The male perineal sling - a viable alternative to the artificial urinary sphincter

University of Arizona Health Sciences Center, Tucson, AZ, USA.
Nature Clinical Practice Urology (Impact Factor: 4.07). 04/2006; 3(3):118-9. DOI: 10.1038/ncpuro0429
Source: PubMed
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    ABSTRACT: To examine the outcomes and adverse events associated with novel male sling designs described in the last decade. A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database. Three principal slings are described in the literature. The bone-anchored sling has success rates of 40-88%, with some series having a mean follow-up of 36-48 months. It is associated with a mesh infection rate of 2-12%, which usually requires sling explantation. The retrourethral transobturator sling has a success rate of 76-91% among three large case series with follow-ups of 12-27 months. There is a low reported explantation rate. The adjustable retropubic sling has a success rate of 72-79% with follow-ups of 26-45 months. Erosion (3-13%) and infection (3-11%) can lead to explantation. Most male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid- and long-term data are now available that indicate the male sling is a viable option for PPI. The use of male slings in severe UI, radiated patients, and non-radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.
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    ABSTRACT: Transobturator slings are currently promoted for the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP), but data on outcome remain limited. To assess, at midterm, the efficacy and safety of the inside-out transobturator male sling for treating post-RP SUI and to determine factors associated with failure. Prospective one-center trial involving 173 consecutive patients without detrusor overactivity, treated between 2006 and 2011 for SUI following RP. Placement of an inside-out transobturator sling. Baseline and follow-up evaluations included uroflowmetry and continence and quality-of-life (QoL) questionnaires. Cure was defined as no pad use and improvement as a number of pads per day reduced by ≥50% and two or fewer pads. Complications were recorded, and factors associated with treatment failure were evaluated. Preoperatively, 21%, 35%, and 44% of the patients were using two, three to five, and more than five pads per day, respectively. After a median follow-up of 24 mo (range: 12-60 mo), 49% were cured, 35% improved, and 16% not improved. QoL was enhanced (p<0.001), and 72% of patients were moderately to completely satisfied with the procedure. Maximum flow rates were slightly reduced (p=0.004); postvoid residual volumes were similar (p=0.097). Complications were urinary retention after catheter removal (15%), perineal/scrotal hematoma (9%), pain lasting >6 mo (3%), and sling infection (2%); all were managed conservatively. Severe SUI before sling surgery was not associated with a worse outcome, whereas obesity and a history of pelvic irradiation or bladder neck stenosis were independent risk factors of failure, with risk ratios of 7.9 (95% confidence interval [CI], 3.3-18.9), 3.3 (95% CI, 1.4-7.8), and 2.6 (95% CI, 1.1-6.5), respectively. The inside-out transobturator male sling is an efficient and safe treatment for post-RP SUI at midterm. Patients with prior pelvic irradiation may not be suitable candidates.
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