Transobturator Sling Surgery Research Articles

Quality of life following transobturator sling surgery for female stress urinary incontinence

ObjectiveThis descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence. Materials and methodsThis was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression. ResultsAt 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43–11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25–5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. ConclusionSling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

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.

A new titanium-covered transobturator tape for surgical treatment of stress urinary incontinence

Introduction and hypothesisTo assess the long-term satisfaction, cure rate and safety of a new titanium-covered transobturator tape compared to polypropylene tape for the treatment of stress urinary incontinence (SUI).MethodsA prospective study was conducted with 151 patients. Seventy patients underwent transobturator sling surgery with titanium tape from 2011 to 2019, and a historical control group (CG) of 81 patients was treated with a noncoated tape and underwent incontinence surgery from 1999 to 2009. We compared patient-reported outcome measures (PROMs) with the incontinence outcome questionnaire (IOQ).ResultsThe median follow-up was 2½ years in both groups. Based on responses to the IOQ, a statistically significantly shorter time of recovery (IOQ 15: 21.3 ± 26.4 [TG], 40.2 ± 38.5 [CG], p = 0.02), improvement of sex life (IOQ 13: 34.1 ± 29.4 [TG] vs. 65.3 ± 35.6 [CG], p = 0.01) and less voiding dysfunction (IOQ 19: 30.9 ± 28.1 [CG], 9.3 ± 18.6 [TG], p = 0.01) were observed in the TG. Objectively, no postoperative urinary retention was observed in the TG, but four cases were described in the CG. Ten patients needed a reoperation for SUI in the CG compared to three in the TG (p = 0.03).ConclusionThe titanium-covered transobturator sling had superior recovery time, improved sexual function and reduced reoperation rate compared to a historical polypropylene group.

Narrow Vagina as a Predictor of Obstructive Voiding Dysfunction after Transobturator Sling Surgery

Background: Voiding dysfunction (VD) is a potential complication after female midurethral sling operations. Objectives: Our goal was to assess the rate of obstructive VD after ­transobturator tension-free tape (TOT) procedures and to find perioperative risk factors (RFs) predicting postoperative voiding problems. Methods: We have retrospectively evaluated the perioperative data of 397 women who underwent TOT operations. Significant post-void residual (PVR) (>50 mL) was considered as the primary (objective) end point of the study, the voiding difficulty as the secondary (subjective) 1. First univariate analysis and then multivariate logistic regression were performed, with a 5% significance level. Results: Significant PVR was present in 51 (12.8%) women; catheterization was needed in 21 (5.3%) and reoperation in 3 (0.8%) cases. Seventy women (17.6%) experienced postoperative voiding difficulty. Narrow vagina (<2 cm), older age >70 years, and preoperative voiding difficulty were independent RFs for significant PVR (odds ratio: 5.07, 2.14, 5.38, respectively, p < 0.05). Preoperative overactive bladder syndrome and previous pelvic organ prolapse surgery were considered independent RFs for postoperative voiding difficulty. Conclusions: Older age, narrow vagina, or preoperative voiding difficulty increases the chance for significant postoperative PVR. These patients should be chosen and counseled appropriately.

Impact of Autologous Transobturator Sling Surgery on Female Sexual Function: A Comparative Study with Mesh Used Mid-Urethral Sling Surgeries

Introduction: To avoid mesh-related complications, autologous transobturator-tape (a-TOT) technique is a viable option in stress urinary incontinence (SUI) surgery. The method differs from TOT and retropubic tape (RT) in the usage of autologous tissue. We hypothesized that a-TOT improves female sexual dysfunction (FSD) more than TOT and RT. Methods: This is a retrospective cohort study. Patients who underwent a-TOT, TOT, and RT surgeries were surveyed regarding the cure of SUI, complications, and FSD parameters. The groups were compared according to baseline and postoperative data. Results: A-TOT, TOT, and RT groups included 37, 69, and 36 patients, respectively. The median follow-up time was 19 months. The groups were similar in terms of preoperative characteristics. The objective cure, subjective cure, and overall complication rates were comparable among the groups (p > 0.05). A-TOT group had significant improvements in mean female sexual function index (FSFI) scores, TOT group deteriorated, and RT group remained stable (p = 0.001, p = 0.001, and p = 0.226, respectively). The postoperative mean total FSFI scores were 25.73 ± 2.46, 23.17 ± 3.35, and 21.53 ± 2.47 for the a-TOT, TOT, and RT groups, respectively. The a-TOT group had better results than the TOT and RT groups (p < 0.05 and p < 0.05), and besides, the difference between the TOT and RT groups was statistically significant (p < 0.05). According to percentage changes in domain scores following the operations, the a-TOT group had significantly better results in desire, arousal, lubrication, satisfaction, and pain domains than the TOT group (p < 0.05) as well as better desire, arousal, and pain domains (p < 0.05) than the RT group. Discussion/Conclusions: Besides comparable outcomes in SUI treatment, the a-TOT technique provides improvements in female sexual functions while TOT worsens and RT does not change. Favorable outcomes in sexual functions caused by improvements in desire, arousal, satisfaction, and pain domains are observed following the a-TOT technique.

