African American (mean age of 60 years at treatment). 165 (3.7%) patients underwent a total of 191 procedures for male urethral sling or artificial urinary sphincter placement. Among men who underwent incontinence surgery, the mean age at radical prostatectomy was 63 years, and the median time from prostatectomy to first incontinence surgery was 20 months. The first incontinence procedure was a male sling in 63% and AUS in 37% of patients. White Caucasian men had a higher rate of anti-incontinence procedure utilization compared to African American men (4.3% versus 2.1%, p 1⁄40.001) and had a shorter time to incontinence surgery after prostatectomy (19.8 months versus 28.3 months, p <0.05). There was no racial difference in the types of incontinence procedure performed (sling versus AUS). There was no difference noted in incontinence procedure utilization based on ethnicity, marital status, or religion. CONCLUSIONS: The overall rate of incontinence surgery after radical prostatectomy at our institute is 3.7%. African American men receive antiincontinence procedures at a lower rate and with a longer delay after prostatectomy than Caucasian men. Further studies are needed to define the potential reasons for this racial disparity in urinary incontinence surgery in the prostate cancer survivor.

Combination options with the male urethral sling to treating post-prostatectomy incontinence

Combination options with the male urethral sling to treating post-prostatectomy incontinence

An Innovative Wound Retractor/Protector for Prosthetic Urologic Surgery

Objective: We demonstrate an innovative use of a barrier surgical wound retractor/protector system for use in a variety of prosthetic urologic procedures (penile prosthetics, artificial urinary sphincters, male slings). Materials and Methods: We demonstrate the use of a self-retaining ring wound retractor in a multitude of prosthetic urological procedures: insertion of an inflatable penile prosthesis through an infrapubic approach as well as penoscrotal approach, placement of a transperineal artificial urinary sphincter, and placement of a male urethral sling. Results: The self-retaining ring wound retractor facilitated a more rapid setup and takedown, provided 360 degrees of atraumatic retraction as well as 360 degrees of wound protection, allowed for maximum exposure with a minimum incision size, significantly shortened the operating wound depth thus maximizing exposure, and isolated the surgical field minimizing prosthesis to skin contact. Conclusion: Our experience shows that prosthetic urologic surgeries can be enhanced with the use of the self-retaining ring wound retractor as it provides better surgical exposure, lowers wound infection risks, sets up more quickly as a safer retraction system with substantial cost savings.

Surgical Practice Patterns for Male Urinary Incontinence: Analysis of Case Logs from Certifying American Urologists

Several options exist for the surgical correction of male stress urinary incontinence including periurethral bulking agents, artificial urinary sphincters and the recently introduced male urethral slings. We investigated contemporary trends in the use of these treatments. Annualized case log data for incontinence surgeries from certifying and recertifying urologists were obtained from the ABU (American Board of Urology), ranging from 2004 to 2010. Chi-square tests and logistic regression models were used to evaluate the association between surgeon characteristics (type of certification, annual volume, practice type and practice location) and the use of incontinence procedures. Among the 2,036 nonpediatric case logs examined the number of incontinence treatments reported for certification has steadily increased over time from 1,936 to 3,366 treatments per year from 2004 to 2010 (p = 0.008). Nearly a fifth of urologists reported placing at least 1 sling. The proportion of endoscopic procedures decreased from 80% of all incontinence procedures in 2004 to 60% in 2010, but they remained the exclusive incontinence procedure performed by 49% of urologists. A urologist's increased use of endoscopic treatments was associated with a decreased likelihood of performing a sling procedure (OR 0.5, p <0.0005). Artificial urinary sphincter use remained stable, accounting for 12% of procedures. Incontinence procedures are on the rise. Urethral slings have been widely adopted and account for the largest increase among treatment modalities. Endoscopic treatments continue to be commonly performed and may represent overuse in the face of improved techniques. Further research is required to validate these trends.

