Sling Procedure Research Articles

Patient Satisfaction and QoL in SUI: Results With Single-Incision or Full-Length Slings.

Understanding treatment impact on quality of life of patients with stress urinary incontinence (SUI) in the short- and long-term is vital to optimizing treatment success. This study aimed to report 36-month patient satisfaction and quality of life results from a 522 study of single-incision and full-length slings in SUI. This was a secondary analysis of the Altis 522 study, a prospective, multicenter, nonrandomized, noninferiority cohort study comparing the Altis single-incision sling to full-length slings for the treatment of SUI. The current study endpoints are patient-reported outcomes on quality of life related to continence status at 6, 12, 18, 24, and 36 months, measured through patient-reported, validated questionnaires: Urogenital Distress Inventory, Incontinence Impact Questionnaire, Patient Global Impression of Improvement, and Surgical Satisfaction Questionnaire. A total of 355 women underwent the sling procedure (184, Altis group; 171, comparator group). At 36 months, 140 (76.0%) of Altis and 101 (59.1%) of comparator group patients were assessed. Patient Global Impression of Improvement at 36 months indicated that 92.9% of Altis and 90.1% of comparator patients reported that their condition was "very much better" or "much better" (P = 0.444). Urogenital Distress Inventory at 36 months indicated improvement in quality of life in both groups with a mean change from baseline of 41.7 ± 19.3 (Altis group; n = 140) versus 44.4 ± 22.2 (comparator group; n = 101) (P = 0.305). The Incontinence Impact Questionnaire indicated average quality-of-life improvement of 50% in both groups from presurgery to 36 months, with a mean change from baseline of 51.8 ± 25.8 (Altis group) versus 50.2 ± 25.1 (comparator group) (P = 0.619). This 36-month study demonstrated the lasting, positive effect that surgical intervention can have on patients with SUI.

Clinical Outcomes of Mid-Urethral Sling Procedures for the Treatment of Female Urinary Incontinence: A Retrospective Cohort Study

Background: Urinary incontinence (UI) significantly affects women’s quality of life globally. Mid-urethral sling (MUS) procedures are common minimally invasive surgeries for treating stress urinary incontinence (SUI) and mixed urinary incontinence (MUI), but comparative outcome studies, especially regarding complication rates, are lacking. The purpose of this study was to assess and compare the efficacy and safety of the retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) approaches in treating SUI and MUI. The study also aimed to investigate predictive factors for intraoperative and postoperative complications. Methods: A retrospective cohort study was conducted at King Saud University Medical City from February 2016 to October 2022, involving 166 women who underwent either TVT or TOT surgeries. Data were collected on intraoperative and postoperative complications, with statistical analyses performed using chi-square tests and multivariate regression to identify significant predictors of morbidity. Results: The study included 166 patients who underwent MUS procedures, with 61% (n = 102) undergoing retropubic TVT and 39% (n = 64) undergoing TOT surgeries. The demographic characteristics were similar between the groups, with no significant differences in age (p = 0.559), body mass index (BMI) (p = 0.600), or presence of cystocele (p = 0.912). The TVT group experienced a significantly higher rate of intraoperative bladder/urethral perforation compared to the TOT group (9.8% vs. 0%, p = 0.008). Early postoperative complications, including urinary retention, were comparable between the groups (TVT: 10.8%, TOT: 12.5%, p = 0.600). Patients in the TOT group had shorter hospital stays, with 71.9% discharged within one day compared to 41.2% in the TVT group (p < 0.001). At long-term follow-up (>6 months), both groups reported high satisfaction, with 93.7% of TVT and 87.3% of TOT patients reporting good or very good comfort (p = 0.252). However, pain-free status was significantly higher in the TVT group (91.1% vs. 67.2%, p < 0.001). Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. Conclusions: Both retropubic and transobturator MUS techniques are effective for managing SUI, with the transobturator approach showing fewer complications and shorter recovery times. We recommend the formation of a national registry to track long-term outcomes and enhance procedural evidence.

Enhancing the autologous fascial sling procedure: A novel fixation method for treating stress urinary incontinence in female patients.

