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The male sling for stress urinary incontinence: urodynamic and subjective assessment.
J Urol. 2004 Jul; 172(1):204-6.JU

Abstract

PURPOSE

We prospectively examined whether the fixed urethral resistance of the perineal male sling for the treatment of stress incontinence causes significant bladder outlet obstruction or de novo voiding dysfunction.

MATERIALS AND METHODS

A total of 22 patients (average age 67 years old) were evaluated before and after surgery with videourodynamics, the self-administered UCLA Prostate Cancer Index incontinence section and pad score.

RESULTS

Mean followup was 25 months (range 6 to 42). All patients complained of a moderate to severe problem before surgery. After surgery 16 (73%) reported a very small problem/no problem, 3 (14%) a moderate problem and 3 (14%) reported a big problem. Average pad use +/- SD decreased from 4.6 +/- 2.5 to 0.74 +/- 1.0 pads (p <0.01). Median UCLA Prostate Cancer Index incontinence score increased from 82 to 313, p <0.001. Mean retrograde leak point pressure (RLPP) increased from 30.4 +/- 15.9 to 59.9 +/- 9.7 cm water. Bladder outlet obstruction did not develop in any patients after surgery. Average maximum flow rate did not change significantly (17.7 +/- 6.5 vs 19.2 +/- 9.7 ml per second, p = 0.6). Nor was there a significant change in detrusor pressure at maximum flow rate (40.3 +/- 9.2 vs 45.8 +/- 14.7 cm water, p = 0.3). While de novo urgency or urge incontinence did not develop in any patients, 2 of 5 patients with a moderate/big leakage problem demonstrated postoperative detrusor overactivity on cystometry. Both individuals requiring more than 3 pads daily had a postoperative RLPP of less than 50 cm water.

CONCLUSIONS

Pad use, leak point pressure and urinary incontinence scores are significantly improved after sling surgery. Fixed resistance does not lead to bladder outlet obstruction. Postoperative RLPP less than 50 cm water and urodynamic detrusor overactivity are associated with increased pad use and bother.

Authors+Show Affiliations

University of Arizona Health Sciences Center and Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15201774

Citation

Ullrich, Nathan F E., and Craig V. Comiter. "The Male Sling for Stress Urinary Incontinence: Urodynamic and Subjective Assessment." The Journal of Urology, vol. 172, no. 1, 2004, pp. 204-6.
Ullrich NF, Comiter CV. The male sling for stress urinary incontinence: urodynamic and subjective assessment. J Urol. 2004;172(1):204-6.
Ullrich, N. F., & Comiter, C. V. (2004). The male sling for stress urinary incontinence: urodynamic and subjective assessment. The Journal of Urology, 172(1), 204-6.
Ullrich NF, Comiter CV. The Male Sling for Stress Urinary Incontinence: Urodynamic and Subjective Assessment. J Urol. 2004;172(1):204-6. PubMed PMID: 15201774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The male sling for stress urinary incontinence: urodynamic and subjective assessment. AU - Ullrich,Nathan F E, AU - Comiter,Craig V, PY - 2004/6/18/pubmed PY - 2004/8/3/medline PY - 2004/6/18/entrez SP - 204 EP - 6 JF - The Journal of urology JO - J Urol VL - 172 IS - 1 N2 - PURPOSE: We prospectively examined whether the fixed urethral resistance of the perineal male sling for the treatment of stress incontinence causes significant bladder outlet obstruction or de novo voiding dysfunction. MATERIALS AND METHODS: A total of 22 patients (average age 67 years old) were evaluated before and after surgery with videourodynamics, the self-administered UCLA Prostate Cancer Index incontinence section and pad score. RESULTS: Mean followup was 25 months (range 6 to 42). All patients complained of a moderate to severe problem before surgery. After surgery 16 (73%) reported a very small problem/no problem, 3 (14%) a moderate problem and 3 (14%) reported a big problem. Average pad use +/- SD decreased from 4.6 +/- 2.5 to 0.74 +/- 1.0 pads (p <0.01). Median UCLA Prostate Cancer Index incontinence score increased from 82 to 313, p <0.001. Mean retrograde leak point pressure (RLPP) increased from 30.4 +/- 15.9 to 59.9 +/- 9.7 cm water. Bladder outlet obstruction did not develop in any patients after surgery. Average maximum flow rate did not change significantly (17.7 +/- 6.5 vs 19.2 +/- 9.7 ml per second, p = 0.6). Nor was there a significant change in detrusor pressure at maximum flow rate (40.3 +/- 9.2 vs 45.8 +/- 14.7 cm water, p = 0.3). While de novo urgency or urge incontinence did not develop in any patients, 2 of 5 patients with a moderate/big leakage problem demonstrated postoperative detrusor overactivity on cystometry. Both individuals requiring more than 3 pads daily had a postoperative RLPP of less than 50 cm water. CONCLUSIONS: Pad use, leak point pressure and urinary incontinence scores are significantly improved after sling surgery. Fixed resistance does not lead to bladder outlet obstruction. Postoperative RLPP less than 50 cm water and urodynamic detrusor overactivity are associated with increased pad use and bother. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/15201774/The_male_sling_for_stress_urinary_incontinence:_urodynamic_and_subjective_assessment_ L2 - https://www.jurology.com/doi/10.1097/01.ju.0000132146.79081.da?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -