Transobturator Sling Placement Research Articles

Ichiorectal Sinus Formation Associated with Mesh Exposure Remote from Transobturator Sling Placement

Ichiorectal Sinus Formation Associated with Mesh Exposure Remote from Transobturator Sling Placement

Valsalva leak point pressure (VLPP) greater than 70cm H2O is an indicator for sling success: a success prediction model for the male transobturator sling.

Urodynamic studies are often performed in the evaluation of post-prostatectomy urinary incontinence (PPUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPUI. Others have reported their results with a specific Valsalva leak point pressure (VLPP) that predicts a good outcome with the male TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high-volume, single center. We hypothesized that a higher pre-operative VLPP better predicts successful outcomes. We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8g per 24h. Cox and linear regression models were performed. 290 patients were included. All patients underwent a radical prostatectomy for prostate cancer and presented with PPUI. Mean age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5months (IQR 1-15). A linear regression model shows an inverse prediction curve for sling failure versus VLPP (p = 0.02). The hazard ratio for failure with a VLPP of ≤ 70cm H2O compared with a VLPP of > 70cm H2O, adjusted for pelvic radiation and 24-h pad weight was 0.5 (95% CI 0.2-0.98). Patient selection is imperative in the success of the male TOS for patients with PPUI. In our cohort of patients with PPUI, those with a pre-procedural VLPP of > 70cm H2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤ 70cm H2O. In our practice, we use these data to support the use of VLPP cut off of 70cm H2O as an indicator for success to help in the evaluation and counseling of patients.

The Correlation Between the Sonographic Course of Transobturator Slings and Sling-Related Pain.

To determine whether transobturator slings follow a consistent path and whether there is an association between ultrasonographically visualized sling pattern or position with sling-related pain. This was a cross-sectional retrospective pilot study. We evaluated women who were presented to our clinic for pain or other urogynecologic symptoms following transobturator sling placement between 2009 and 2014. Patients had undergone a 3-dimensional endovaginal pelvic floor ultrasound, assessing minimal levator hiatus, antero-posterior diameter, left-right diameter, and the hiatal shape. The mesh patterns were categorized as seagull patterns (normal), lopsided, flat, and convoluted. A total of 68 cases were reviewed. Fifty patients reported pain, and 18 did not. There were wide variations in the course of the slings. The sling center- minimal levator hiatus position ranged 14.8 mm below and 17.9 mm above the minimal levator hiatus. The lateral arm insertion points ranged between 17.1 mm below and 16.6 mm above the minimal levator hiatus. The right arm insertion points ranged between 9.6 mm below and 18.8 mm above the minimal levator hiatus. Thirty-five of 68 (70%) patients with pain and 13 of 18 (72.2%) without had abnormal sling patterns. The abnormal sling shape was not correlated with pain (P=1). The levator shape trended toward a statistical significant correlation with sling shape abnormality (P=.084). This population of women with transobturator sling complications demonstrated wide variations in anatomic paths. Neither the abnormal sling shape nor the distance of the center of the tape from the minimal levator hiatus level were correlated with pain.

Complicaciones intraoperatorias y posoperatorias de las cintas medio uretrales libres de tensión en incontinencia urinaria de esfuerzo

Antecedentes: La colocación de cintas medio uretral son actualmente el tratamiento de primera línea para la incontinencia urinaria de esfuerzo. El objetivo fue evaluar las complicaciones intra y posoperatorias de las cintas transobturadora y retropúbica; y los factores de riesgo asociados.
 Material y métodos: Estudio de cohorte retrospectivo en 105 mujeres durante el 2016 a 2018. Se dividió en dos grupos: TVT (n=28) y TOT (n=77). Se analizaron variables demográficas, factores de riesgo, complicaciones intra y posoperatorias. Se realizo estadística descriptiva y correlación de variables con programa SPSS v17.0, y p ≤ 0.05 estadísticamente significativo.
 Resultados: La edad promedio fue 56.7 ± 8.8 años; 31.4% (n=33) con incontinencia de esfuerzo, 65.7% (n=69) con incontinencia mixta (IUM) y 2.9% (n=3) con incontinencia oculta. La tasa de complicación global fue de 29.5% (n=31). La complicación intraoperatoria común fue la perforación vesical 3.8% en el grupo TVT asociada a obesidad (OR 12.9). Las complicaciones posoperatorias estuvieron relacionadas con la TOT (p=0.049), compuestas por infección de vías urinarias (11.4%), inguinodinea (7.6%) y otras (6.9%). El riesgo de infección urinaria posoperatorio estuvo asociado con incontinencia de esfuerzo (p=0.03), ausencia de tratamiento de incontinencia urinaria mixta (p=0.04); aumentado la tasa de incontinencia urinaria de urgencia de novo.
 Conclusiones: El enfoque transobturador tiene bajos índices de complicaciones transoperatorias en comparación con la retropúbica. La complicación más común en nuestra serie fue la infección urinaria por lo que se requieren estudios prospectivos aleatorizados.

