Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

Abstract

Introduction: The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI. Methods: A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day. Results: There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs. 16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006). Conclusions: For mild to moderate PPI there is no difference in continence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

Artificial urinary sphincter significantly better than fixed sling for moderate post‐prostatectomy stress urinary incontinence: a propensity score‐matched study

“…[39] study, no significant difference in the overall complication rate was observed between the two study groups. However, severe complications (Clavien–Dindo Grade IIIb) occurred only in the AUS group, in agreement with the Hoy and Rourke study [38].…”

“…Only two previous studies compared AUS with a fixed sling [38,39]. Hoy and Rourke [38] performed a retrospective study of 124 patients (76 AdVance, 48 AUS) with mild‐to‐moderate PPI and no significant differences were detected between treatments for continence outcomes and complications. The inclusion of mild UI, longer follow‐up and higher proportion of patients with worse features in the AUS group may explain the disagreement with our present results.…”

Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors

“…The occurrence of PPI being approximately 8.4% [2], nearly 5% of the patients after radical prostatectomy even undertake surgical therapy for urinary incontinence within the first 15 years of treatment [3], highlighting the high patient demand in this field. The artificial urinary sphincter (AUS) is an established surgical treatment option for the treatment of PPI [4]; nevertheless, the usage of male slings could in the future supersede its use as the gold standard for certain indications [5].…”

Preoperative pad usage is independently associated with failure of non-adjustable male trans-obturator slings in otherwise well-selected patients

“…While the Advance sling has shown effectiveness in treating mild to moderate post-prostatectomy incontinence. 3 This current work builds on the concept of further delineating which patient should or should not be offered a male sling. The most important association our study adds to the literature is that for those otherwise well selected patients preoperative pad usage is the most important predictor of sling success.…”

“…Many consider the artificial urinary sphincter the gold standard of treatment for PPI but in mild to moderate cases of incontinence, slings may offer similar efficacy. 3 Additionally, when given a choice, 92% of men prefer a male sling over an AUS to avoid the use of a mechanical device and associated manipulation of a scrotal pump. 4 In 2006, the AdVance TM transobturator male sling was introduced as a minimally invasive alternative to the AUS (AMS, Minnetonka, MN).…”