The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence

Abstract

Study Type – Therapy (outcomes research) Level of Evidence 2c OBJECTIVE To evaluate the efficacy and safety of a transobturator retroluminal repositioning sling suspension in the treatment of male stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS In 118 men with SUI after prostatic surgery, a transobturator retroluminal repositioning sling suspension was implanted. Patients were evaluated including: complete history and physical examination, 24‐h pad test, a questionnaire (International Consultation on Incontinence Questionnaire, Short‐Form), urodynamic evaluation and endoscopy. The surgical technique was described previously. The findings before and at 1 year after sling placement were compared. RESULTS At the 12‐month follow‐up, 73.7% of the men were cured, 16.9% were improved, and 9.3% were still incontinent. After sling placement the daily pad use decreased significantly (P < 0.001), while the ICIQ‐SF improved significantly (P < 0.01). The detrusor voiding pressure, postvoid residual urine volume and maximal flow rates remained unchanged, while the Valsalva leak‐point pressure improved significantly (P < 0.01). In 19.5% of the men, there was transient scrotal pain or perineal discomfort. In 5.1% of the men, postoperative urinary retention occurred but resolved spontaneously after a few weeks of catheter placement. In 1.7% of the men adductor pain was reported, which resolved spontaneously. There were no major complications. CONCLUSION The transobturator retroluminal repositioning sling suspension for the treatment of male SUI is effective and safe with a low complication rate after 1 year of follow‐up.

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study

“…In summary, historically bulbourethral compression devices have been a prominent component of the armamentarium for treatment of PPI and have achieved very satisfactory results in 65 to 90% of patients (3,5,10,17,21,22,24,26,27). Based on examination of data from medium and long-term follow-up, we believe that the common goal of all these devices is to create mild bulbourethral pressure that allows coaptation of the mucosa, thus controlling incontinence.…”

“…Among the non-adjustable devices are various models of autologous facials slings or polypropylene tapes such as Invance™ (bone anchored sling), AdVance™ and other devices (21)(22)(23)(24)(25)(26)(27). The AdVance™, one of the most commonly used non-adjustable devices, reportedly has very good results (around 80%) in selected cases of mild to moderate PPI (3).…”

“…It is claimed that this retro-urethral transobturatory sling works by repositioning the residual sphincter to an intra-abdominal location by mobilizing the urethra from the perineal central tendon, thus avoiding the urethral hypermobility that can be caused by surgery. At the same time, the urethra is occluded by the sling, which should be implanted under tensioning, as is recommended (25,26). The main advantage of adjustable systems is that they allow postoperative increasing or decreasing of sling tension to improve or correct initial outcomes.…”

Mid‐term outcomes after AdVanceXP male sling implantation

“…Several studies have evaluated outcomes after AdVance implantation, and, currently, data up to a maximum follow-up of 39 months are available [12][13][14][15][16][17][18]. The AdVanceXP was marketed in 2010 and its innovations aim to improve both surgical implantation and postoperative stability.…”

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

“…It offers a non-compressive functional approach due to repositioning of the descended posterior urethra after prostate surgery [3]. In several studies the effectiveness and safety of the AdVance sling was shown [4,5,6,7,8]. However, the reported failure rate after AdVance sling implantation is 20-40% [1].…”