Slings Effective for Male SUI
BEIJING—Surgical placement of male transobturator slings cures three-quarters of cases of male stress urinary incontinence (SUI) that develop as a result of prostate surgery, British investigators reported at the 2012 annual meeting of the International Continence Society.
In a study of 50 men who underwent sling placement for SUI resulting from radical prostatectomy (47 patients) or transurethral resection of the prostate (three patients), researchers at the Royal Hospital in Reading, U.K., found an overall cure rate of 74%. In addition, 10% improved, 12% had no change in symptoms, and 4% experienced worsening of symptoms. Patients with mild or moderate SUI had the best outcomes, with 85% and 90% cure rates, respectively.
The slings they used were the AdVance Male Sling System (American Medical Systems, Inc.) and I-STOP TOMS (CL Medical). The investigators observed few complications.
The principal investigator of the study was urologist John Henderson, BMBS. Stephen Foley, MBBS, performed or supervised the surgeries in all patients. The AdVance sling was used for the first 25 patients and the I-STOP TOMS was used for the rest.
All 50 patients failed non-surgical treatment, including pelvic floor exercises and physiotherapy, before receiving a male transobturator sling. The mean age was 69 years (range 56-85). Most had developed SUI after radical prostatectomy (94%) and the remainder after transurethral resection of the prostate. Twelve patients (24%) had previously undergone radiotherapy.
The team defined mild SUI as needing two or fewer pads per day, moderate as needing three to four pads per day, and severe as needing at least five pads per day. They also defined cure as the need for no pads or just one pad for reassurance. They defined improvement as at least a 50% reduced pad usage and need for two or fewer pads per day. Men who had an increased in the number of pads per day were considered to have gotten worse.
Among patients with mild SUI, the cure rate was 85%, 7% improved, 7% had no change in symptoms, and none experienced worse symptoms post-operatively. For those with mild preoperative SUI, 90% improved, 5% had no change, and 5% worsened. The respective figures for severe SUI patients were 43%, 25%, 25%, and 6%.
Eight patients had Clavien-Dindo grade I complications: two had dysuria, three had pain and one had bruising. Three other patients had Clavien-Dindo grade II complications, in the form of failing a trial without a catheter on post-operative day 1. Both went on to have a subsequent successful trial without a catheter. These results compare favorably to those in previous studies.