Open Access

ARTICLE

The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence

John F. Sullivan, Paul N. Stassen, Diarmuid Moran, Eva M. Bolton, Lisa G. Smyth, Cliodhna M. Browne, James C. Forde, Raanan Tal, Thomas H. Lynch

Department of Urological Surgery, St James’s Hospital, Dublin, Ireland
Address correspondence to Dr. John Sullivan, Urology Registrar,StJames’sHospital,James’sStreet,Dublin8,Ireland

Canadian Journal of Urology 2018, 25(2), 9268-9272.

Abstract

Introduction: Male stress urinary incontinence (SUI) following radical prostatectomy (RP) is a common complication. While the artificial urinary sphincter (AUS) has traditionally been considered the surgical standard of care, the transobturator male sling has emerged as a viable alternative with distinct advantages, including lower complication rates and a less complex surgical technique. The aim of this study was to evaluate outcomes of a consecutive series of suburethral sling insertions using the AdVance sling in men with all degrees of post-RP SUI. Materials and methods: A prospective cohort of men who underwent AdVance sling placement for post-RP SUI was analyzed. Pre- and postoperative urinary function, 24-hour pad usage, quality of life (QoL), complications, and need for further interventions were assessed. Incontinence severity was categorized based on daily pad use: mild (1–2 pads/day), moderate (3–5 pads/day), or severe (≥6 pads/day). Patients were followed up at 1, 4, and 6 months postoperatively. Symptom severity and QoL were evaluated using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF). Results: A total of 77 patients were included in the study, with a mean age of 68 years and a mean time from RP to sling placement of 34 months (range: 8–113 months). Preoperatively, 22% had mild, 58% had moderate, and 20% had severe incontinence. Fourteen percent had undergone post-RP radiation therapy. Overall, 73% of patients experienced complete resolution of symptoms after sling placement, 12% showed significant improvement, and 15% had no reduction in pad use. Among those with severe incontinence, 60% were classified as cured (defined as zero pads or one dry pad for security purposes). When patients who had received post-RP radiation therapy were excluded, the cure rate increased to 82%. At a mean follow-up of 30 months, ICIQ-SF scores improved significantly from a baseline mean of 17.7 (9–21.0) to 8.0 (0–20) (p < 0.0001; 95% CI: 8–12). Conclusion: Suburethral slings, particularly the AdVance sling, are effective and safe for treating all degrees of post-radical prostatectomy stress urinary incontinence. They are associated with significant improvements in quality of life and can be a viable option even for patients with more severe forms of SUI when appropriately selected and counseled.

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