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The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study.
Eur Urol. 2012 Mar; 61(3):608-15.EU

Abstract

BACKGROUND

Transobturator slings are currently promoted for the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP), but data on outcome remain limited.

OBJECTIVE

To assess, at midterm, the efficacy and safety of the inside-out transobturator male sling for treating post-RP SUI and to determine factors associated with failure.

DESIGN, SETTING, AND PARTICIPANTS

Prospective one-center trial involving 173 consecutive patients without detrusor overactivity, treated between 2006 and 2011 for SUI following RP.

INTERVENTION

Placement of an inside-out transobturator sling.

MEASUREMENTS

Baseline and follow-up evaluations included uroflowmetry and continence and quality-of-life (QoL) questionnaires. Cure was defined as no pad use and improvement as a number of pads per day reduced by ≥50% and two or fewer pads. Complications were recorded, and factors associated with treatment failure were evaluated.

RESULTS AND LIMITATIONS

Preoperatively, 21%, 35%, and 44% of the patients were using two, three to five, and more than five pads per day, respectively. After a median follow-up of 24 mo (range: 12-60 mo), 49% were cured, 35% improved, and 16% not improved. QoL was enhanced (p<0.001), and 72% of patients were moderately to completely satisfied with the procedure. Maximum flow rates were slightly reduced (p=0.004); postvoid residual volumes were similar (p=0.097). Complications were urinary retention after catheter removal (15%), perineal/scrotal hematoma (9%), pain lasting >6 mo (3%), and sling infection (2%); all were managed conservatively. Severe SUI before sling surgery was not associated with a worse outcome, whereas obesity and a history of pelvic irradiation or bladder neck stenosis were independent risk factors of failure, with risk ratios of 7.9 (95% confidence interval [CI], 3.3-18.9), 3.3 (95% CI, 1.4-7.8), and 2.6 (95% CI, 1.1-6.5), respectively.

CONCLUSIONS

The inside-out transobturator male sling is an efficient and safe treatment for post-RP SUI at midterm. Patients with prior pelvic irradiation may not be suitable candidates.

Authors+Show Affiliations

Department of Urology, University of Liège, Liège, Belgium.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

22104591

Citation

Leruth, Julie, et al. "The Inside-out Transobturator Male Sling for the Surgical Treatment of Stress Urinary Incontinence After Radical Prostatectomy: Midterm Results of a Single-center Prospective Study." European Urology, vol. 61, no. 3, 2012, pp. 608-15.
Leruth J, Waltregny D, de Leval J. The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. Eur Urol. 2012;61(3):608-15.
Leruth, J., Waltregny, D., & de Leval, J. (2012). The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. European Urology, 61(3), 608-15. https://doi.org/10.1016/j.eururo.2011.10.036
Leruth J, Waltregny D, de Leval J. The Inside-out Transobturator Male Sling for the Surgical Treatment of Stress Urinary Incontinence After Radical Prostatectomy: Midterm Results of a Single-center Prospective Study. Eur Urol. 2012;61(3):608-15. PubMed PMID: 22104591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. AU - Leruth,Julie, AU - Waltregny,David, AU - de Leval,Jean, Y1 - 2011/11/12/ PY - 2011/08/14/received PY - 2011/10/26/accepted PY - 2011/11/23/entrez PY - 2011/11/23/pubmed PY - 2012/5/31/medline SP - 608 EP - 15 JF - European urology JO - Eur Urol VL - 61 IS - 3 N2 - BACKGROUND: Transobturator slings are currently promoted for the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP), but data on outcome remain limited. OBJECTIVE: To assess, at midterm, the efficacy and safety of the inside-out transobturator male sling for treating post-RP SUI and to determine factors associated with failure. DESIGN, SETTING, AND PARTICIPANTS: Prospective one-center trial involving 173 consecutive patients without detrusor overactivity, treated between 2006 and 2011 for SUI following RP. INTERVENTION: Placement of an inside-out transobturator sling. MEASUREMENTS: Baseline and follow-up evaluations included uroflowmetry and continence and quality-of-life (QoL) questionnaires. Cure was defined as no pad use and improvement as a number of pads per day reduced by ≥50% and two or fewer pads. Complications were recorded, and factors associated with treatment failure were evaluated. RESULTS AND LIMITATIONS: Preoperatively, 21%, 35%, and 44% of the patients were using two, three to five, and more than five pads per day, respectively. After a median follow-up of 24 mo (range: 12-60 mo), 49% were cured, 35% improved, and 16% not improved. QoL was enhanced (p<0.001), and 72% of patients were moderately to completely satisfied with the procedure. Maximum flow rates were slightly reduced (p=0.004); postvoid residual volumes were similar (p=0.097). Complications were urinary retention after catheter removal (15%), perineal/scrotal hematoma (9%), pain lasting >6 mo (3%), and sling infection (2%); all were managed conservatively. Severe SUI before sling surgery was not associated with a worse outcome, whereas obesity and a history of pelvic irradiation or bladder neck stenosis were independent risk factors of failure, with risk ratios of 7.9 (95% confidence interval [CI], 3.3-18.9), 3.3 (95% CI, 1.4-7.8), and 2.6 (95% CI, 1.1-6.5), respectively. CONCLUSIONS: The inside-out transobturator male sling is an efficient and safe treatment for post-RP SUI at midterm. Patients with prior pelvic irradiation may not be suitable candidates. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/22104591/The_inside_out_transobturator_male_sling_for_the_surgical_treatment_of_stress_urinary_incontinence_after_radical_prostatectomy:_midterm_results_of_a_single_center_prospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(11)01222-X DB - PRIME DP - Unbound Medicine ER -