Synthetic mid-urethral sling surgery has long been the standard surgical treatment for stress urinary incontinence (SUI) worldwide. Using an autologous fascial sling is an alternative to reduce adverse events. We evaluated the treatment outcomes of a novel fixation method applied to the autologous transobturator fascial (TOF) sling procedure for female patients with SUI. A retrospective study was conducted between 2017 and 2020, including 33 patients with SUI who underwent mid-urethral TOF sling surgery with the novel fixation method. We used a self-locking feature (V-LOC™) that was fixed to each side of skin layer above the obturator foramen, and the tension of the fascia sling was adjusted by manipulating the V-LOC™ suture. We analyzed all data collected through questionnaires, including Urinary Distress Inventory-Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), Overactive Bladder Symptom Score (OABSS), and Clinical Global Impressions of Improvement (CGI-I). Adverse events were also recorded. This study included 33 female patients aged 39-79 (mean 59.76 years). Following the procedure, there was a significant reduction in the total scores of UDI-6, IIQ-7, and OABSS (preoperative 9.73±4.35, 10.21±5.79, 6.06±4.03 and postoperative 3.52±3.41, 0.85±3.67, 3.06±2.90, respectively) (p < 0.001). Further analysis of each sub-score of the questionnaires revealed significant improvement in certain symptoms. The mean total score of CGI-I was 2.00 ± 0.80. The maximum flow rate was documented for 18 patients, and no significant reduction was observed after the procedure (p = 0.804). Complications reported included voiding dysfunction in two patients (6.1 %), inguinal pain in one patient (3.0 %), and mild delayed wound healing in one patient (3.0 %). This modified TOF sling surgery with a novel fixation method by V-LOC™ suture offers feasibility and adjustability as its main advantages. Our study demonstrated significant improvements in patient outcomes.

Urethral Bulking.

This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI). We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications. One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened. Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.

Male sling versus artificial urinary sphincter for the treatment of incontinence after prostate surgery: a systematic review with meta-analysis.

Urinary incontinence following prostate treatment (IPT) represents a significant complication that detrimentally impacts the quality of life for patients who have undergone prostate surgery. Presently, there is a scarcity of evidence regarding the preferred surgical techniques for IPT. We conducted a meta-analysis to compare the outcomes of the male sling and artificial urinary sphincter (AUS) in the treatment of IPT. Data were extracted through electronic literature searches on PubMed, Web of Science, and Embase databases until September 2023. Eligible studies included patients who underwent AUS or male sling procedures for IPT and had a follow-up duration exceeding 12 months. The primary end point was the success rate, with the secondary outcome focusing on complication rates. A fixed-effects or random-effects models were used to calculate the pooled estimate and its 95% confidence interval (CI). The publication bias was assessed using funnel plots and Egger's regression test. The meta-analysis included nine studies, involving a total of 1,350 participants. No statistically significant difference in success rates was found between AUS and male sling [odds ratio (OR): 0.96, 95% CI: 0.91-1.01]. In terms of the complication rate, there was no significant disparity between the two procedures (OR: 0.87, 95% CI: 0.86-1.12). The findings from this study indicated that male sling surgery yielded success and complication rates comparable to those of AUS. This suggests that male sling could serve as a viable alternative surgical option in the treatment of IPT.

A Randomized Controlled Trial of Consent for Patients Undergoing Transobturator Slings.

Improving patients' recall and understanding of their planned surgery is essential for fully informed consent. The objective of this study was to assess if the addition of an information handout to the standard preoperative consent process for the transobturator midurethral sling procedure improved patient understanding, recall, and satisfaction. This is a randomized controlled trial of adult women undergoing a transobturator midurethral sling procedure for the treatment of stress urinary incontinence. After standard counseling, participants were randomly assigned to either the control or the intervention group, with the latter receiving an extra informational handout detailing surgical information. Before surgery, all participants filled out a questionnaire assessing key points discussed during the surgical consent, which was used to calculate a knowledge score, the primary endpoint. Secondary outcomes included perception of the consent process and patient satisfaction. Of 98 randomized participants (50 control, 48 intervention), knowledge scores were 43% for controls and 57% for the intervention group (P = 0.015). Despite low scores, high self-rated understanding and satisfaction were noted across both groups (78% control, 71% intervention, P = 0.4). Notably, younger individuals, those with some college education, and patients undergoing additional prolapse surgery benefited most from the handout. The informational handout improved knowledge scores, though overall knowledge scores were low in both groups. High satisfaction and perceived understanding of the planned procedure persisted, but the addition of a handout was not associated with a significant difference in knowledge scores.