1079 CHLORHEXIDINE VERSUS POVIDONE-IODINE FOR SURGICAL SKIN SITE ANTISEPSIS DURING GENITOURINARY PROSTHETIC SURGERY A RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121079 CHLORHEXIDINE VERSUS POVIDONE-IODINE FOR SURGICAL SKIN SITE ANTISEPSIS DURING GENITOURINARY PROSTHETIC SURGERY A RANDOMIZED CONTROL TRIAL Shaun Grewal, Lawrence Yeung, Arnold Bullock, Henry Lai, and Steven Brandes Shaun GrewalShaun Grewal St Louis, MO More articles by this author , Lawrence YeungLawrence Yeung Gainesville, FL More articles by this author , Arnold BullockArnold Bullock St Louis, MO More articles by this author , Henry LaiHenry Lai St Louis, MO More articles by this author , and Steven BrandesSteven Brandes St Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infection after genitourinary prosthetics implantation is uncommon (1−3%), The primary source of bacterial colonization is staphylococcus from the skin. Chlorhexidine has been shown to decrease positive skin cultures around the surgical skin site (SSS) from 31% (povidone−iodine alone) to 7%, for orthopaedic prosthesis implants (J Bone Joint Surg Am. 2009;91:1949-1953). We compared the efficacy of chlorhexidine (ChloraPrep) to that of povidone−iodine (current standard) at decreasing the rate of positive bacterial skin cultures at the SSS for genitourinary prosthetic device implantations. METHODS Single−institution, prospective, randomized, controlled study to evaluate 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients randomized to a standard 10 minute scrub and paint with povidone−iodine or chlorhexidine to the SSS. Patients excluded for preexisting GU implants or history of surgical site infection. Skin culture obtained from the SSS (scrotum or perineum) before and after skin preparation. RESULTS 100 consecutive patients were randomized to two types of skin preparation arms - 50 chlorhexidine and 50 povidone−iodine. 65 patients underwent inflatable penile prosthesis (IPP), 14 patients had male urethral sling (MUS), 14 patients had artificial urinary sphincter, 5 patients had combination IPP and MUS, and 2 patients testicular prothesis placement. Mean operative time was 86.2 + 32.4 min (range 45−204 min). Pre−preparation cultures were positive in 79%. In post−preparation cultures, 4 patients in Chlorhexidine group had a positive culture compared to 16 in the povidone−iodine group (8% vs 32%, p=0.0051). Coagulase negative staphylococus was the most commonly isolated organism in post prep cultures in the povidone-iodine group (13/16 patients), as opposed to propionobacterium in the chloraprep group (3/4 patients). Clinical infection requiring additional operations or device removal occurred in 6 patients (6%), with no significant difference between the two groups. No urethral (dysuria, meatitis) or genital skin complications (rash) occurred in either group. CONCLUSIONS Chlorhexidine is superior to povidone−iodine at eradicating skin flora at the SSS prior to genitourinary prosthetic implantation. Chloraprep is well tolerated on the external genitalia, with no increased risk of urethral or genital skin irritation compared to povidone−iodine. Chlorhexidine should be the standard of care for skin preparation prior to GU prosthetic procedures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e438 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shaun Grewal St Louis, MO More articles by this author Lawrence Yeung Gainesville, FL More articles by this author Arnold Bullock St Louis, MO More articles by this author Henry Lai St Louis, MO More articles by this author Steven Brandes St Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1348 IMPACT OF MALE URETHRAL SLING PLACEMENT ON POST-PROSTATECTOMY CLIMACTURIA

INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) is an effective treatment for localized prostate cancer, but can result in long term complications such as stress urinary incontinence and erectile dysfunction. Climacturia is a poorly characterized consequence of RP that can have adverse quality of life implications and has been cited to affect up to 93% of post RP patients. The aim of this study is to determine the impact of male urethral sling placement on postprostatectomy climacturia. METHODS: A retrospective review of all men who underwent urethral sling placement between 2007 and 2011 was generated. All patients were queried by telephone questionnaire that examined aspects of climacturia, including frequency, amount of urine loss, bother score of patient and partner, and coping mechanisms (Lee, et al), both before and after urethral sling placement. RESULTS: Thirty-three patients were eligible for analysis. Twenty patients answered the full questionnaire and comprise the study cohort. Pre operative average pad weight was 153 g (range 50-370). Mean follow-up was 18 months (range 3.1-37.8). Sixteen of 20 men (80%) were pad-free or minimally spotting on chart review at last follow-up. Fifteen of 20 men were not sexually active prior to sling placement. Eight were impotent, 1 was celibate and 6 were potent, but avoided sexual activity due to incontinence during intercourse. In total, there were 11 potent men, of which 10 acknowledged climacturia. All of the men and their partners (100%) found climacturia to be bothersome to varying degrees (see Figure). After sling placement, 9 of 10 men (90%) had improvement in bother score for climacturia (p 0.05). Six of 10 men (60%) had completely resolved climacturia, including 3 who avoided sexual activity due to leakage prior to sling placement. In three of the 4 patients who still had climaturia, it rarely occurred and the amount of urine loss was quantified as a few drops. CONCLUSIONS: Male urethral sling placement for post-prostatectomy climacturia has a positive effect, with 90% of the study group showing a benefit. Climacturia should be specifically inquired about in the post-prostatectomy period and if it results in sufficient bother to the patient, urethral sling placement as a treatment should be discussed.