The association between personal history and the outcomes of transobturator sling surgery.

This study aims to verify the association between risk factors for the onset of SUI and transobturator suburethral sling surgical treatment outcomes. A retrospective study was conducted with 57 patients operated by the Pelvic Floor Surgery Service. Demographic data were compiled from the sample, the body mass index (BMI) was calculated, and the patients were divided according to the response to the surgical treatment. A total of 77.2% of the sample was cured or improved after surgical treatment. Out of the total sample, 75.4% of the women were postmenopausal, and 73.7% denied current or past smoking. The median age was 61 years, the median number of births was 4.0, the median BMI was 28.6 kg/m2, and 50.9% of the sample was classified as pre-obese. BMI, menopausal status, age, smoking, and sexual activity were not factors associated with the surgical outcome. However, parity equal to or greater than 5 was associated with worse postoperative results (p = 0.004). among risk factors associated with the emergence of SUI, only parity greater than 4 showed a negative impact on transobturator sling surgery outcomes.

Autologous transobturator midurethral sling.

The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and non-absorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day. At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well. Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed.

Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon.

To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results. A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant. In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001). The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study

Introduction: Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. Methods: In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (Monarc^TM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire – short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. Results: We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). Conclusions: Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.

Did surgical failure and complications affect incontinence-related quality of life in women after transobturator sling procedure?

ObjectiveTo report the objective outcome, subjective measurement of incontinence-related quality of life (QoL) for female urodynamic stress incontinence (USI) after transobturator sling surgery (TVT-O) and to evaluate the effects of surgical failure and complications on QoL. Materials and methodsWe analyzed the data from women who underwent TVT-O for USI and completed two validated QoL questionnaires, the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) preoperatively and at least 12 months postoperatively. We evaluated the subjective results of QoL questionnaires, objective results and compare the effect of QoL on those with surgical failure and complications after TVT-O surgery. ResultsA total of 78 women were followed for a median of 13.5 months (range 12–15 months) after surgery. Within this group, 75 (96%) were considered subjectively cured or improved after TVT-O. There were significant improvements in the IIQ-7 and total UDI-6 scores postoperatively, as well as in the UDI-6 subscales for urge, stress and voiding dysfunction symptoms. Even the 18 women with objective urodynamic failure had significant improvement in QoL scores. For those with surgical related complications, the QoL scores were also significantly improved. ConclusionsTVT-O for USI resulted in improvement of incontinence-related QoL including urgency, stress, and voiding dysfunction symptoms. Surgical failure and complications didn't impair postoperative QoL.

Mechanism of Action of the Transobturator Sling for Post-Radical Prostatectomy Incontinence: A Multi-institutional Prospective Study Using Dynamic Magnetic Resonance Imaging

