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

TI  - The transobturator suburethral sling: a safe and effective option for all degrees of post prostatectomy urinary incontinence
T2  - Canadian Journal of Urology

PY  - 2018
VL  - 25
IS  - 2
SN  - 1488-5581

AB  - <b>Introduction:</b> 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.

<b>Materials and methods:</b> 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).

<b>Results:</b> 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).

<b>Conclusion:</b> 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.
KW  - suburethral slings
KW  -  male stress urinary incontinence
KW  -  radical prostatectomy

DO  -