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The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence.
Can J Urol. 2018 04; 25(2):9268-9272.CJ

Abstract

INTRODUCTION

Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI.

MATERIALS AND METHODS

A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes.

RESULTS

Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12).

CONCLUSIONS

Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI.

Authors+Show Affiliations

Department of Urological Surgery, St James's Hospital, Dublin, Ireland.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

Language

eng

PubMed ID

29680005

Citation

Sullivan, John F., et al. "The Transobturator Suburethral Sling: a Safe and Effective Option for All Degrees of Post Prostatectomy Urinary Incontinence." The Canadian Journal of Urology, vol. 25, no. 2, 2018, pp. 9268-9272.
Sullivan JF, Stassen PN, Moran D, et al. The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence. Can J Urol. 2018;25(2):9268-9272.
Sullivan, J. F., Stassen, P. N., Moran, D., Bolton, E. M., Smyth, L. G., Browne, C. M., Forde, J. C., Tal, R., & Lynch, T. H. (2018). The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence. The Canadian Journal of Urology, 25(2), 9268-9272.
Sullivan JF, et al. The Transobturator Suburethral Sling: a Safe and Effective Option for All Degrees of Post Prostatectomy Urinary Incontinence. Can J Urol. 2018;25(2):9268-9272. PubMed PMID: 29680005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence. AU - Sullivan,John F, AU - Stassen,Paul N, AU - Moran,Diarmuid, AU - Bolton,Eva M, AU - Smyth,Lisa G, AU - Browne,Cliodhna M, AU - Forde,James C, AU - Tal,Raanan, AU - Lynch,Thomas H, PY - 2018/4/23/entrez PY - 2018/4/24/pubmed PY - 2019/4/6/medline SP - 9268 EP - 9272 JF - The Canadian journal of urology JO - Can J Urol VL - 25 IS - 2 N2 - INTRODUCTION: Male stress urinary incontinence (SUI) after radical prostatectomy (RP) is common. The surgical standard of care traditionally has been placement of an artificial urinary sphincter (AUS) but since its introduction the transobturator male sling has been shown to have particular unique advantages. Our aim was to assess outcomes of a consecutive series of suburethral sling insertions in men presenting with all degrees of post RP SUI. MATERIALS AND METHODS: A consecutive cohort of men undergoing AdVance sling insertion following RP were studied. Parameters assessed included pre and postoperative urinary function, 24 hour pad use, quality of life (QoL) outcomes, complications and further treatments. Degree of incontinence was categorized as mild (1-2), moderate (3-5) or severe (≥ 6) depending on daily pad use. Patients were reviewed at 1, 4 and 6 months. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was used to assess symptom severity and QoL outcomes. RESULTS: Seventy-seven patients were included, mean age 68 and mean time to sling post RP 34 (8-113) months. Preoperative degree of incontinence: mild 22%, moderate 58%, severe 20%. Fourteen percent had undergone post RP radiation therapy (RT). In total 73% experienced complete resolution of symptoms post sling, 12% significant improvement, 15% no reduction in pad use. Sixty percent with severe incontinence were classified as cured (no pad or 1 dry pad for security reasons). When patients with preoperative RT were excluded, cure rate rose to 82%. On follow up survey at 30 months (mean), the ICIQ-SF score decreased from baseline 17.7 (9-21.0) to 8.0 (0-20) (p < 0.0001), CI 95% (8-12). CONCLUSIONS: Suburethral slings are effective and safe for all degrees of post RP incontinence, are associated with improved QoL parameters and with appropriate selection and counseling are a viable option for more severe degrees of post RP SUI. SN - 1195-9479 UR - https://www.unboundmedicine.com/medline/citation/29680005/The_transobturator_suburethral_sling:_a_safe_and_effective_option_for_all_degrees_of_post_prostatectomy_urinary_incontinence_ DB - PRIME DP - Unbound Medicine ER -