Cystourethroscopy following midurethral slings: is it always necessary?

Midurethral slings are the mainstay of treatment for stress urinary incontinence. The role of cystourethroscopy to detect lower urinary tract injury following retropubic midurethral slings is well-established; however, its role following transobturator or single-incision sling placement remains controversial. Some advocate "routine" whereas others advocate for "selective" cystourethroscopy. This paper reviews the arguments for and against cystourethroscopy to detect lower urinary tract injury following transobturator and single-incision slings.

Titanized Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-out Single-incision Technique: Minimum 12-Months Follow-up Study

To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence. From January 2013 to June 2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or transurethral resection of prostate (5) underwent transobturator 2-arm titanium-coated sling (TiLOOP Male) implantation with an inside-out, single-incision technique, leaving the bulbourethral muscle in place. Patients have been assessed postoperatively with uroflowmetry, pad count, International Prostate Symptom Score-Short Form, Incontinence Impact Quetionnaire-7, Patient's Global Impression of Improvement, Overactive Bladder questionnaire, International Prostate Symptom Score, and satisfaction (yes or no). Successful outcome included cure (no pad use or 1 dry "security" pad) or improvement (reduction of at least 50% of the pad count). Evaluated patients had mild (11 of 44, 25%), moderate (26 of 44, 59%), or severe (7 of 44, 16%) incontinence. After a median follow-up of 25 months (range 12-55, minimum 12 months), 24 (54.6%) patients were cured and 10 (22.7%) were improved, which was a global success rate of 77.3%. There were 10 (22.7%) failures in the first 6 months. Zero pad rate was 50%. Subjective success (Patient's Global Impression of Improvement very much or much improved) was achieved in 33 (75%) patients. Mean scores of ICIQ-SF, ICIQ-QoL, and IIQ-7 improved to a statistically significant extent. Satisfaction was reported by 33 (75%) patients. Uroflowmetry parameters were unchanged postoperatively, and most of the complications were Clavien-Dindo grade I. Body mass index ≥30 and previous irradiation or high-intensity focused ultrasound were independent predictors of failure. TiLOOP Male provided favorable and stable midterm continence outcomes. The inside-out approach was safe, and the tolerability of the sling and the single-incision technique was satisfactory. Patients with obesity and previous irradiation or high-intensity focused ultrasound should be aware of their higher risk of failure.

