Elsevier

Urology

Volume 78, Issue 3, September 2011, Pages 708-712
Urology

Reconstructive Surgery
Urodynamic Parameters After Retrourethral Transobturator Male Sling and Their Influence on Outcome

https://doi.org/10.1016/j.urology.2011.03.068Get rights and content

Objective

To evaluate prospectively detailed urodynamic parameters before and after retrourethral transobturator sling (RTS) placement and the impact of adverse preoperative urodynamic parameters on postoperative outcome.

Methods

Fifty-five consecutive patients with postprostatectomy stress urinary incontinence (SUI) underwent urodynamics with pressure flow and abdominal leak point pressure (ALPP) measurements, quality of life, 1-hour pad test, and daily pad use assessment before RTS (AdVance) and 12 months postoperatively. Volume of first sensation and first desire to void, maximum cystometric capacity (MCC), ALPP, maximum flow rate (Qmax.), average flow rate, time to Qmax., detrusor voiding pressure at Qmax., voiding time, and postvoid residual urine volume (PVR) were assessed. The success rate was defined as cure (no or one dry “security” pad) or improvement (1-2 pads or pad reduction ≥50%). Adverse parameters included ALPP ≤30 cm H2O, Qmax. ≤10 mdL/s, and MCC ≤200 mL.

Results

Success rate after RTS was 73% (40/55 patients). Mean follow-up was 21 ±11.7 (range, 12-41) months. Only ALPP changed significantly (61 ± 14.2 vs 79 ± 20.4 cm H2O). No PVR >30 mL, de novo reduced bladder compliance and hypo- or overactivity were observed. Urine loss by 1-hour pad test (136.1 ± 119.4 vs 39.4 ± 77.0) and daily pad use (4.6 ± 2.0 vs 1.9 ± 2.1) decreased significantly. Adverse preoperative urodynamic parameters were not associated with postoperative outcome.

Conclusion

The RTS is an effective and safe device for SUI treatment without signs of compression or obstruction of the urethra or any influence on voiding parameters. Adverse preoperative urodynamic parameters have no influence on postoperative outcome.

Section snippets

Material and Methods

Between February 2006 and December 2009, 55 consecutive patients were treated with RTS in a prospective, sequential clinical study. All patients were recruited from our outpatient office and consecutively included if they had SUI after radical prostatectomy. All of them had a history of failed pelvic floor training.

Informed consent forms were received from all patients after ethical approval by the local institutional review board. The data were collected before RTS and at standardized

Results

Characteristics and specific preoperative data of patients recruited for RTS placement are listed in Table 1. The mean follow-up was 21 ±11.7 months (range, 12-41). At maximum follow-up, the cure rate was 47% (26/55 patients) and the improvement rate was 26% (14/55 patients). The failure rate was 27% (15/55 patients).

No intraoperative complications were observed. Postoperative AUR (23.6%, 13/55 patients) was treated with suprapubic or transurethral catheter for a time span ranged between 4 days

Comment

SUI remains one of the major complications after radical prostatectomy with significant negative impact on QoL. The RTS is described as a functional and nonobstructive device for treatment of SUI,6 showing a high efficacy rate in the mid-term follow-up.7, 8

The present study was conducted to evaluate changes of urodynamic parameters before and after RTS placement and the impact of adverse preoperative urodynamic parameters on postoperative outcome. At maximum follow-up, the cure rate was 47% and

Conclusions

RTS suspension is an effective and safe device for SUI treatment, without signs of urethral obstruction or any influence on voiding parameters, except for ALPP. Low ALPP, low bladder capacity, and low flow do not adversely affect the RTS outcome. Preoperative urodynamic evaluation has no predictive value on RTS outcome and should be reserved only for selected patients with symptoms of overactive bladder or to exclude neurogenic bladder dysfunction.

References (30)

Cited by (0)

Current address: Department of Urology (Chair: Dr. C. Gozzi), Hospital Brixen, Brixen, Italy

View full text