Surgimesh M‐SLING^® transobturator and prepubic four‐arm urethral sling for post‐prostatectomy stress urinary incontinence: clinical prospective assessment at 24 months

Abstract

ObjectiveTo assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of postprostatectomy incontinence (PPI) in men. Material and MethodsThis was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING â implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Q max ) and urinary retention. We also analysed Urinary Symptom Profile (USP â ) score, degree of erectile dysfunction, patients' satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was <2 g. Patients whose condition was considered to have improved reduced their daily urinary losses by >50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures. ResultsThe mean hospitalization period was 1.57 AE 0.70 days. All patients remained catheterized for 1.17 AE 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred. ConclusionThe Surgimesh M-SLING transobturator and prepubic fourarm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes.

The role of male slings in post prostatectomy incontinence: ICI‐RS 2015

“…The main difference, however, appears to be that the bulbospongiosus muscle is incised and the central tendon is dissected and partially released akin to the AdVance MS. In this study with 2‐year follow up 34% were cured (no pads and 24 h pad test <2 g), 27% improved (reduction in daily urine loss >50%), and 19% were considered failures . Subjective urinary symptom profile scores statistically improved at 12 and 24 months compared to baseline.…”

“…In this study with 2-year follow up 34% were cured (no pads and 24 h pad test <2 g), 27% improved (reduction in daily urine loss >50%), and 19% were considered failures. 30 Subjective urinary symptom profile scores statistically improved at 12 and 24 months compared to baseline. Seventy-one percent of patients were satisfied or very satisfied with treatment.…”

“…Sixteen patients were excluded but the authors published their results on an intention to treat basis. Furthermore they did not use fixation which they felt may well improve the efficacy of the sling and as a result are planning a follow up study …”

“…Furthermore they did not use fixation which they felt may well improve the efficacy of the sling and as a result are planning a follow up study. 30…”

The Virtue quadratic male sling for postradical prostatectomy urinary incontinence: 3‐Year outcome measurements and a predictive model of surgical outcome from a European prospective observational study

“…The authors concluded that Virtue male sling implantation should not be recommended. At 24 months follow‐up, Le Portz et al, 15 using a daily pad weight <2 g as success criteria, showed that with the M‐SLING®, another type of four‐arm mesh sling, 34.4% of patients were cured, 27.1% had improvement, and 19.4% were considered as failures. In a recent systematic review and meta‐analysis on the male sling, Meisterhofer et al 16 showed that the objective cure rate varies between 8.3% and 87.3% with a pooled proportion estimate of 0.50 (95% CI: 0.45–0.56).…”