Study Type – Therapy (outcomes research) Level of Evidence 2c
OBJECTIVE
To present a prospective long‐term evaluation of the bone‐anchored male sling (InVanceTM, American Medical Systems, Minnetonka, MN, USA) for patients with moderate to severe stress urinary incontinence (SUI) after prostate surgery
PATIENTS AND METHODS
Forty‐five patients had a male sling implanted for SUI after prostate surgery. The evaluation before and after surgery included a complete history and physical examination, various questionnaires (American Urological Association Symptom Score, University of California Los Angeles/RAND prostate index), cysto‐urethroscopy, International Continence Society (ICS) 1‐h pad test and a urodynamic study. The follow‐up assessments were at 2, 6 and 12 months after surgery, and yearly thereafter. The success rate was defined as the percentage of patients ‘dry’ and ‘improved’.
RESULTS
The median (range) follow‐up was 36 (2–64) months. Twelve patients (27%) had previous adjuvant radiotherapy. Eighteen patients (40%) had moderate SUI (two or three pads/day) and 27 (60%) had severe SUI (more than three pads/day). All preoperative ICS 1‐h pad tests were positive. The success rate was 76%; 16 patients were dry (36%), 18 were improved (one or two pads/day, 40%) and in 11 the sling was a failure (24%); 76% of ICS 1‐h pad tests were negative after surgery. The postoperative urodynamic study showed no signs of bladder outlet obstruction. In all, 72% of patients were satisfied/very satisfied with the surgery and 86% considered themselves cured/almost cured. The success rate was not affected by the presence of previous radiotherapy or the severity of SUI. Ten patients had perineal numbness, but in all it resolved within 1–3 months. There was one mesh infection which required its removal. There was no urethral erosion.
CONCLUSION
Compared to previous studies, the InVance male sling had a good success rate for moderate and severe SUI, with a median follow‐up of 36 months. The results did not differ for moderate or severe SUI or with the presence of previous radiotherapy.
Introduction: Since the marketing of the percutaneous permanent tined leads (PPTL), many centres rely solely on these instead of the percutaneous nerve evaluation (PNE) as a screening tool. At our centre, we routinely perform PNE. Moreover, with our limited hospital resources, we have adopted a stricter definition of success in the patient selection process using an improvement of more than 60% as a cut-off point. This study presents our experience with sacral nerve stimulation using PPTL as an adjunct to PNE to improve the outcome of the screening method for patients suffering from refractory voiding dysfunction. Methods: We reviewed the charts of 106 patients who underwent a PNE between 2001 and 2008. The outcome of the procedures, the complication rates and its long-term effect were reviewed. Results: Overall, 116 PNE were performed and it was successful in 54%. Forty-five out of the 62 patients with a successful PNE underwent the stage I procedure. Of these, 93% had a successful stage I and were later implanted with the implantable pulse generator (IPG). The remaining 12 patients underwent the simultaneous implantation of the PPTL and IPG using the open procedure and it was successful in 10 of them. Conclusion: The PNE is a good adjunct to the staged procedure to select the appropriate candidates for sacral nerve stimulation, especially with limited resources.
Introduction: Since the marketing of the percutaneous permanenttined leads (PPTL), many centres rely solely on these instead ofthe percutaneous nerve evaluation (PNE) as a screening tool. Atour centre, we routinely perform PNE. Moreover, with our limitedhospital resources, we have adopted a stricter definition of successin the patient selection process using an improvement of morethan 60% as a cut-off point. This study presents our experiencewith sacral nerve stimulation using PPTL as an adjunct to PNE toimprove the outcome of the screening method for patients sufferingfrom refractory voiding dysfunction.Methods: We reviewed the charts of 106 patients who underwenta PNE between 2001 and 2008. The outcome of the procedures,the complication rates and its long-term effect were reviewed.Results: Overall, 116 PNE were performed and it was successfulin 54%. Forty-five out of the 62 patients with a successful PNEunderwent the stage I procedure. Of these, 93% had a successfulstage I and were later implanted with the implantable pulse generator(IPG). The remaining 12 patients underwent the simultaneousimplantation of the PPTL and IPG using the open procedure andit was successful in 10 of them.Conclusion: The PNE is a good adjunct to the staged procedureto select the appropriate candidates for sacral nerve stimulation,especially with limited resources.
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