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Bone anchored sling for the treatment of post-prostatectomy incontinence.
J Urol. 2001 Jan; 165(1):72-6.JU

Abstract

PURPOSE

This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence.

MATERIALS AND METHODS

A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure.

RESULTS

Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications.

CONCLUSIONS

This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence.

Authors+Show Affiliations

Bnai-Zion Medical Center, Haifa, Israel, Northwest Hospital, Seattle, Washington, and San Paolo Hospital, Savona, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11125367

Citation

Madjar, S, et al. "Bone Anchored Sling for the Treatment of Post-prostatectomy Incontinence." The Journal of Urology, vol. 165, no. 1, 2001, pp. 72-6.
Madjar S, Jacoby K, Giberti C, et al. Bone anchored sling for the treatment of post-prostatectomy incontinence. J Urol. 2001;165(1):72-6.
Madjar, S., Jacoby, K., Giberti, C., Wald, M., Halachmi, S., Issaq, E., Moskovitz, B., Beyar, M., & Nativ, O. (2001). Bone anchored sling for the treatment of post-prostatectomy incontinence. The Journal of Urology, 165(1), 72-6.
Madjar S, et al. Bone Anchored Sling for the Treatment of Post-prostatectomy Incontinence. J Urol. 2001;165(1):72-6. PubMed PMID: 11125367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bone anchored sling for the treatment of post-prostatectomy incontinence. AU - Madjar,S, AU - Jacoby,K, AU - Giberti,C, AU - Wald,M, AU - Halachmi,S, AU - Issaq,E, AU - Moskovitz,B, AU - Beyar,M, AU - Nativ,O, PY - 2000/12/23/pubmed PY - 2001/2/28/medline PY - 2000/12/23/entrez SP - 72 EP - 6 JF - The Journal of urology JO - J Urol VL - 165 IS - 1 N2 - PURPOSE: This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure. RESULTS: Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications. CONCLUSIONS: This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/11125367/Bone_anchored_sling_for_the_treatment_of_post_prostatectomy_incontinence_ L2 - https://www.jurology.com/doi/10.1097/00005392-200101000-00018?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -