Introduction: The surgical options for post prostatectomy incontinence are implantation of an artificial sphincter or male sling. Outcomes for artificial sphincters, and predictive values for good outcome have been documented. However, the criteria for patient selection and the likelihood of a good outcome for male slings are limited. Most authors have relied on pad number/weight as their primary parameter, despite poor correlation with success rates. It remains unclear whether pre-operative urodynamic parameters might better predict surgical outcomes and facilitate patient selection.
Methods: We performed a retrospective case notes and video-urodynamics review of men who underwent AdVanceXP male mid-urethral sling insertion in three London hospitals between 2012 and 2019. Collected data included demographics, postoperative continence and urodynamic parameters. Video-urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was only performed in one centre. Analysis was performed using chi-squared and independent t tests, with p<0.05 is considered significant
Results: 114 men were identified. 89/114 (78%) patients were cured of their incontinence requiring 1 pad per day or less for reassurance (59/114 (52%) did not use any pads), whilst 25/114 (22%) patients remained significantly wet. Success by urodynamic parameters is shown in Figure 1. 43/114 (38%) had detrusor overactivity (DO) on preoperative urodynamics, with a mean pressure of 41cmH2O (range 15-78). The rate of DO demonstrated in the wet group was significantly higher than in dry group (60% vs 31%, p=0.009), but the peak DO pressure did not correlate with outcomes (p = 0.778). 31/114 (27%) had abnormal compliance, with higher incidence in the wet group (48% vs. 21%, p= 0.008). Having a bladder capacity less than 400ml was also associated with worse outcomes (p=0.001).
Preoperative RLPP did not correlate with surgical outcomes (p=0.495), but was only was performed in 55 men (48%).
Conclusions: Urodynamic parameters can be used to predict outcome for male sling. The predictors of significance are detrusor overactivity, reduced compliance and reduced bladder capacity (<400mls). Further study is required to accurately define urodynamic parameters that will differentiate outcomes and criteria for sling (and sphincter) selection. Source of
