(211) Comparable Continence Rates Following Male Urethral Sling Surgery in “Standard” versus “Nonstandard” Patients
Authors: Martinez M , Antonellis M , Kaplan-Marans E , West M , Vazquez-Rivera K , Lee J , Schulman A , Khurgin J 
Published: February 2024

Abstract

Introduction
Transobturator male urethral slings are a surgical option for the management of stress urinary incontinence (SUI). Historically, patient continence and satisfaction rates are influenced by several variables, including: baseline incontinence severity, prior surgical interventions, and exposure to radiation. Ideal or “standard” patients for sling placement have mild or moderate incontinence and no prior incontinence procedures or radiation exposure. Standard patients have been proposed to have better postoperative continence and satisfaction rates than their “nonstandard” counterparts.

Objective
In this study we sought to compare the efficacy and complication rates of transobturator male sling placement between standard and nonstandard patients.

Methods
A retrospective, single-institution review was performed of all patients who underwent either an AdVance™ or an AdVanceXP™ sling insertion between October 2016 and May 2023. Patient demographics, preoperative and postoperative continence rates, and complication rates were collected. Patients were then stratified as “standard’ vs “nonstandard”. Standard patients were defined as having a history of radical prostatectomy (robotic or open) and no prior radiation or prior incontinence procedure. Nonstandard patients had prior history of transurethral resection of the prostate, simple prostatectomy, radical cystectomy, prior sling insertion, or prior radiation. The continence and complication rates were compared between groups. Continence was measured in pads per day (PPD). Improvement in continence was defined as a reduction of at least 50% in PPD at 6 weeks postoperatively. Baseline and postoperative PPD were tabulated with median and 25th-75th percentiles, then compared using Wilcoxon signed-rank test. Other variables were summarized with frequency and percentages, and compared using Fisher’s exact test.

Results
62 patients were included in this study, of which 48 and 14 were standard and nonstandard, respectively. Mean age was 66 (52-85) years and body mass index (BMI) was 29 (20.3-39.8) kg/m2. No difference in baseline characteristics were noted between the groups (Table 1). 77% of patients had an improvement in SUI following sling placement: 38/48 (79%) patients in the standard group and 10/14 (71%) patients in the non standard group. The most common complication among both groups was urinary retention requiring catheterization (29%), which resolved spontaneously within two weeks in all patients. In the nonstandard group, one patient developed an abscess, one had a scrotal hematoma, and two patients had urinary tract infections (UTI). One patient with history of radiation developed a urethrocutaneous fistula requiring sling removal. There was no significant difference in overall complication rates between standard and nonstandard patients. Comparable rates of improvement in preoperative to postoperative SUI were noted: 2.5 to 0.8 PPD in the standard group and 3.3 to 1.0 PPD in the nonstandard group (Figure 1).

Conclusions
In this study, nonstandard and standard patients had similar continence and complication rates following urethral sling placement. Future prospective studies are warranted to assess the safety and long-term outcomes of standard and nonstandard patients.

Disclosure
No.