Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence?

Abstract

Purpose To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. Methods We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. Results Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). Conclusion Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.

Prevalence of chronic pain following suburethral mesh sling implantation for post‐prostatectomy incontinence

“…At our institutions, we keep a prospective database of all patients implanted with AdVance™/ AdVance™ XP slings and we build on our outcomes and complications previously published. 8 The AdVance™/ AdVance™ XP sling is the most commonly used male sling in the UK and our reported success rates with AdVance™/AdVance™ XP systems for mild and moderate incontinence, 79% and 72%, respectively, are in keeping with published literature. 6 This study presents a mean 52 (3-112) month follow up for functional, complication and pain outcomes.…”

“…The lack of a central register for woman with mesh implants may have led to under‐reporting of complication data. At our institutions, we keep a prospective database of all patients implanted with AdVance™/AdVance™ XP slings and we build on our outcomes and complications previously published 8 . The AdVance™/AdVance™ XP sling is the most commonly used male sling in the UK and our reported success rates with AdVance™/AdVance™ XP systems for mild and moderate incontinence, 79% and 72%, respectively, are in keeping with published literature 6 …”

Modified female mid‐urethral sling for the treatment of incontinence after prostate treatment: One‐center experience

“…However, there is no high level of evidence to support this view. The history of radiotherapy as a negative risk factor has been inconsistently reported in the literature 25–28 . Intuitively, it might inhibit tissue healing and urethral sphincter function, limit the mobility and flexibility of the tissues required for urethral repositioning 29,30 .…”

“…Third, we do not have data on urodynamic studies. Recent data have suggested that preoperative reduction in bladder capacity less than 250 ml and the detrusor overactivity are indicative of poor results 25 . Patients with underactive bladder are considered to be best treated by AUS, as adequate detrusor contractility is required to urinate against the compressive force of a sling 36 .…”

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy

“…The exclusion criteria included a need to undergo endourological surgery for stone surgery or a bladder tumor that obliged modifying the ATOMS system filling decided at the time of the final ATOMS adjustment and the impossibility of performing postoperative urodynamic evaluation for technical reasons. The sample size was calculated according to the study by Toia et al [15] performed with a retrobulbar sling. According to that study, we needed a minimum sample size of 54 patients to find the baseline OAB in 27% of continent patients and 55% of incontinent ones after retro-urethral sling implantation, with an alpha error of 5% and a statistical power of 80%.…”