51 - Readjustable sling procedure (Remeex System) for female stress urinary incontinence: Over 7 years follow-up, a single italian centre experience

51 - Readjustable sling procedure (Remeex System) for female stress urinary incontinence: Over 7 years follow-up, a single italian centre experience

Treatment of Stress Urinary Incontinence: Does Race Matter?

The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI). The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population. This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications. A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications. Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.

Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage.

Surgeon kinematics play a significant role in the prevention of patient injury. We hypothesized that elbow extension and ulnar wrist deviation are associated with bladder injury during simulated midurethral sling (MUS) procedures. We used motion capture technology to measure surgeons' flexion/extension, abduction/adduction, and internal/external rotation angular time series for shoulder, elbow, and wrist joints. Starting and ending angles, minimum and maximum angles, and range of motion (ROM) were extracted from each time series. We created anatomical multibody models and applied linear mixed modeling to compare kinematics between trials with versus without bladder penetration and attending versus resident surgeons. A total of 32 trials would provide 90% power to detect a difference. Out of 85 passes, 62 were posterior to the suprapubic bone and 20 penetrated the bladder. Trials with versus without bladder penetration were associated with more initial wrist dorsiflexion (-27.32 vs -9.03°, p = 0.01), less final elbow flexion (39.49 vs 60.81, p = 0.03), and greater ROM in both the wrist (27.48 vs 14.01, p = 0.02), and elbow (20.45 vs 12.87, p = 0.04). Wrist deviation and arm pronation were not associated with bladder penetration. Compared with attendings, residents had more ROM in elbow flexion (14.61 vs 8.35°, p < 0.01), but less ROM in wrist dorsiflexion (13.31 vs 20.33, p = 0.02) and arm pronation (4.75 vs 38.46, p < 0.01). Bladder penetration during MUS is associated with wrist dorsiflexion and elbow flexion but not internal wrist deviation and arm supination. Attending surgeons exerted control with the wrist and forearm, surgical trainees with the elbow. Our findings have direct implications for MUS teaching.

Effect of lower urinary tract conditions on surgical outcomes of different suburethral sling procedures for female stress urinary incontinence.

The suburethral sling procedure has been widely used as the first-line treatment for female stress urinary incontinence (SUI). This study retrospectively compared the long-term surgical outcomes and complications between retropubic and transobturator suburethral sling procedures. From 2010 to 2022, a total of 533 women with SUI underwent retropubic pubovaginal sling (PVS) or transobturator tape (TOT) procedures using a synthetic polypropylene mesh with or without concomitant anterior colporrhaphy. All patients underwent preoperative videourodynamic studies, Valsalva leak point pressure (VLPP), and voiding efficiency (VE). The success rate, postoperative complications, overactive bladder symptoms, transvaginal urethrolysis, and repeat procedures were compared among different surgical procedures. Among the patients, PVS was performed in 251 (47.1%) patients and with colporrhaphy in 58 (10.9%), TOT in 174 (32.6%) and with colporrhaphy in 50 (9.4%). The success rate was 87.4% in the PVS group and 75.4% in the TOT group, with or without colporrhaphy (p = 0.001). Urethrolysis was performed in 4.7% of the patients, and repeat suburethral sling procedures were performed in 8.3%. The overall success rate was significantly lower in TOT group, either with high or low VLPP, or with high or low VE. The rate of persistent OAB was significantly higher in TOT group regardless of VLPP or VE, whereas patients with VE < 90% at baseline had a significantly higher rate of postoperative dysuria. TOT procedures had an inferior long-term success rate than PVS procedures for female SUI. Additionally, no differences in the success rate were observed between patients with different bladder functions, high or low VLPP, and high or low VE.

