A New Quadratic Sling for Male Stress Incontinence: Retrograde Leak Point Pressure as a Measure of Urethral Resistance

Abstract

The Virtue sling provides ventral urethral elevation using a transobturator approach, and a long segment of urethral compression against the genitourinary diaphragm via a straightforward prepubic technique without the risks of bone screws or retropubic needle passage. Transobturator and prepubic components of the quadratic fixation contributed to increasing urethral resistance as measured by intraoperative retrograde leak point pressure. This quadratic technique has a potentially greater ability to provide urethral compression than does a purely perineal or transobturator sling.

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“…Urodynamic testing was also performed to assess the filling variables of sensitivity, capacity, compliance, detrusor overactivity and to confirm the stress nature of the UI as well as the retrograde leak point pressure (RLPP) (7,8). The emptying variables of free flow and voluntary detrusor contractility were also recorded.…”

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“…11) without the risks of bone screws or retropubic needle passage. Comiter and colleagues 25 described a standardized procedure for the placement of the Virtue quadratic. In their study of 22 consecutive men who had SUI after RP, they evaluated the resistance of the sling to leakage via measurement of retrograde leak point pressure (RLPP) during key intraoperative steps.…”

“…Each mean retrograde leak point pressure value was significantly higher than the preceding value. 25 …”

“…Comiter and colleagues 25 assessed the 1-year safety and efficacy of the device in a cohort of 66 patients with severe incontinence (defined as the need for ≥3 PPD) post-RP. Continence was recovered totally in 49 cases (79%), partially in 9 cases (1 PPD in 5 patients, 2 PPD in 3 patients), and remained unchanged in 4 patients (≥3 PPD).…”

“…The self-sealing valve was replaced successfully in 3 of the malfunctioning cases (4.5%). 25,26 Discussion SUI following RP has been described as a major adverse effect affecting quality of life and remains a daily challenge for urologists. After initial assessment, the first-line treatment is non-invasive, based on supervised pelvic floor muscle training.…”