The retrourethral transobturator sling is an effective, safe, and minimally invasive option for treating male stress urinary incontinence (SUI) after radical prostatectomy (RP), German researchers concluded.
Ricarda M. Bauer, MD, and colleagues at the Ludwig-Maximilian-University in Munich, studied the use of the sling (the AdVance sling) in 124 patients with mild to severe SUI after RP. The mean interval between RP and sling implantation was 44 months.
The AdVance sling is a polyprophylene monofilament mesh that is self-anchoring because of its woven nature, the authors explained. Using a trochar system, surgeons implant the device employing a transobturator approach via a median perineal incision.
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Patients were considered cured if they were completely dry (needed no pads or only one dry security pad) and improved if they need only one or two pads or had a pad reduction of 50% or more. The researchers considered treatment to be successful if patients were cure or improved.
After six months, 55.8% of patients were cured and 27.4% were improved, for a treatment success rate of 83.2%, the researchers reported in European Urology (2009; published online ahead of print). The remaining 16.8% were treatment failures. At one year, the cure rate and improved rate were 51.4% and 25.7%, respectively, for a treatment success rate of 77.1%. The failure rate was 22.9%.
Dr. Bauer’s team observed no severe intraoperative complications except for one case of a misplaced sling. Sixteen patients (12.9%) experienced postoperative urinary acute retention, which was treated a suprapubic or transurethral catheter. The investigators observed no significant changes in residual urine and flow rate.
The researchers noted that their findings at six and 12 months are comparable to previously published data for the retrourethral transobturator sling with a three-month follow-up.
“All currently marketed slings for the minimally invasive treatment of male SUI that are implanted in the region of the anterior (bulbar) urethra induce compression of the urethra,” the authors noted. “The retrourethral transobturator sling offers a noncompressive functional therapeutic approach.” This sling exerts its function on the posterior (membranous) urethra by fixing it into the “normal” anatomic position, thus allowing adequate function of the sphincter, they explained.
“The current data illustrate that the retrourethral transobturator sling achieves similar results to devices that achieve continence mainly by compression of the urethra,” the authors wrote.