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling

IntroductionWe performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.Case presentationAt the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1‐h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1‐h pad test resulted in 0 g of leakage.ConclusionWe believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

(017) Comparing Complication Rates and Continence Control in Concurrent Dual Implantation of Inflatable Penile Prosthesis/Artificial Urinary Sphincter vs. Inflatable Penile Prosthesis/Male Sling: An Updated Comparative Pilot Study

Abstract Introduction Artificial urinary sphincter (AUS) and bulbourethral male sling are used frequently in the management of post prostatectomy urinary incontinence (UI) in men. Some surgeons used to combine an inflatable Penile Prosthesis (IPP) procedure at the same setting to treat concurrent erectile dysfunction (ED). Recent clinical trials have aimed to determine the comparative effectiveness between the male sling and the artificial urinary sphincter (AUS) in men with urodynamic stress urinary incontinence (SUI) after prostate surgery, focusing on non-inferiority. Objective We aim to compare continence control and complications rates in patients who underwent bulbourethral slings or AUS during IPP surgery via perineal approach. Methods A retrospective chart review was done in a large tertiary center. Post prostatectomy patients who underwent perineal dual implantation IPP and AUS or bulbourethral sling for ED and UI purposes, between 2014 and 2022 were included. Clinical data, patients’ demographics were retrieved. Post-operative outcomes with regards to IPP complication rates, revision rates for IPP/ AUS / Male sling, and continence control at 6 weeks, 6 months and 1 year were collected and included in the analysis. Continence control rates were assessed by the number of pads used per day on subsequent follow up visits for both groups. Results A total of 32 patients met the inclusion criteria. 16 Patients underwent synchronous IPP and AUS insertion, whereas another 16 patients underwent IPP with bulbourethral sling procedure. Patient demographics, median follow up &amp; complication rates are summarized below in Table 1. In both groups the procedure was done through a perineal approach. There was no significant difference in baseline data among groups. Complication rates between AUS devices and bulbourethral slings showed no statistically significant differences (12.5% vs 6.25% p= 0.22 respectively). Infection rates and need for revision also did not show any statistically significant differences. With regards to post-operative continence rates, both groups had comparable outcome with no significant differences (P = 0.81). Upon the 6 months follow up visit, the AUS group, 56% were pad free, 19% used 1 pad per day, 19% used 2 pads per day, and 6% used 3 pads or more per day, while in the sling group, 50% were pad free, 25% used 1 pad per day, 19% used 2 pads per day, and 6% used 3 pads or more per day. Patients were followed for a total of 1 year after the surgery. Conclusions The combined insertion of IPP with either AUS or sling procedures has comparable outcomes with regards to continence rate and device- related complications. Each incontinence surgery should be chosen according to surgeon experience and specific patient indications. Further prospective studies on a larger sample of patients with longer follow up period are needed to solidify these findings and will guide patient's decision and preference for incontinence surgeries along with IPP once indicated. Disclosure No.

(178) Climacturia: Emerging Type of Urinary Incontinence, Its Prevalence, Risk Factors, and Management: A Systematic Review and Prevalence Meta-analysis

Abstract Introduction Climacturia is an emerging type of urinary incontinence which occurs immediately following orgasm. Both men and women may suffer from climacturia in equivocal rates. This phenomenon is becoming more problematic as it impacts physiological and psychosexual aspect of well-being and quality of life. While awareness of climacturia becomes evident, studies are inadequate to support evidenced-based management in primary and urologic care settings. Objective This study aimed to conduct a systematic review and prevalence meta-analysis of climacturia and investigate its risk factors and evidenced-based management. Methods A systematic review of 24 articles were conducted following PRISMA 2020 guidelines. The PubMed, CINAHL, and Cochrane Library database were searched using the word “climacturia” and phrase “orgasm associated urinary incontinence” respectively. Search limiters applied included literature written in English from year of inception to 2022. Title and abstract reviews were conducted on 78 articles. Articles which did not discuss climacturia, duplicates, and previous systematic reviews were excluded after full article review. Results The review accounts a total of N = 7798 subjects which are composed of N = 7629 (97.83%) males and N = 169 (2.17%) females with age range of 18 to 80 years old. A total of N = 2, 039 (26%) participants are with climacturia, N = 87 or 4.26% are females and N = 1, 931 or 95.74% are males. The risk factors associated with climacturia include sexually active male, history of prostate cancer after prostatectomy within 12 months of surgery or radiation therapy, increased Body Mass Index (BMI), erectile dysfunction (ED), increased urethral width, presence of urinary incontinence, pain-associated orgasm and loss of penile length after pelvic surgery, use of aides to obtain an erection, and increased incontinence scores for men. For women, the risk factors are high scores of female sexual function index (FSFI) and detrusor overactivity. The management for females is limited to pharmacologic therapy with use of antimuscarinic agents. While, behavioral therapy, pharmacologic regimen, pelvic floor muscle training (PFMT), surgery (sling procedure) are the management options for affected men. Conclusions Climacturia affects males more than females, however, the evidence to support the efficacy of treatment options for both sexes are equally inadequate. Primary care and Advanced Practice Providers in primary and urologic care settings are at best position to query patients for the presence of and manage climacturia in timely manner. Further research is needed to increase evidence supporting effective management of climacturia for both men and women. Disclosure No.