Combination options with the male urethral sling to treating post-prostatectomy incontinence

The male urethral sling (MUS) has been embraced by many urologists as a treatment option for mild to moderate post-prostatectomy incontinence. The potential advantages compared to the artificial urinary sphincter (AUS) make it an attractive option to physicians and patients. However, the published literature on the MUS is limited. The role of a MUS in patients with previous pelvic radiation or more severe incontinence (>5 pads per day) is still unclear. The authors present a case series of 40 patients treated with a MUS (primarily with the AdVance Sling [American Medical Systems, Minnetonka, MN]).1 Their success rate is 63% (25 of 40) and is in keeping with other published series. The authors also present their approach and outcomes for the failed male sling patients (15 of 40), all of whom had a significant initial degree of incontinence (7–10 pads per day) that did not respond to MUS placement. These patients were all treated with a second procedure: either an AUS if they had previous radiation, or activation/implantation of an adjustable continence therapy system (ProACT, Uromedica Inc., Plymouth, MN). After the second procedure, all 15 patients achieved continence (≤1 pad per day). The AdVance MUS is hypothesized to increase the membranous urethral length by elevating the posterior urethra.2 This is different from the compressive mechanism of adjustable continence therapy or an AUS. We do not know if the MUS contributed to the continence achieved from the subsequent placement of the adjustable continence therapy system or AUS. There were 2 men who had previously failed adjustable continence therapy; they also failed to respond to MUS placement. However, when their ProACT system was reactivated, the combination of the MUS and ProACT resulted in continence. This result suggests that the 2 treatments can contribute to continence in an additive fashion. This concept has also been demonstrated with the successful use of an AdVance MUS in AUS patients with recurrent incontinence.3 The combination of a MUS and a compressive device is a novel approach to male patients with persistent or recurrent stress incontinence.

Editorial Comment

Traditional surgical treatments for postprostatectomy urinary incontinence include artificial urinary sphincter (AUS) and male urethral sling implantation. In this study, a third surgical alternative is presented: implantation of a periurethral constrictor. Treatment of Post-prostate Surgery Urinary Incontinence With the Periurethral Constrictor: A Retrospective AnalysisUrologyVol. 75Issue 6PreviewIn this study, we present safety and efficacy data for a surgical alternative for the treatment of postprostate surgery urinary incontinence, based on the use of the periurethral constrictor, a two-part device—constrictor cuff and self-sealing valve with a tube—activated by injection of saline solution. Full-Text PDF ReplyUrologyVol. 75Issue 6PreviewFirst, we would like to stress that the device was originally used successfully in treating urinary incontinence of neurogenic origin.1 The authors presented that implanting the device with a pressure of 70 cm H2O in the system led to long-term urinary continence in most cases, showing rates of efficiency and erosion similar to those obtained with AUS use in this type of patient. Full-Text PDF

Outcomes of Simultaneous Placement of an Inflatable Penile Prosthesis and a Male Urethral Sling through a Single Perineal Incision