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OBJECTIVES/SPECIFIC AIMS: Perineal urethral sling placement is an option for men with mild to moderate post-prostatectomy stress urinary incontinence (SUI). However, men with persistent incontinence after sling placement often require secondary artificial urinary sphincter (AUS) placement, made difficult by the sling occupying the proximal bulbar urethra. This proximal section has a thicker corpus spongiosum which may mitigate cuff-induced ischemia and subsequent urethral atrophy. The authors report a series of AUS placements after failed sling, using sling revision or removal to access the proximal urethra. METHODS/STUDY POPULATION: Cutting the sling arms during urethral cuff placement increased urethral exposure and mobility. If feasible, completely removing the sling allowed the most proximal cuff site; but if dissection was felt unsafe, the mesh was left in situ and the cuff placed distally. This study is a retrospective cohort design of patients with SUI who underwent AUS placement after failed sling from 2010 to 2016. Variables included baseline patient characteristics, SUI severity, intraoperative variables, and postoperative outcomes. AUS failure, defined as infection, erosion or urethral atrophy, was analyzed at 12 and 96 months using univariate and multivariable logistic regression. RESULTS/ANTICIPATED RESULTS: Over the study period, 29 patients underwent AUS placement after failed sling. At the time of AUS placement, mean urethral circumference was 6.2 cm and 68% of patients had a 4.5 cm cuff placed; no cases required a 3.5 cm cuff. Seventy-three percent of cases were after transobturator sling placement (27% bone-anchored) and 45% of slings were explanted. AUS failure rate at 12 and 96 months was 17.8% and 45%, respectively; atrophy was the most common indication. Prior transobturator sling placement had lower rates of both 12 month (9.1% vs. 57%, p=0.006) and 96 month (36% vs. 71%, p=0.11) failure, though the latter was not statistically significant. Sling explant was not a significant predictor of 12 month (p=0.12) or 96 month failure (p=0.17). DISCUSSION/SIGNIFICANCE OF IMPACT: Sling revision during AUS placement helps expose the wider proximal urethra, allowing larger cuff size placement. This procedure appears safe, with low rates of erosion and short-term failure—albeit with high rates of long-term urethral atrophy possibly due to more significant dissection causing devascularization. However, sling removal was not a significant predictor of failure. The transobturator sling’s smaller profile may result in less trauma to urethra—possibly explaining the improved outcomes.

Urology Residents' Experience and Attitude Toward Surgical Simulation: Presenting our 4-Year Experience With a Multi-institutional, Multi-modality Simulation Model

To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course.

699 - Medium-term outcomes after transobturator sling placement for male post-prostatectomy urinary incontinence using a titanised mesh with De Leval technique

699 - Medium-term outcomes after transobturator sling placement for male post-prostatectomy urinary incontinence using a titanised mesh with De Leval technique

Prospective Evaluation of the Effect of Thigh Dissection for Removal of Transobturator Mid Urethral Slings on Refractory Thigh Pain

Transobturator slings have higher rates of de novo neurologic symptoms than retropubic slings, most commonly related to the thigh. Cases refractory to conservative management may require removal of the thigh portion of the sling. In this series we prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from October 2012 to October 2015. Patients were assessed preoperatively, with a pain score using a visual analog scale, and postoperatively with a global response assessment. A total of 12 thigh dissections were performed from October 2012 to October 2015 in 8 patients. Mean (±SD) time from original mesh placement to presentation was 2.7 (±1.5) years. Average preoperative pain score was 7.9(±1.7) out of 10, with pain in the thigh in all patients. Seven cases involved unilateral thigh dissection and 1 had concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. On postoperative evaluation the average global response rating was 1.6, with 1 defined as very much better and 2 defined as much better. Of the 8 patients 3 went on to have the contralateral side done with an average global response rating of 1.3 (±0.6). One patient underwent further treatment for stress urinary incontinence with placement of a retropubic mid urethral sling. Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. The procedure can be performed safely with positive outcomes for the patient.

MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II1 Apr 2016MP65-13 PROSPECTIVE EVALUATION OF THE EFFECT OF THIGH DISSECTION FOR REMOVAL OF TRANSOBTURATOR MIDURETHRAL SLINGS ON REFRACTORY THIGH PAIN Ashley King, Christopher Tenggardjaja, and Howard Goldman Ashley KingAshley King More articles by this author , Christopher TenggardjajaChristopher Tenggardjaja More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1224AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) can be treated successfully with both retropubic and transobturator midurethral synthetic slings. Transobturator slings were developed to decrease the risk of injury to the viscera and have been found to have lower rates of de novo irritative symptoms. However, they do have higher rates of de novo neurologic symptoms, most commonly related to the thigh. These symptoms can initially be treated conservatively; however, refractory cases may require removal of the thigh portion of the sling. The objective of our series was to prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. METHODS All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from 10/2012 to 10/2015. Patients were assessed thoroughly preoperatively, including obtaining a pain score using a visual analog scale, and postoperatively with a global response assessment. RESULTS A total of 11 thigh dissections were performed from 10/2012-10/2015 on 8 patients. All patients had failed conservative management. All cases were performed by a single urologist without any consulting surgeons. Average age of the patients was 53.7 (± 9.2), and the mean time from mesh placement to presentation to our clinic was 2.7 (± 1.5) years. Prior to our initial thigh dissection, 62.5% of the patients had already undergone transvaginal mesh excision. Average preoperative pain score was 7.9 (± 1.7) out of 10 with pain in the thigh in all patients. Initially, 7 cases involved unilateral thigh dissection; one patient underwent concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. Average operative time was 135.8 (± 145.5) minutes; mean estimated blood loss was 77.9 (± 35) mL. On postoperative evaluation, the average global response rating was 1.6 with 1=very much better and 2=much better. Four of the eight patients went on to have the contralateral side done with average global response rating of 1.3 (±0.6). One patient underwent further treatment for SUI with placement of a TVT sling. CONCLUSIONS Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. Significant relief of symptoms is possible in the small minority of patients with significant thigh pain after transobturator slings. The procedure can be performed safely with positive outcomes for the patient. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e869 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ashley King More articles by this author Christopher Tenggardjaja More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

198 Outcomes of transobturator sling placement in men with incontinence secondary to radical prostatectomy and radiotherapy for prostate cancer: A systematic review and meta-analysis

198 Outcomes of transobturator sling placement in men with incontinence secondary to radical prostatectomy and radiotherapy for prostate cancer: A systematic review and meta-analysis

MP88-11 EXTERNAL BEAM RADIATION THERAPY AFTER MALE TRANSOBTURATOR SLING PLACEMENT INCREASES FAILURE RATES

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-11 EXTERNAL BEAM RADIATION THERAPY AFTER MALE TRANSOBTURATOR SLING PLACEMENT INCREASES FAILURE RATES 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.2015.02.1844AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-prostatectomy stress urinary incontinence (PPSUI) is a well−recognized side effect of treatment for prostate cancer that negatively impacts quality of life. There is ample evidence to suggest that patients who undergo external beam radiation therapy (EBRT) prior to transobturator sling (TOS) placement have high rates of TOS failure. However, whether EBRT delivered for biochemical recurrence after TOS placement affects continence outcomes is not known. Our objective was to evaluate TOS outcomes in patients with post-sling EBRT. METHODS We conducted an IRB approved review of all patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent placement of TOS were identified using our patient data portal (DEDUCE). Demographic and follow-up data were extracted by chart review. Success was defined post-operatively by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 hours. Student's T-test was performed. RESULTS During this time period 290 TOS were performed. Of these, we identified 11 patients who received EBRT after TOS placement. All of these underwent a radical prostatectomy for prostate cancer and presented with PPSUI. Average age at TOS surgery was 66.3 years (± 7.4). They underwent EBRT at a median of 18 months (IQR 11-38) from TOS placement. 8/11 (73%) were dry prior to EBRT. Of the patients who were dry, 87.5% (7/8) reported TOS failure after EBRT treatment at a median of 0 months (IQR 0-11) from the end of radiation therapy. This is in comparison to a 42.6% overall failure rate in the entire cohort (p<0.01). CONCLUSIONS EBRT delivered after male TOS placement may cause TOS failure. This information will be helpful in clinical decision making for PPSUI patients with advanced stage prostate cancer or with positive surgical margins at radical prostatectomy who may need adjuvant EBRT. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1096 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 ...

Evaluation of Salvage Male Transobturator Sling Placement Following Recurrent Stress Urinary Incontinence After Failed Transobturator Sling

To evaluate the outcome of patients treated with a salvage AdVance male sling after a failed primary transobturator sling placement. Retrospective review of patients treated at our center with a primary and subsequent salvage AdVance sling. Success was defined as a dry safety pad or no pads (cured), or >50% improvement in pads used per day and patient satisfaction (improved). Early primary sling failures (<6 months) were compared with late (≥6 months) failures with regard to continence outcomes. We identified 18 patients who underwent a salvage AdVance sling placement at our institution. Overall success was 72% at 6 months postoperatively and 56% at a mean follow-up of 17.5 months, including 50% and 39% of patients who were dry at those same time periods. Patients failing late after their primary sling (n = 8) enjoyed improved outcomes with salvage sling placement compared with patients who failed early (n = 10) after the primary sling. At 6 months, more patients in the late primary failure group were cured (75% vs. 30%; P = .031). These improved cure rates remained significant through final follow-up with cure rates of 63% and 20%, respectively (P = .041). Salvage AdVance male sling is a viable treatment option after a failed primary sling procedure, especially in patients who demonstrated a prolonged efficacy period before primary sling failure.