(172) Managing Proximal Perforation of Inflatable Penile Prosthesis in Pelvic Trauma

Abstract Introduction Corporal perforation is a complication that occurs secondary to misdirected or over-aggressive dilation or weakened tunica albuginea. One major risk factor is corporal fibrosis, as the corpora is more difficult to dilate, and sharp dissection or counter-incisions may be required. Fibrosis is most commonly observed in patients with history of infection, priapism, Peyronie’s disease, or multiple revision surgeries. In the setting of pelvic trauma, normal anatomical landmarks can be altered leading to proximal perforation during dilation. Proximal corporal perforation first manifests as unequal corporal measurements intraoperatively or palpable malposition of the cylinder into the perineum. Objective Herein we discuss the case of a 24-year-old male with erectile dysfunction secondary to pelvic trauma who presents one year postoperatively with malposition of his right cylinder due to proximal migration from altered pelvic anatomy. We aim to describe our surgical techniques that can be utilized to correct proximal perforation. Methods Physical exam and preoperative imaging revealed grossly malpositioned right prosthetic cylinder. We utilized the prior transverse penoscrotal incision to deliver the scrotal pump from the surgical capsule. Given normal appearance of reservoir on imaging and duration from initial placement, only the scrotal pump and cylinders were exchanged. Bilateral cylinders were explanted through vertical corporotomies. Proximal measurements of 20cm on the left and 24cm on the right were consistent with corporal perforation. The Windsock procedure was performed by placing a 2–0 PDS suture from out to in through the tunica albuginea, through the right rear-tip extender, then in to out back through the albuginea of corporotomy. After copious irrigation of corporal space, new cylinders were placed using the modified rear tip extender. A new scrotal pump was placed in anterior dependent position. The device cycled properly in symmetric position bilaterally before all tissue layers were closed. Results The patient was observed overnight and discharged on post-operative day 1 after passing void trial. He was noted to be doing well at his post-operative clinic visit 6 weeks later and has been cleared for sexual activity. Conclusions We describe a patient with challenging anatomy due to extensive pelvic fracture leading to corporal perforation and proximal migration of a prosthetic cylinder. Due to lack of a normal pubic tubercle, we performed the Windsock sling procedure to provide posterior support of the right cylinder to prevent future proximal migration. An alternate approach is to secure the prosthesis tubing via sutures to the corporotomies is also presented. A critical intraoperative maneuver is evaluating for equal dilator depth alignment to recognize proximal perforation. These techniques can be applicable to other patients with altered anatomy secondary or in the setting of proximal corporal perforation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry.