Synchronous implantation of an inflatable penile prosthesis (IPP) and a bulbourethral sling single via a single perineal is a unique approach in managing erectile dysfunction and stress urinary incontinence. This article describes our surgical approach and reviews the operative time, length of hospital stay (LOS), estimated blood loss (EBL), and cost of synchronous dual prosthetic implantation compared with the implants performed individually. Additionally, we review the short-term outcomes in patients with dual sling and penile prosthesis synchronous implants. Fifty-eight patients with IPP, 53 slings, and eight simultaneous dual implantations between January 2000 and July 2008 were retrospectively reviewed. Operative times, EBL, length of stay, cost, and complications were compared in three groups (group 1, IPP; group 2, slings; group 3, dual implants). Additionally, we reviewed pre- and postoperative Sexual Health Inventory for Men (SHIM) scores and pad use in group 3. Review of operative times, EBL, LOS, cost, and complications. Dual implantation had similar operative times compared with the total time for the individual procedures (98 +/- 24 minutes for IPP; 86 +/- 24 minutes for sling; 177 +/- 17 minutes for dual implant, P > 0.05). EBL was reduced (57 +/- 30 mL for IPP; 48 +/- 59 mL for sling; 49 +/- 5 mL for group 3). LOS was also reduced (1.2 +/- 0.45 days for IPP, 0.7 +/- 0.48 days for sling; and 1.1 +/- 0.50 days for dual implant). Dual implantation was associated with approximately $9,000 in savings. With a mean follow-up of 13.6 months, group 3 reported SHIM increase from 1.3 +/- 0.5 to 23.5 +/- 0.6 and a decrease in pad use from three pads per day (range 2-6) down to a mean of one pad per day (range 0-2). One sling erosion and one sling infection occurred in group 2. One patient in group 3 had acute urinary retention resolved with 5 days of catheter drainage. Dual penile prosthesis and bulbourethral sling implantation through a single perineal incision is safe, efficient, and cost-effective.

Outpatient Perineal Sling in Adolescent Boys With Neurogenic Incontinence

Management for urinary incontinence in boys with sphincteric incompetence secondary to a neurogenic etiology is a challenge. Minimally invasive approaches have inconsistent efficacy and may require multiple treatments. Open bladder neck reconstruction requires inpatient hospitalizations and can be associated with a high complication rate. To overcome some of these shortcomings we placed a polypropylene male perineal sling in male adolescents with neurogenic sphincteric incontinence. We retrospectively reviewed the outcome in our initial 6 patients. Six patients 14 to 20 years old underwent placement of a polypropylene male perineal sling on an outpatient basis. Followup was 27 to 39 months (median 33). All patients had a history of myelomeningocele and underwent urodynamics showing normal compliance, adequate capacity and sphincteric incompetence. A suburethral sling was placed on an outpatient basis through a small perineal incision. Sling tension was adjusted for maximal urethral compression while still permitting uncomplicated urethral catheter passage. All 6 patients reported immediate complete continence after sling placement. Two slings were removed after local infection developed and 1 was replaced. Another sling required revision secondary to incomplete bone anchor fixation. No patients had urethral erosion. All 5 patients with a sling currently in place were fully continent on intermittent catheterization every 3 hours and they reported excellent satisfaction with the procedure. Our retrospective study suggests that the male urethral sling may be an outpatient option for neurogenic incontinence secondary to sphincteric incompetence. Long-term followup in our initial 6 patients shows encouraging durability. Continued study is required to determine strategies that might decrease the complication rate of this approach.

EROSION OF A MALE POLYPROPYLENE SLING

No AccessJournal of UrologyAdult Urology: Voiding Dysfunction1 Nov 2004EROSION OF A MALE POLYPROPYLENE SLING J. HAKIM and M. GIGNAC J. HAKIMJ. HAKIM More articles by this author and M. GIGNACM. GIGNAC More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000142106.38139.e2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "EROSION OF A MALE POLYPROPYLENE SLING." The Journal of Urology, 172(5), p. 1925 References 1 : Management of vaginal erosion of polypropylene mesh slings. J Urol2003; 169: 2242. Link, Google Scholar 2 : Polypropylene sling of the bulbar urethra for post-radical prostatectomy incontinence. Eur Urol2003; 43: 152. Google Scholar 3 : The male sling for stress urinary incontinence: a prospective study. J Urol2002; 167: 597. Link, Google Scholar From the Triangle Urology Group, Pittsburgh, Pennsylvania© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 5November 2004Page: 1925 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordssurgical meshurinary incontinence, stresspolypropylenesMetricsAuthor Information J. HAKIM More articles by this author M. GIGNAC More articles by this author Expand All Advertisement PDF downloadLoading ...