Impact of the ‘Repositioning Test' on Postoperative Outcome of Retroluminar Transobturator Male Sling Implantation

Abstract

Objective: To evaluate prospectively the value of the ‘repositioning test' (RT) in preoperative patient selection for the efficacy of male stress urinary incontinence (SUI) treatment using a retroluminar transobturator male sling (AdVance sling). Patients and Methods: 65 consecutive patients with SUI after radical prostatectomy were included in this single-center prospective study. Preoperatively, patients were classified into those with ‘positive' and ‘negative' RT. Postoperative results were analyzed and the association between the result of the RT and postoperative outcome was evaluated. Results: 53 patients (81.5%) showed preoperatively a positive RT and 12 patients (18.5%) a negative RT. After a follow-up of 12 months, patients with positive RT showed a cure rate (0 pads/day) of 83% and patients with a negative RT showed only a cure rate of 25%. A positive RT significantly correlated with cure in outcome (p < 0.001). Conclusions: Patients with positive RT have a significantly better chance for successful AdVance sling implantation. The RT is minimally invasive, easy to learn and easy to perform. Therefore, the RT is a very useful tool for preoperative patient selection.

Mid‐term outcomes after AdVanceXP male sling implantation

“…After a mean follow-up of 17.3 months, they observed significantly worse efficacy outcomes for previously irradiated patients; however, the authors do not state if an exhaustive cystoscopic evaluation, including a repositioning test to determine the coaptive urethral zone, was performed. A short coaptive zone, however, has been shown to be an important predictive factor of treatment failure after AdVance implantation [7,21]. Consistent with these results, the present findings highlight the impact of preoperative clinical assessment and subsequent patient selection and indicate that good long-term results can be achieved in carefully selected patients even if the medical history includes suboptimal features.…”

“…A daily pad usage of 1-3 pads was further defined as mild incontinence. In addition, a mandatory urethroscopic evaluation of the sphincter, including a repositioning test and assessment of the coaptive urethral zone, was performed as previously described [7]. To detect potential cutting down of drinking that could mask more severe stress urinary incontinence, fluid drinking habits were assessed preoperatively and patients were advised to reach a daily fluid intake of at least 1.5 L daily.…”

Long-Term Outcomes of the Implant of a Periurethral Constrictor for Stress Urinary Incontinence Following Radical Prostatectomy

“…One could argue that the inclusion of such patients may lead to overestimation of the overall risk of complications. However, when we stratified patients on the bases of exposure to radiations, we observed an erosion rate of 26.8% among radiation-naïve patients, which is consistent with what has been reported by Lima et al [11] and significantly higher compared to the reports by Schiavini et al [9] and Introini et al [16]. …”

“…Second, our study provides long-term follow-up data, which is mandatory for the accurate understanding of risks and benefits related to a relatively novel technology such as the Silimed PC. This was confirmed by Lima et al [11] who recently analyzed a retrospective series of 56 patients. The authors reported that 41% of patients required removal of the device after a mean follow-up of 82.2 months.…”

“…The incidence of iatrogenic-induced intrinsic sphincteric deficiency following pelvic surgery has been reported to be 5-58% in large series of RP [10,11]. This is currently a major concern for urologists, as the persistence of urine leaks can significantly compromise patients QoL, eventually requiring surgery to fix this cumbersome problem [12,13].…”