To assess and compare 30-day perioperative adverse events following suburethral sling surgery using synthetic mesh, autologous rectus fascia, and autologous fascia lata in women. This was a retrospective cohort study of patients who underwent fascial or synthetic sling placement for stress urinary incontinence between 2008 and 2021 using the American College of Surgeons' National Surgical Quality Improvement Program database. Current Procedural Terminology codes were used to identify patients undergoing each type of sling procedure. Multivariable regression analysis with stepwise regression was used to assess the odds of composite adverse events (e.g., urinary tract infection, surgical site infection, pulmonary embolism, and other reportable events) between cohorts. Of the 41 533 female patients who underwent isolated suburethral sling placement without concurrent procedures, 41 292 (99.4%) received a synthetic mesh sling, and 241 (0.6%) received an autologous facial sling. In the fascial sling cohort, 160 (66.4%) underwent rectus fascia harvest and 81 (33.6%) underwent fascia lata harvest. Sling surgeries involving autologous fascia were associated with increased odds of adverse events compared to those involving synthetic mesh, even after adjusting for confounders (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 2.56-5.15). Compared to fascial slings from rectus fascia, slings from fascia lata were associated with increased odds of composite adverse events (aOR: 2.11, 95% CI: 1.03-4.04). However, with the exclusion of urinary tract infections, the adverse event rate was similar between slings using the two fascial harvest techniques (aOR: 1.93, 95% CI: 0.81-4.63). In this retrospective database study, suburethral sling surgeries using autologous fascia were independently associated with a 3.6-fold increase in odds of 30-day perioperative adverse events compared to sling surgeries using synthetic mesh.

The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up

The purpose of this study was to analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10 % anterior glenoid bone loss. The aim was to explore if this procedure would be successful in preventing recurrent shoulder dislocation. Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed by x-ray (12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12 and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and ROM. Fifteen patients were included with a dislocation rate of zero % after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57 % (904) at baseline to 88 % (241) at 24 months (p < 0.001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated Minimal Clinically Important Difference (MCID) was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, p = 0.211). Flexion and abduction were significantly improved from 152° to 174° (p=0.001) and 141° to 170° (p<0.001) after 24 months. The surgical procedures were completed without any intraoperative complications. The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24-months follow-up.

(220) Does Complication and Continence Rates Differ When Combining Inflatable Penile Prosthesis with Post Prostatectomy Incontinence Procedures Inserted Via Perineal Approach? An Updated Pilot Study

Abstract Introduction Artificial urinary sphincter (AUS) and bulbourethral male sling are used frequently in the management of post prostatectomy urinary incontinence (UI) in men. Some surgeons used to combine an inflatable Penile Prosthesis (IPP) procedure at the same setting to treat concurrent erectile dysfunction (ED). Recent clinical trials have aimed to determine the comparative effectiveness between the male sling and the artificial urinary sphincter (AUS) in men with urodynamic stress urinary incontinence (SUI) after prostate surgery, focusing on non-inferiority. Objective We aim to compare continence control and complications rates in patients who underwent bulbourethral slings or AUS during IPP surgery via perineal approach. Methods A retrospective chart review was done in a large tertiary center. Post prostatectomy patients who underwent perineal dual implantation IPP and AUS or bulbourethral sling for ED and UI purposes, between 2014 and 2022 were included. Clinical data, patients’ demographics were retrieved. Post-operative outcomes with regards to IPP complication rates, revision rates for IPP/ AUS / Male sling, and continence control at 6 weeks, 6 months and 1 year were collected and included in the analysis. Continence control rates were assessed by the number of pads used per day on subsequent follow up visits for both groups. Results A total of 32 patients met the inclusion criteria. 16 Patients underwent synchronous IPP and AUS insertion, whereas another 16 patients underwent IPP with bulbourethral sling procedure. Patient demographics, median follow up &amp; complication rates are summarized below in Table 1. In both groups the procedure was done through a perineal approach. There was no significant difference in baseline data among groups. Complication rates between AUS devices and bulbourethral slings showed no statistically significant differences (12.5% vs 6.25% p= 0.22 respectively). Infection rates and need for revision also did not show any statistically significant differences. With regards to post-operative continence rates, both groups had comparable outcome with no significant differences (P = 0.81). Upon the 6 months follow up visit, the AUS group, 56% were pad free, 19% used 1 pad per day, 19% used 2 pads per day, and 6% used 3 pads or more per day, while in the sling group, 50% were pad free, 25% used 1 pad per day, 19% used 2 pads per day, and 6% used 3 pads or more per day. Patients were followed for a total of 1 year after the surgery. Conclusions The combined insertion of IPP with either AUS or sling procedures has comparable outcomes with regards to continence rate and device- related complications. Each incontinence surgery should be chosen according to surgeon experience and specific patient indications. Further prospective studies on a larger sample of patients with longer follow up period are needed to solidify these findings and will guide patient's decision and preference for incontinence surgeries along with IPP once indicated. Disclosure No.