To compare the length of the membranous (functional) urethra in male patients who underwent the male transobturator sling (TOS) for postradical prostatectomy urinary incontinence (PPI). The TOS is in established use for treatment of PPI; however, the precise mechanism of action is unknown. This is a prospective case-controlled study on men undergoing male TOS surgery from 2008 to 2014. The comparison arm included patients without incontinence after radical prostatectomy. All participants underwent dynamic magnetic resonance imaging (MRI) at baseline and this was repeated after TOS placement for those who underwent the procedure. Three standardized points were measured using MRI and compared in both groups in addition to clinical measures. Thirty-nine patients were enrolled and 31 patients completed the protocols. The controls (N = 14) had a longer vesicourethral anastomosis to urethra measured at the penile bulb (functional urethral length) distance compared to the pre-TOS group at rest (1.92 cm controls vs 1.27 cm pre-TOS, P = .0018) and at Valsalva (2.13 cm controls vs 1.72 cm pre-TOS, P = .0371). Placement of the sling (N = 17) increased the functional urethral length distance at rest (1.92 cm control vs 1.53 cm post-TOS, P = .09) and at Valsalva (1.94 cm post-TOS vs 2.13 cm control, P = .61), so that the difference was no longer statistically significant. We identified that one possible mechanism in improvement in stress urinary incontinence post-TOS placement is the lengthening of the vesicourethral anastomosis to bulbar-urethra distance. This is the first such study utilizing dynamics MRI in post prostatectomy controls, incontinent pre-TOS, and post-TOS to assess and show these findings.

196 Refining Male Sling Selectivity Improves Outcomes: Role of Standing Cough Test in Physical Demonstration of Mild Male Stress Urinary Incontinence

We reviewed our 9-year surgical experience with male AdVance sling cases, determining clinical features associated with treatment success in an effort to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence (SUI) by standing cough test (SCT) improves patient selection for male transobturator sling surgery. A retrospective review of men undergoing primary AdVance sling surgery between 2008-2016 was performed. Patients without preoperative SCT were excluded. Treatment success was defined as ≤1 PPD postoperatively and no further intervention. SCT was performed during preoperative consultation and objectively graded using the Male Stress Incontinence Grading Scale (MSIGS). Of the 203 male sling patients with complete data, 80 (39%) failed during a median follow up of 63.5 months. From 2008-2016, the proportion of male transobturator slings performed as a surgical treatment modality for SUI declined from 66% to 13%. Increasing sling selectivity correlated with greater treatment success. Treatment success was greater among men without radiation (64% vs 41%; p=0.02), having a history (≤2 PPD; 77% vs 36%; p<0.0001) and physical findings of mild SUI (MSIGS grade 0-2 incontinence on SCT; 67% vs 26%; p<0.0001). In combination, non-radiated men with mild SUI and favorable SCT had an 81% treatment success rate. Incremental increases in PPD usage (OR 1.8 per pad; p<0.0001) and MSIGS grade (OR 1.7 per grade; p=0.005) were independently associated with treatment failure, while history of radiation trended towards significance (OR 2.2; p=0.09).

Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1year following surgery?

To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery. This is an unmatched case-control study of 100 patients who underwent transobturator sling surgery at our center between 2009 and 2012. Group A (n = 50) patients had successful outcomes and group B (n = 50) patients had suboptimal outcomes 1year following surgery. The patients underwent 2D dynamic and 3D transperineal ultrasound. The two groups were compared with regard to the deformability of the sling on Valsalva, the concordance of urethral movement with the sling, and location of the sling. When compared with group B, group A had a significantly greater number of patients in whom the sling deformed at Valsalva (flat at rest, curving into a c-shape at Valsalva), the urethral movement was concordant with the sling and the sling had a midurethral location (p < 0.0001). In all 17 patients in group B in whom the urethra moved in a concordant manner with the sling (34%), the sling did not deform on Valsalva maneuver and was located proximally. In all 15 patients in group A in whom the sling remained either flat or curved (30%), the urethra moved concordant with the sling and the sling was in midurethral location. On 2D and 3D transperineal ultrasound, the best outcomes following transobturator sling surgery are associated with concordance of urethral movement with the sling, midurethral location, and deformability of the sling on dynamic assessment.

The Impact of Midurethral Sling Surgery on Sexual Activity and Function in Women With Stress Urinary Incontinence

