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abstract

abstract

061

The male sub-urethral sling versus the artificial urinary sphincter for treatment of stress urinary incontinence

Dockray, J1; Chang, RT1; Rees, RW1

1: University Hospital Southampton, United Kingdom

Objectives: An increasing number of men are seeking surgical treatment for stress urinary incontinence (SUI). With the emergence of the less invasive sub-urethral slings, the dominance of the Artificial Urinary Sphincter (AUS) has been challenged. We have looked at our series of surgically treated, male SUI in a regional implant centre to compare outcomes from both modalities and identify risk factors for failure.

Materials and Methods: This was a prospective study, incorporating all prostheses patients over 3 years. The groupe were matched for age and aetiology of incontinence.

 

Total number

Prior Duloxetine

Mean pre-op pad use/24 hours

Wet at night

Additional radiotherapy

Sling

37

17 (46%)

4

11

4

AUS

35

7 (20%)

5.4

12

8

 

 

 

 

 

 

 

Post-op pad use/24 hours

Change

Pad-free (%)

Including safety pad (%)

Improved (%)

Complications

Minor

Surgical Revision

Elective 2nd surgery

Sling

0.8

-3

68

81

94

5/37 (13.5%)

4

1

4

AUS

0.8

-4.6

57

89

94

11/35 (31%)

3

8

2

Results: The major risk factor for complications, in both groups, was the combination of radical prostatectomy and radiotherapy. In the AUS group, 8 patients had undergone both. 4/8 had complications and 2/8 suffered erosions requiring staged reconstruction. In the sling group, 3 patients had undergone dual treatment and 2/3 of them failed to improve sufficiently. These patients have both been subsequently offered AUS insertion.

Conclusions: Improvement was equal in both groups, although overall dryness was higher in the AUS group. This is counterbalanced by the much higher complication and revision rate. Interestingly the AUS patients had a much higher safety-pad rate, anecdotally explained by the post-micturition dribble experienced by not waiting until the cuff is fully closed. The most challenging group is those patients who have undergone the combination of surgery and radiotherapy. They must be counseled that they have both a higher rate of failure with slings, and a higher risk of erosion with AUS insertion. Due to the poor tissue quality post radiotherapy, erosions can be particularly challenging, with patients undergoing multiple staged salvage procedures with limited success.

Disclosure:

Work supported by industry: no.

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