Open Access

ARTICLE

Transobturator sling for post-prostatectomy incontinence: radiation’s effect on efficacy/satisfaction

Henry C. Wright¹, Kevin McGeagh¹, Lee A. Richter², Jonathan J. Hwang³, Krishnan Venkatesan³, Amanda Pysher⁴, George E. Koch⁴, Keith Kowalczyk¹, Gaurav Bandi¹, Daniel Marchalik²

1 Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
2 Department of Urogynecology, MedStar Washington Hospital Center, Washington, DC, USA
3 Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
4 Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
Address correspondence to Dr. Henry Collier Wright, Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Rd, NW 1 PHC, Washington, DC 20007

Canadian Journal of Urology 2017, 24(5), 8998-9002.

Abstract

Introduction: We review our experience with the AdVance sling in patients with post-prostatectomy incontinence, comparing the role that adjuvant radiation therapy plays in sling success and patient satisfaction at short and long term follow ups.
Materials and methods: Men who underwent AdVance sling placement for post-prostatectomy incontinence from 2007 to present were identified using Current Procedural Terminology (CPT) codes. Manual chart review was performed. Level of incontinence was assessed using Expanded Prostate Cancer Index Composite (EPIC) and pads per day (PPD) use. Satisfaction was assessed by willingness to recommend the procedure to a friend. Outcomes in men who received radiation were compared to radiation-naïve men.
Results: Fifty-two men underwent AdVance sling placement. Eighteen men received adjuvant radiation. Thirty-six men were available for short term (19.4 months) and 16 men for long term (61.5 months) follow up. Overall, significant improvement was seen in post-sling EPIC score (24.6, p < 0.001), EPIC incontinence score (39.1, p < 0.001), and pad use (3.2 PPD to 1.4 PPD, p < 0.001). Greater improvement in EPIC scores and PPD use was seen in radiation-free men. Irradiated men were less satisfied with the procedure at both short and long term follow up. Diminished efficacy and satisfaction occurred at extended follow up for both groups but was more pronounced with radiation.
Conclusions: The majority of patients undergoing the AdVance sling procedure for post-prostatectomy urinary incontinence saw a significant reduction in pad use, and were overall satisfied in both radiated and non-radiated groups at short and long term follow up. However, improvements were greater in the non-radiated groups and diminished with time.

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