IntroductionStress urinary incontinence has a negative impact on sexual function. AimTo assess the effect of midurethral sling surgery on sexual activity and function in women with stress urinary incontinence. MethodsThis is a secondary analysis of the Value of Urodynamics Prior to Stress Incontinence Surgery (VUSIS-II) study, which assessed the value of urodynamics in women with (predominantly) stress urinary incontinence. Patients who underwent retropubic or transobturator sling surgery were included in the present study if information was available on sexual activity before and 12 months after surgery. Data were collected from a self-report validated questionnaire combined with non-validated questions. The association between midurethral sling surgery and sexual function (coital incontinence, satisfaction, and dyspareunia) was compared with McNemar χ2 tests for nominal data and paired t-tests for ordinal data. Potentially influential factors were analyzed with univariable and multivariable logistic regression analyses. Main Outcome MeasuresChanges in sexual activity and sexual function after midurethral sling surgery. ResultsInformation on sexual activity was available in 293 of the 578 women (51%) included in the VUSIS-II study. At baseline, 252 of 293 patients (86%) were sexually active vs 244 of 293 (83%) after 12 months. More patients with cured stress urinary incontinence were sexually active postoperatively (213 of 247 [86%] vs 31 of 46 [67%], P < .01). There was a significant decrease in coital incontinence (120 of 236 [51%] preoperatively vs 16 of 236 [7%] postoperatively, P < .01). De novo dyspareunia was present in 21 of 238 women (9%). There was a greater improvement in coital incontinence after placement of the retropubic sling compared with the transobturator sling (odds ratio = 2.04, 95% CI = 1.10–3.80, P = .02). ConclusionThese data show that midurethral sling surgery has an overall positive influence on sexual function in women with stress urinary incontinence. The retropubic sling is more effective than the transobturator sling for improvement of coital incontinence. De novo dyspareunia was present in 1 of 11 women.

Unilateral sling transection for patients with postoperative voiding dysfunction after transobturator sling surgery.

Clin Oncol 2000;18(8):1606–13. [3] Cohen L, deMoor CA, Eisenberg P, Ming EE, Hu H. Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 2007;15(5):497–503. [4] Richardson JL, Marks G, Levine A. The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy. J Clin Oncol 1988;6(11): 1746–52.

Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age.

ObjectivesWe performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older.MethodsWe searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale–Pelvic Floor Disorders form, the Satisfaction Decision Scale–Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form.ResultsFifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8–44 months). There were four cases (7%) of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication). Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T® polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse.ConclusionConstricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision to perform an incontinence procedure should be individualized based on preoperative findings after prolapse reduction.

MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI John Patrick Selph, Mustafa Bashir, Shubham Gupta, Michael J. Belsante, Timothy Brand, Timothy Tausch, Jessica Lloyd, Zachariah Goldsmith, and Andrew Peterson John Patrick SelphJohn Patrick Selph More articles by this author , Mustafa BashirMustafa Bashir More articles by this author , Shubham GuptaShubham Gupta More articles by this author , Michael J. BelsanteMichael J. Belsante More articles by this author , Timothy BrandTimothy Brand More articles by this author , Timothy TauschTimothy Tausch More articles by this author , Jessica LloydJessica Lloyd More articles by this author , Zachariah GoldsmithZachariah Goldsmith More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1839AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The precise mechanism by which the AdVance(TM) transobturator sling (TOS) improves continence is unknown. Postulated mechanisms of action include changes in urethral mobility or an increase in functional membranous urethral length (FUL). Using dynamic MRI, we sought to determine how anatomic and functional relationships change in the male urethra after TOS surgery. METHODS We conducted a prospective study of males undergoing TOS from 2010 to 2014. Males with SUI after radical prostatectomy (RP) who were scheduled for TOS were enrolled. Patients underwent pad weight testing, voiding diary, urodynamics, and cystoscopy preoperatively. Dynamic MRI was performed before and after TOS. On matched pre- and post-operative sagittal T2 weighted images using a 3T MR system, the following measurements were obtained both at rest (R) and Valsalva (V): 1) distance from bladder neck BN to pubic symphysis (termed AP); 2) distance from BN to urethra at the pubococcygeal line (termed CC); and 3) distance from BN to urethra at the penile bulb (termed FUL). A group of patients who underwent RP with no SUI on pad weight testing underwent MRI post-RP and served as controls. RESULTS A total of 34 (20 cases, 14 controls) patients were enrolled in the study. All patients who underwent TOS had improvement in continence (12 used zero pads, 5 used 1 pad/day). Prior to TOS, there was a significant difference in rest and Valsalva CC but not AP distance when compared to non-leaking controls (mean case CC R 0.42cm and V 0.32cm vs. control CC R 1.06cm and V 1.09cm, resp, p < 0.05). Post-TOS, neither R and V AP nor R and V CC were different when compared to non-leaking controls. When comparing post-TOS to pre-TOS among the cases, there was a trend towards a difference in mean CC distance at rest and Valsalva (R pre 0.42cm vs post 0.63cm, p = 0.09; V pre 0.32cm vs post 0.54cm, p = 0.13). To assess urethral mobility, we looked at the rest to Valsalva change in AP and CC distance before and after TOS, and there was no significant difference in either measurement (mean difference in R-to-V AP pre 0.21cm vs post 0.3cm, mean difference in R-to-V CC pre 0.1cm vs post 0.09cm). However, the pre-sling cases had a shorter rest FUL when compared to controls (1.27 vs 1.92cm, p <0.05) and the post-TOS FUL increased significantly (1.27 vs 1.53 cm, p <0.05) and approximated the FUL found in dry controls. CONCLUSIONS The mechanism of action of the male TOS appears to be via an increase in functional urethral length rather than changes in urethral mobility. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1094 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Patrick Selph More articles by this author Mustafa Bashir More articles by this author Shubham Gupta More articles by this author Michael J. Belsante More articles by this author Timothy Brand More articles by this author Timothy Tausch More articles by this author Jessica Lloyd More articles by this author Zachariah Goldsmith More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD24-11 THE ARTIFICIAL URINARY SPHINCTER IS SUPERIOR TO A SECONDARY TRANSOBTURATOR MALE SLING IN CASES OF A PRIMARY SLING FAILURE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2015PD24-11 THE ARTIFICIAL URINARY SPHINCTER IS SUPERIOR TO A SECONDARY TRANSOBTURATOR MALE SLING IN CASES OF A PRIMARY SLING FAILURE 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.2015.02.1466AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The male transobturator sling (TOS) is a minimally invasive treatment for postprostatectomy stress urinary incontinence (PPSUI). Reported success rates for the male transobturator sling (TOS) are 41-76%. In the case of a failed primary sling, many surgeons offer a secondary sling; however, there is no literature describing the success of a secondary TOS placement in these situations. Our objective was to assess the success of secondary TOS in comparison to AUS for PPSUI patients who failed a primary TOS. METHODS We retrospectively reviewed all patients undergoing salvage procedures after failure of TOS from 2006 to 2012 at our institution. Demographic and follow-up data were extracted by chart review. Post-operative success was defined as the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g/day. Cox regression model and Kaplan-Meier survival analysis were performed. RESULTS 61 men were included. All had a TOS for PPSUI and presented with persistent incontinence after initial sling placement. 32 subsequently underwent placement of an AUS and 29 had a secondary TOS at a median of 10(IQR 6-29) and 14(IQR 7-19) months from primary TOS surgery, resp. The mean ages of the AUS and secondary TOS cohorts were not significantly different. 47% of the AUS cohort had received prior external beam radiation therapy versus 18.5% of the secondary TOS (p<0.01). Average pre-operative 24 hour pad weight was higher in the AUS cohort (517g) versus the TOS cohort (274g; p<0.01). The median follow-up for the AUS and TOS patients was 5 (IQR 4-16) and 4 (IQR1-5) months, resp. Treatment failure was seen in 55% (16/29) of secondary TOS versus 15% (5/32) of AUS patients with a hazard ratio of 2.9 (95%CI 1.1-8.3). 6 (21%) patients who failed a secondary TOS went on to receive an AUS. Figure 1 shows improved treatment success rates for TOS failures who received an AUS versus a secondary TOS (p=0.03). CONCLUSIONS In this cohort of patients with PPSUI who failed TOS, those who underwent a secondary TOS were 2.9 times as likely to have persistence incontinence in comparison to those who underwent AUS placement. This finding was noted despite the fact that there was a higher likelihood of radiation therapy in the AUS group. This data may be very useful in counseling patients and surgical planning. We currently recommend placement of an AUS for patients who have failed an initial TOS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e490 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 ...

