Hypothesis / aims of study
Male urinary stress incontinence is a rare complication after prostate surgery, but it has a very important effect on quality of life. Depending on the severity of this incontinence, there are various surgical solutions to correct this situation. Our aim was to analyze if using suburethral sling for male incontinence was a feaseable, secure and efective technique. We have analyzed our series and the functional results of male incontinence correction surgery using suburethral sling.
Study design, materials and methods
We conducted a retrospective analysis of patients undergoing suburethral sling (AdvanceTM XP® and Virtue®) between years 2013 and 2017 at our institution, with a total of 32 patients treated with this two techniques (11 with AdvanceTM XP® and 21 with Virtue®). We analyced separetly both groups and compared complications (using Clavien-Dindo scale) and functional results, measured as continence if the patient was using no pads or only using a security pad per day as much. We analyzed the early continence at 2 months, and then at 12 and 24 months from surgery with a median follow up of 28 months.
We have a total of 32 patients with an average age of 69 years, checking the homogeneity between both groups for the demographic characteristics. A 90.6% (n = 29) present incontinence secondary to a prostate adenocarcinoma treated by radical prostatectomy; 6.25% (n = 2) secondary to endourological surgery of the BPH and 3.1% (n = 1) secondary to pelvic trauma (treated with Virtue® both reasons of incontinence, secondary to endourological surgery and trauma). None of these patients had a previous history of radiotherapy. 2 patients (6.25%) had a previous history of cervical sclerosis, wich was firstly corrected by an endourological procedure, and afterwards, one treated with Virtue® and the other one with AdvanceTM XP®. The pad test prior to surgery was 270cc (± 136) for the Virtue® mesh group and 175cc (± 118) for the AdvanceTM XP®, with no significant diferences between both groups. 21.8% (n = 7) of the total sling presented postoperative complications. In the case of the AdvanceTM XP®, 2 patients presented postoperative complications, (18.2%) being one of them a Clavien III outlet obstruction, that required urethrolysis and the other one, Clavien I (wound infection). In the case of the Virtue®, 5 patients (23.8%), being all cases Clavien I, (one case outlet obstruction solved by temporary urethral catheter). When analyzing the functional results, the continence at 2 months after surgery was 62.5%, at 12 months 74% and after 24 months of follow up a 78.5% for the total of patients treated with both kinds of suburethral slings. If we focus in each group, in the AdvanceTM XP® group we find a 81.8% of continence at 2 months, and then 91% at 24 months (2 cases presented obstruction during the follow up wich one needed surgery and the other one only temporary urethral catheter). In the Virtue® group we find a 52.4% of continence at 2 months from surgery, being then a 71.4% after 24 months of follow up (there were no significant differences between the two techniques in the final continence, nor in complications during follow up).
Interpretation of results
We find that the use of suburethral sling for male patients suffering from secondary incontinence (due to a previous surgery or trauma) with an accurate selection, in our experience, it is a really good therapeutic option, with good rates of continence after 24 months. It is remarkable that the continence in both groups gets slightly better during the follow up, rising up to nearly an 80% of continence. With this data, we can assume that both devices have similar functional results and complications, and we included them in our usual management.