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Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success.
Neurourol Urodyn. 2018 11; 37(8):2632-2637.NU

Abstract

AIMS

To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms.

METHODS

We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated.

RESULTS

Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001).

CONCLUSIONS

MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI.

Authors+Show Affiliations

Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.Department of Urology, UT Southwestern Medical Center, Dallas, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29717511

Citation

Shakir, Nabeel A., et al. "Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Male Transobturator Sling Success." Neurourology and Urodynamics, vol. 37, no. 8, 2018, pp. 2632-2637.
Shakir NA, Fuchs JS, McKibben MJ, et al. Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourol Urodyn. 2018;37(8):2632-2637.
Shakir, N. A., Fuchs, J. S., McKibben, M. J., Viers, B. R., Pagliara, T. J., Scott, J. M., & Morey, A. F. (2018). Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourology and Urodynamics, 37(8), 2632-2637. https://doi.org/10.1002/nau.23703
Shakir NA, et al. Refined Nomogram Incorporating Standing Cough Test Improves Prediction of Male Transobturator Sling Success. Neurourol Urodyn. 2018;37(8):2632-2637. PubMed PMID: 29717511.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. AU - Shakir,Nabeel A, AU - Fuchs,Joceline S, AU - McKibben,Maxim J, AU - Viers,Boyd R, AU - Pagliara,Travis J, AU - Scott,Jeremy M, AU - Morey,Allen F, Y1 - 2018/05/01/ PY - 2018/02/23/received PY - 2018/04/09/accepted PY - 2018/5/3/pubmed PY - 2019/11/8/medline PY - 2018/5/3/entrez KW - male stress urinary incontinence KW - male transobturator sling KW - predictive nomogram SP - 2632 EP - 2637 JF - Neurourology and urodynamics JO - Neurourol. Urodyn. VL - 37 IS - 8 N2 - AIMS: To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms. METHODS: We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated. RESULTS: Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001). CONCLUSIONS: MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/29717511/Refined_nomogram_incorporating_standing_cough_test_improves_prediction_of_male_transobturator_sling_success_ L2 - https://doi.org/10.1002/nau.23703 DB - PRIME DP - Unbound Medicine ER -