Extended Outcomes in the Treatment of Male Stress Urinary Incontinence With a Transobturator Sling

Zuckerman, Jack M.; Edwards, Brooke; Henderson, Katherine D.; Beydoun, Hind A.; McCammon, Kurt

doi:10.1016/j.urology.2013.10.065

Cited by 51 publications

(38 citation statements)

References 11 publications

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“…In their 3-year analysis, Rehder et al [15] reported only one late-onset complication, which was a case of symphysitis requiring explantation of the device. Consistent with those results, neither Zuckerman et al [17] nor Kowalik et al [18] observed any late-onset complications. Thus, it seems that both for AdVance as well as AdVanceXP retrourethral transobturator male slings, the first postoperative months seem to be the most important ones in terms of complications.…”

Section: Discussionsupporting

confidence: 52%

“…Several studies have evaluated outcomes after AdVance implantation, and, currently, data up to a maximum follow-up of 39 months are available [12][13][14][15][16][17][18]. The AdVanceXP was marketed in 2010 and its innovations aim to improve both surgical implantation and postoperative stability.…”

Section: Discussionmentioning

confidence: 99%

“…After a mean follow-up of 39 months, the authors reported a cure rate (0 or 1 dry safety pad) of 60% and a cure-and-improved rate of 73%. In addition, Zuckerman et al [17] retrospectively analysed 102 patients and found a 3-year cure rate (0 or 1 dry safety pad) of 42% and a cure-and-improved rate of 62% after AdVance implantation.…”

Section: Discussionmentioning

confidence: 99%

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Mid‐term outcomes after AdVanceXP male sling implantation

et al. 2016

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ObjectiveTo describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow‐up of almost 3 years.Patients and MethodsA total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow‐up of 12months and after an individual maximum follow‐up. Efficacy was evaluated by daily pad usage, 24‐h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed‐rank test was used. A P value <0.05 was taken to indicate statistical significance.ResultsThe mean ± sd follow‐up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow‐up. At follow‐up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24‐h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected.ConclusionsThe present study had the longest follow‐up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow‐up of almost 3 years. The results indicate that late‐onset complications are rare after AdVanceXP implantation.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Mid‐term outcomes after AdVanceXP male sling implantation

et al. 2016

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“…11 Importantly, even in the setting of initial improvement, some patients experience a decline in their degree of continence over time with slings. 14,15 For those patients who desire surgery for recurrent or persistent incontinence, surgeons are faced with the decision to pursue a repeat sling or proceed to AUS placement. Repeat slings are successful in some patients, and an increased success rate has been reported in patients who present with recurrent incontinence further out from their initial MUS.…”

Section: Discussionmentioning

confidence: 99%

“…13 Despite success in appropriately selected patients, up to 20% of males treated with MUS for SUI may experience a decline in their degree of improvement over time. 14,15 In those patients with persistent or recurrent SUI, treatment options include conservative management with pads or a condom catheter, repeat sling procedure, or AUS placement. Several small published series have reported improvements, such as pad reduction and higher quality of life scores, with a repeat sling procedure, and late incontinence recurrence after the primary sling seems to correlate with improved outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of prior urethral sling on artificial urinary sphincter outcomes

Ziegelmann

Linder

Rivera

et al. 2016

CUAJ

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Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS). Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis. Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy. Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

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Outcome of post‐prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity

Bhatt,

Ippoliti,

Nambiar

et al. 2024

BJUI Compass

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BackgroundUrodynamic evidence of storage dysfunction such as detrusor overactivity (DO) and/or poor compliance are present in up to 30–40% of patients after Radical Prostatectomy (RP). However, the current optimal management of men with DO on preoperative urodynamics prior to male stress urinary incontinence (SUI) surgery is not known.MethodsWe performed a systematic search of the literature including articles on patients undergoing SUI surgery after prostatectomy with preoperative DO between January 2003 and May 2023 to ensure contemporaneous data was obtained.ResultsWe identified 11 eligible publications with a total of 792 patients. On Urodynamics, 29% (n = 229) patients had DO prior to SUI surgery. Overall 69% patients had a successful outcome after SUI surgery while 26% (132/499) failed while 34% (32/95) patients who had proven DO preoperatively failed SUI surgery. The difference was not statistically significant. Considering the sub‐group analysis, the failure rate with preoperative DO was significantly higher in the sling group (43%) than in the AUS group (18%). The review was limited by the outcome heterogeneity, variability in study inclusion criteria, reporting and analysis and the quality of the available studies.ConclusionsWithin the limitations of the data, this review did not show a statistically significant higher failure rate of male incontinence surgery in patients with DO. Hence, patients with DO on preoperative urodynamics who are eligible for male SUI surgery should not be denied surgery but should be counselled appropriately of the risks and potential need for subsequent treatment, to manage expectations.

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Extended Outcomes in the Treatment of Male Stress Urinary Incontinence With a Transobturator Sling

Cited by 51 publications

References 11 publications

Mid‐term outcomes after AdVanceXP male sling implantation

Mid‐term outcomes after AdVanceXP male sling implantation

The impact of prior urethral sling on artificial urinary sphincter outcomes

Outcome of post‐prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity

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