Editorial Comment

The authors present a large cohort with relatively long-term follow-up. In contrast to Rehder's recent report that initial efficacy rates were indeed maintained over a 3-year period, 1 Rehder P. Haab F. Cornu J.N. et al. Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol. 2012; 62: 140-145 Abstract Full Text Full Text PDF PubMed Scopus (153) Google Scholar this present article notes that the initial success realized with the transobturator sling diminishes over time. Thus, it remains important for investigators to continue to monitor their sling patients and to report the intermediate and longer-term continence status. Extended Outcomes in the Treatment of Male Stress Urinary Incontinence With a Transobturator SlingUrologyVol. 83Issue 4PreviewTo review extended patient outcomes after male transobturator sling placement for stress urinary incontinence. Full-Text PDF ReplyUrologyVol. 83Issue 4PreviewPatient selection in all aspects of urology is of utmost importance, and this fact is no different when discussing male stress urinary incontinence (SUI). As nicely outlined in the editorial comment, it seems that the bulk of available literature would support the use of artificial urinary sphincters (AUS) in men with severe SUI. This device has the longest follow-up data available and has proven to be efficacious even in the most incontinent patients. Because of this, we specifically counsel patients with large volume incontinence toward AUS placement. Full-Text PDF

Extended Outcomes in the Treatment of Male Stress Urinary Incontinence With a Transobturator Sling

To review extended patient outcomes after male transobturator sling placement for stress urinary incontinence. A retrospective review of a prospectively maintained database for patients with at least 12 months of postoperative follow-up after AdVance male sling placement was performed. Success was defined as a dry safety pad or less (cured) or >50% improvement in pads used per day and patient satisfaction (improved). Patients requiring repeat continence procedures were considered failures. We reviewed data from 102 patients with a minimum of 12 months of follow-up (mean ± standard deviation 36.2 ± 16.5 months). The mean age at surgery was 66.1 years, and 86.4% had previously undergone a prostatectomy. At 12 months, 24 months, and final follow-up, success rates were 74%, 63%, and 62%, respectively. Although cure rates also declined over time, 40% of patients experienced a durable cure with no complaints of wet pads at final follow-up. Complications were minimal and similar with previous reports. Multivariate Cox regression analysis revealed detrusor overactivity and an elevated detrusor pressure and peak flow negatively predicted being cured using sling placement. AdVance sling placement continues to represent a viable option in the treatment of male stress incontinence. Although a decrease in efficacy over time was observed, a substantial portion of patients can expect a durable cure.

Retrospective evaluation of male slings for patients with urinary incontinence after radical prostatectomy - one surgeon’s experience

Stress urinary incontinence is one of the main complications after radical prostatectomy (RP) with a significant percentage of patients reporting bothersome incontinence > 1 year after surgery. Assessment of one surgeon's results in surgical treatment of urinary stress incontinence of patients with radical prostatectomy applying transobturator and suprapubic slings. From February 2010-February 2014, 20 patients, age 57-76, with moderate and severe stress urinary incontinence (SUI) were treated surgically. All patients previously had radical prostatectomy due to prostate cancer. All 20 patients with stress urinary incontinence (PRPUI) had Argus slings placement after radical prostatectomy. Patients were followed for a longer period of time, 6 months minimum, 48 months maximum.18 patients (90%) had negative, dry PAD test after surgery, one patient (5%) had positive PAD test, and one patient (5%) who previously had Advance transobturator sling placement with no positive results, had sling removed due to an infection. 6 patients (30%) needed additional sling adjustment, performed between 9-21st day after the surgery. We concluded that Argus sligs, suprapubic or transobturatory are an effective and safe treatment for PRPUI. This procedure is minimal invasive and our results clearly demonstrate that both heavy and moderate incontinence responds well.

