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| |  Bone-Anchored Perineal Sling Effective for Male Stress Urinary Incontinence: Presented at CURy By Chris Berrie BARCELONA, SPAIN -- February 5, 2008 -- Long-term use of InVance(TM) bone-anchored perineal slings is effective in the treatment of male patients with postprostatectomy stress urinary incontinence (SUI), researchers reported here at the World Congress on Controversies in Urology (CURy). This finding indicates potential for its choice over artificial urinary sphincter (AUS) for patients with mild/moderate SUI without previous treatment or incontinence surgery, and with poor manual dexterity, the researchers said. Use of perineal bone-anchored male slings has been suggested for men with intrinsic sphincter deficiency. Principal investigator Francisco Cruz, MD, PhD, Professor and Chairman, Department of Urology, Hospital De São João, Porto, Portugal, presented on February 2 the long-term results of such treatment. Sixty-two patients underwent perineal bone-anchored male sling placement between July 2003 and July 2006. Their incontinence was originally classified as mild (1-2 pads/day) in 8 patients, moderate (3-5 pads/day) in 41, and severe (>5 pads/day) in 13. Pretreatment profiles included 40 who had previous radical prostatectomy alone, 18 who had previous radical prostatectomy plus external beam radiation therapy, and 4 with benign prostate hyperplasia prostatectomy. Twenty-four men also underwent prior treatment for incontinence: 19 with periurethral injection of bulking material, 3 with AUS, and 2 with an adjustable vertical sling. During the surgical procedures, three titanium screws loaded with polypropylene suture were placed in each descending pubic ramus, via a 3- to 4-cm perineal incision at the level of the bulbar urethra. The polypropylene mesh was positioned over the bulbospongiosus urethra and tied to the bone anchors, with the sling adjusted to its maximum possible tension. Following prospective evaluations, immediate outcome for the SUI were as follows: 64.5% of patients were cured, 22.6% were improved, and 12.9% failed. After 3 (n = 30) and 4 (n = 12) years of follow-up, 70% and 66.7% of patients were cured, while 20.0% and 16.7% were improved, respectively. Complications of this bone-anchoring sling surgery included 19.4% of patients who had scrotal/perineal pain or numbness, 9.7% with prolonged postvoid residual, 3.2% with infection (which required explantation of the sling), and 1.6% with bone anchor dislodgement. Therefore, this study shows that this bone-anchored perineal sling has long-term safety and efficacy as first-line treatment in men with SUI after prostatic surgery. The study researchers concluded that with the proviso that the mesh needs to be adjusted to its maximum tension, this procedure could replace AUS in selected patient groups: those with mild/moderate SUI who have not had previous treatment or incontinence surgery; and those who have poor manual dexterity.
[Presentation title: Treatment of Male Stress Urinary Incontinence With the Bone-Anchored Perineal Sling. Poster 36]
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