Titanised Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-Out Single-Incision Technique: Minimum 12-Months Follow-Up Study

To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence.

From 01/2013 to 06/2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or TURP (5) underwent transobturator two-arm titanium-coated sling (TiLOOP Male®) implantation with an inside-out, single-incision technique, leaving the bulbourethral muscle in place. Patients have been assessed postoperatively with uroflowmetry, pad count, ICIQ-SF, IIQ-7, PGI-I, OABq, IPSS, satisfaction (yes/no). Successful outcome included cure (no pad use or one dry "security" pad) or improvement (reduction of at least 50% of the pad count).

Evaluated patients were suffering from mild (11/44, 25%), moderate (26/44, 59%) or severe (7/44, 16%) incontinence. After a median follow-up of 25 months (range 12-55, minimum 12 months), 24(54.6%) patients were cured and 10(22.7%) were improved, which was a global success rate of 77.3%. There were 10(22.7%) failures in the first 6 months. Zero pad rate was 50%. Subjective success (PGI-I very much/much improved) was achieved in 33(75%) patients. Mean scores of ICIQ-SF, ICIQ-QoL and IIQ-7 improved to a statistical significant extent. Satisfaction was reported by 33(75%) patients. Uroflowmetry parameters were unchanged postoperatively, and most of complications were Clavien-Dindo grade I. BMI≥30 and previous irradiation/HIFU were independent predictors of failure.

TiLOOP Male®provided favourable and stable midterm continence outcomes. The inside-out approach was safe, and the tolerability of the sling and the single-incision technique was satisfactory. Patients with obesity and previous irradiation/HIFU should be aware of their higher risk of failure.

Urology. 2018 Mar 01 [Epub ahead of print]

Emilio Sacco, Carlo Gandi, Luigi Vaccarella, Salvatore Recupero, Marco Racioppi, Francesco Pinto, Angelo Totaro, Nazario Foschi, Giuseppe Palermo, Francesco Pierconti, Pierfrancesco Bassi

Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, Catholic University School of Medicine, Rome, Italy. Electronic address: ., Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, Catholic University School of Medicine, Rome, Italy.

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