Intraoperative Crede Maneuver for Tape Adjustment During Transobturator Sling Placement

This study evaluated the efficacy of intraoperative extrinsic manual compression on the bladder, or Crede maneuver (CM) for tape adjustment during transobturator tape (TOT) sling procedure versus the traditional method where tension-free tape is adjusted the same for all patients. All patients undergoing TOT sling procedure for stress urinary incontinence (SUI) between May 2008 and June 2011 by the first author were assessed. Tape adjustment was either performed in a traditional manner, leaving a tonsil clamp-size space between the sling and posterior urethra, or by using CM after filling the bladder to 300 ml capacity. Patients were considered cured at postoperative visits if they had no SUI symptoms and negative Cough Stress Test (CST) result, improved if they had some SUI symptoms and negative CST result, and failed if symptomatic and had positive CST result. The Fisher exact test and the Wilcoxon rank sum test were used to evaluate the baseline differences between the 2 groups, along with multiple logistic regression to evaluate independent predictors of cure. The continence rate was 77.67% in the traditional group (87/112) and 79.65% (137/172) in the CM group (P = 0.76). Older patients and smokers were less likely to be continent (odds ratio, 0.95; P = 0.015; and odds ratio, 0.22; P = 0.003, respectively). Five (4.5%) of the 112 patients in the traditional group and 12 (6.9%) of the 172 patients in the CM group had adverse outcomes including transient urinary retention, mesh erosion, or dysuria (P = 0.45). Using CM for intraoperative tape adjustment does not improve continence rates compared to the traditional method of TOT sling placement.

Editorial Comment

The study titled “Radiation History Affects Continence Outcomes After AdVance Transobturator Sling Placement in Patients With Postprostatectomy Incontinence” found a significantly lower success rate for the retrourethral transobturator sling (RTS) implanted in men with postprostatectomy stress urinary incontinence (male SUI) after adjuvant radiotherapy (RT) compared with those who did not undergo adjuvant RT. Although it would be easy to criticize this study because of the small sample size, retrospective nature, and single-institution participation, this study represents the typical type of clinical research that can be done at this time for male SUI, especially given its lower prevalence compared with that of female SUI.

Radiation History Affects Continence Outcomes After AdVance Transobturator Sling Placement in Patients With Post-prostatectomy Incontinence

To evaluate the effects of preoperative external radiation therapy (XRT) on a cohort of patients who underwent AdVance transobturator urethral sling (ATUS) placement for post-prostatectomy incontinence. Thirty-seven patients underwent placement of an ATUS from 2008 to 2010. Patients with and without a history of preoperative XRT were retrospectively compared in regard to their demographical, preoperative, perioperative, and postoperative details. The median follow-up was 17.3 months. Preoperative pad usage was significantly higher in the XRT patient group (P= .03). Overall, 19 patients (51.4%) used no pads, 10 patients (27.0%) were improved, 4 patients (10.8%) had no change, and 4 patients (10.8%) experienced worsening incontinence after the surgery. In patients with and without a history of XRT, 0 (0%) and 19 (63.3%) used no pads, 2 (28.6%) and 8 (26.7%) were improved, 2 (28.6%) and 2 (6.7%) showed no change, and 3 (42.9%) and 1 (3.3%) were worse, respectively. In comparing patients with more severe incontinence preoperatively (>1 pad/day), those with and without radiation, 0 (0%) and 7 (46.7%) used no pads, 2 (28.6%) and 7 (46.7%) were improved, 2 (28.6%) and 0 (0%) had no change, and 3 (42.9%) and 1 (6.7%) were worse, respectively, after ATUS placement. Thus, patients without XRT had an advantage in postoperative pad usage (P= .001), and, furthermore, had improved quality of life (86.2% vs 28.6%, P= .006). The ATUS provides excellent continence outcomes in patients suffering from post-prostatectomy urinary incontinence. However, previous pelvic irradiation seems to severely compromise the effectiveness of the ATUS.