Hage B, Hanna S, Schmutz G, Carmel M, Ponsot Y, and Tu LM

Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.

Introduction and Objectives: Stress urinary incontinence (SUI) after prostate surgery has significant impact on patient’s quality of life. Recently, bulbourethral sling has gained popularity for the treatment of this condition as previous series showed encouraging results. We present further evaluation of this procedure using objective, subjective measurements and dynamic magnetic resonance imaging (MRI).

Methods: A total of 33 consecutive men (mean age 68) underwent the bulbourethral bone anchored sling for post prostatic surgery SUI. The procedure was performed with the AMS InVance™ male sling kit. Pre and postoperative evaluation consisted of physical examination, history (including AUA symptoms score, incontinence/quality of life questionnaire, UCLA/RAND), cystoscopy, ICS1H pad test and videourodynamic study. Reassessment was done 2, 6, 12 months after the surgery and yearly thereafter. One third of the patients were randomly selected to have a pelvic dynamic MRI before and 6 months after the male sling.

Results: The median follow-up time was 20.6 months. Seven patients (21.2%) have had adjunctive radiotherapy. Incontinence was described as moderate (2-3 pads per day) by 14 (42.4%) and severe (more than 3 pads) by 19 (57.6%). ICS1H pad test done 6 months after the surgery was negative in 72.7% of the patients. Seventeen (51.5%) were dry, 11 (33.3%) used 1 to 2 pads and 5 (15.1%) used more than 3 pads. Post operative videourodynamic demonstrated unobstructed voiding patterns, clinically none of the patients had de novo voiding or filling symptoms.

Mean results reported on the visual anagogic scale about discomfort caused by SUI were 75.8% and 20.0% before and after the male sling respectively. Twenty six patients (83.9%) said to be satisfied/very satisfied from the surgery and 22 (71%) said to be cured/almost cured. Outcomes were not significantly affected by the degree of SUI neither by adjunctive radiotherapy. Dynamic MRI and fluoroscopic images did not show any difference in bladder neck position or mobility. Instead, the mesh seemed to dynamically compress and elevate the posterior bulbar urethra by creating a kink at this level.

Conclusion: This study shows that bone anchored male sling appears to have high success rate, both subjectively and objectively in patients with moderate to severe SUI.

Mechanism of action could be dynamic posterior compression with a secondary elevation of the bulbar urethra, allowing better transmission of intra-abdominal pressure.

UroToday.com Coverage of SUFU 2007

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