MP88-07 OBESITY IS ASSOCIATED WITH MALE TRANSOBTURATOR SLING FAILURE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-07 OBESITY IS ASSOCIATED WITH MALE TRANSOBTURATOR SLING FAILURE Divya Ajay, John Selph, Michael Belsante, Aaron Lentz, Ngoc-Bich Le, 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 , Aaron LentzAaron Lentz More articles by this author , Ngoc-Bich LeNgoc-Bich Le 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.2015.02.1840AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While the reported Transobturator Sling (TOS) success rates for post-prostatectomy stress urinary incontinence (PPSUI) ranges from 41-76%, little is known about pre-operative risk factors that affect TOS outcomes. Our objective is to identify factors that contribute to TOS outcomes to aid in patient counselling and clinical decision making. METHODS Under an IRB-approved protocol, we reviewed all patients undergoing a TOS placement at our institution from 2006 to 2012. Demographic data, comorbidities and continence rates were evaluated. Post-operative sling success was defined as the use of 0 or 1 security pads over 24 hours, negative stress test on exam or pad weight less than 8 g per 24 hours. BMI was calculated by height and weight as recorded on the day of surgery or within 6 months prior to TOS surgery. Obesity is defined as BMI greater or equal 30 kg/m2 per WHO guidelines. Cox regression model and Kaplan-Meier survival analysis were performed. RESULTS 290 patients met inclusion criteria. Average age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 14). Preoperative risk factors including age, race, BMI, diabetes, hypertension, immunosuppression, smoking status and prior pelvic were evaluated. The hazard ratio for failure with a BMI of greater than or equal to 30 compared with a BMI of less than 30 kg/m2 was 1.5 (p=0.04). After adjusting for age, race, diabetes, hypertension, immunosuppression, smoking status and prior pelvic radiation, the hazard ratio was 1.06 (p=0.039). In comparison, the hazard ratio for a known poor risk factor, prior EBRT, was 1.5 (p=0.031). None of the other variables significantly affected TOS outcomes. Figure 1 illustrates a statistically significant difference in estimated TOS failure over time for obese versus not obese patients. CONCLUSIONS In our cohort of patients with PPSUI, those with a BMI of greater than or equal to 30 kg/m2 were 1.5 times as likely to experience TOS failure versus those with a BMI of 30 kg/m2 or less. This is important for the clinicians when counseling the obese patient for surgical management of PPSUI. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1094-e1095 Peer Review Report 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 Aaron Lentz More articles by this author Ngoc-Bich Le 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 ...

V1-14 REPAIR OF COMPLETE URETHRAL DISRUPTION DUE TO SYNTHETIC SLING COMPLICATION

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-14 REPAIR OF COMPLETE URETHRAL DISRUPTION DUE TO SYNTHETIC SLING COMPLICATION Nitya Abraham and Sandip Vasavada Nitya AbrahamNitya Abraham More articles by this author and Sandip VasavadaSandip Vasavada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.608AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral complications due to synthetic mid-urethral slings are rare. Possible causes may include unrecognized trocar injury, mesh implantation despite recognized injury, mesh contamination leading to inflammation and delayed perforation, and excessive sling tension. There is no consensus as to the surgical management of urethral complications with regard to how much mesh should be excised, whether an interposition flap should be utilized, and whether a pubovaginal sling should be placed at the time of surgery. We present a case of complete urethral disruption due to a synthetic mid-urethral sling complication. METHODS A 56 year old woman was referred for a hole in her urethra. She reported mixed urinary incontinence requiring 6 pads per day. She denied continuous incontinence, split stream, or recurrent UTI. Her surgical history was significant for prolapse repair and synthetic transobturator sling surgery complicated by synthetic sling extrusion with subsequent sling revision. Physical exam revealed complete urethral distraction distal to the bladder neck. The proximal urethral segment was about 2 cm in length and the distal urethral segment about 1 cm in length. The patient also had stage 3 pelvic organ prolapse. Cystoscopy confirmed that the urethral distraction was distal to the urethral sphincter. The bladder was normal. RESULTS The patient was counseled regarding surgical repair of the complete urethral distraction. A primary end-to-end urethral reconstruction was performed. Any residual synthetic mesh was excised. Given the good tissue quality and water-tight closure, we did not place an interposition flap. We also opted not to address her stress incontinence with concomitant fascial sling placement as we did not want to compromise the urethral repair. VCUG was performed after 3 weeks revealing no extravasation. The foley catheter was removed. On follow-up the patient reports bothersome urgency incontinence. She denies stress urinary incontinence. CONCLUSIONS Complete urethral disruption is a rare complication of synthetic mid-urethral sling surgery, that can be repaired primarily with good results. There is no consensus regarding the surgical management of such complications and thus an individualized approach should be used based on the patient’s presentation and surgeon expertise. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e295 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nitya Abraham More articles by this author Sandip Vasavada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...