Introduction: The efficacy of NoS for treatment of stress urinary incontinence (SUI) after prostatic surgery (PS) has been well established in patients not exposed to radiotherapy (RT) and with mild to moderate SUI. In a non-ideal population the evidence is less solid. Nevertheless, patients opt for sling surgery, even if they have bad prognostic factors. We analysed the outcomes of AdVance (AdV) and AdVance XP (AdV-XP) slings on our cohort of patients with different preoperative features and we calculated the risk factors for failure.
Methods: A consecutive series of patients treated since 2007 was analysed. Pads/day use defined the SUI grade: mild =2 pads/day, moderate and severe (SSUI) respectively =4 pads/day or >4 pads/day. A urodynamic study (UDS) was performed before the implant. During follow up (FU), social continence (SC) defined the use of 1 pad/day, totally dry (TD) was used for no pad use. Success described a reduction in pad use = 50%. A time-to-event model identified the risk factors, uni- and multi-variate analysis provided the Hazard Ratio (HR).
Results: Of 216 implanted slings, 43% had at least one risk factor: RT (n=41), SSUI (n=44), previous surgery for incontinence (IS) and urethral stricture (US) (n=39). 57% were ideal candidates: 81% of them achieved SC at last FU, 51% were TD. SC and TD outcomes were significantly less after RT (resp. 47%-18%), in SSUI patients (resp. 51%-32%), after IS (resp. 56%-44%) and after US (44%-9%). No erosions were observed. A high post-void residual volume (hPVR) after catheter removal was seen in 46 cases (21,3%) but spontaneously resolved in 94%. Two cases required sling transection due to persistent hPVR. Multivariate analysis showed 3 significant factors for impaired SC outcome: RT (HR:3,4), US (HR:2,4) and detrusor overactivity at UDS (HR:2,6). The analysis for the TD outcome showed again RT (HR:1,7) and leaking during UDS (HR:1,8) as factors for failure. An increased cystometric capacity was protective (HR: 0,9). For the risk of PVR, increasing age (OR: 0.68) was protective, history of US was a risk factor (OR: 2.59).
Conclusions: Implantation of NoS is effective and safe. The undesired events are rare also on comorbid patients, most of these events are transient. RT and US should be carefully considered as they significantly impair outcomes. Source of