Autologous Fascial Slings for Stress Urinary Incontinence: a 17-year Follow-up of a Randomised Controlled Study.

Safety concerns with the use of mesh in vaginal surgery have been ongoing. Autologous fascial slings (AFS) avoid foreign body complications. We compared the long-term (17-year) outcomes of two AFS repair methods-the standard sling and short sling (sling-on-string), and assessed durability and patient satisfaction of these for the treatment of stress urinary incontinence (SUI). A total of 107 patients from three urogynaecology units who had participated in a randomised controlled trial assessing standard (n = 52) and short (n = 55) slings were followed up for a median period of 17 years. Primary outcomes were Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores to assess the impact on the quality of life and symptom distress. Logistic quantile regression was employed to compare the two methods. Secondary outcomes included long-term complications and patient satisfaction. Mean scores showed no statistically significant difference between the standard and short slings at the 17-year follow-up relating to IIQ and UDI scores, leakage or urgency (p > 0.05). Improved bladder function was observed at 17 years compared with baseline (standard sling-IIQ scores mean difference [MD] 1.22 [CI: 0.69, 1.74], UDI scores MD 0.83 [CI: 0.70, 0.97]; short sling-IIQ score MD 1.14 [CI: 0.73, 1.54], UDI scores MD 0.54 [CI: 0.40, 0.67]) with age-related deterioration over time. Re-operation rates were low and patient satisfaction rates were high (67.2%) at follow-up. Autologous fascial slings are an effective and durable option for management of SUI and the short sling procedure can be recommended owing to plausible surgical advantages.

Analysis of British Columbia practice patterns in the management of female stress urinary incontinence with emphasis on mesh use.

Female stress urinary incontinence (SUI) is common and has a profound impact on quality of life. Suburethral slings are the most common treatment for SUI in this population. These can be placed with synthetic mesh or autologous fascia. Mesh-related complications after midurethral sling procedures are documented in the literature but the risk of complications and reoperation is lower than the use of transvaginal mesh for pelvic organ prolapse repair. In this study, we sought to evaluate local practice patterns of management of female SUI with specific emphasis on mesh use. A survey created by an expert panel was disseminated to respective provincial societies. Sixty-eight percent of respondents offer midurethral slings in their practice but only 60.6% of these respondents would offer surgical removal of the sling if there were complications, such as mesh erosion or pain. A large portion (39.4%) of respondents are performing transobturator slings as compared to retropubic midurethral slings (36.3%) and only 8.5% have removed the leg component associated with the transobturator sling in their practice. Furthermore, compared to most respondents offering midurethral slings (64.8%), only a minority of surgeons offer alternatives: 23.9% of respondents offer periurethral bulking agent injections, 15.5% offer pubovaginal slings, and 12.7% offer retropubic urethropexies. Our study supports that surgeons should continue to review surgical risks and alternative treatment options as part of the surgical consent process. As such, surgeons should be able to offer a variety of surgical approaches to manage female SUI.

Midurethral sling position and surgical outcome: A meta-analysis.

There is still ongoing debate as to whether the outcome of the sling is determined by the position of the midurethral sling. In order to evaluate the potential impact of sling position on the outcomes of retropubic and transobturator sling procedures for stress urinary incontinence, it is necessary to conduct further investigations. We conducted a comprehensive search across various electronic databases such as PubMed, EMBASE, MEDLINE. Relevant data were extracted, organized in a table format, and analyzed using RevMan software for further analysis. This review comprised a total of 9 studies. The findings indicate that patients with TVT tape placement in the midurethra exhibited a slightly higher cure rate compared to those with proximal placement. Conversely, tape placement in the midurethra was associated with a significantly higher cure rate compared to distal placement [RR = 0.84, 95% CI (0.74-0.95), P < .05]. In the case of transobturator slings, tape positioning beneath the midurethra or distal urethra yielded better outcomes compared to placement near the bladder neck [RR = 0.74, 95% CI (0.57-0.94), P = .02; RR = 0.61, 95% CI (0.39-0.96), P = .03]. Based on 2D and 3D ultrasound imaging, differences in TVT placement appear to have minimal impact on the cure rate. However, the highest rate of failure after transobturator sling surgery is closely linked to the positioning.