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Male Sling (male + sling)
Selected AbstractsComparison of bone-anchored male sling and collagen implant for the treatment of male incontinenceINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006RAHMI ONUR Aim: To compare the effectiveness of transurethral collagen injection and perineal bone-anchored male sling for the treatment of male stress urinary incontinence (SUI). Methods: Seventy-one men with SUI underwent either transurethral collagen injections (n = 34) or perineal bone-anchored male sling (n = 37) between June 1999 and October 2003. Most of the patients in each group had radical retropubic prostatectomy and/or external beam radiation therapy (EBRT) in relation to the cause of incontinence. There was one patient in both groups who only had EBRT for the cause. The mean duration of incontinence were 4.2 and 4.4 years, respectively. Collagen injections were carried out transurethrally either under regional or general anesthesia until co-aptation of mucosa was observed. The male sling was placed under spinal anesthesia with a bone drill using either absorbable or synthetic materials. Retrospectively, all patients were assessed for continence status and procedure-related morbidity, if present. The outcome of both procedures was also compared with the degree of incontinence. Results: Ten (30%) patients in the collagen group showed either significant improvement or were cured following injections. Preoperatively, the mean pad use in collagen group was 4.5 (SD 2.8) per day, whereas it was 2.2 (SD 1.1) after the injection(s). Collagen injection failed in 24 (70%) of the patients. Patients who received the male sling had a mean preoperative pad use of 3.7 (SD 1.5) and postoperatively, the number decreased to 1.6 (SD 1.2). Most of the patients in this group were either totally dry or significantly improved (n: 28, 76%). There was a statistically significant difference between two groups in respect to success rate (P < 0.05). Analysis of treatment outcome with the degree of incontinence revealed that the male sling is most effective in patients with minimal-to-moderate incontinence. Conclusions: Our results suggest that the male sling, a minimally invasive procedure, is more effective than collagen implant in the treatment of mild-to-moderate SUI in men. [source] 87 French multicentric prospective study for treatment of postprostatectomy stress urinary incontinence (SUI) using adjustable continence therapy (PROACTÔ)BJU INTERNATIONAL, Issue 2006E. CHARTIER KASTLER Introduction:, This study assessed the feasibility and efficacy of ProACTÔ for treatment of postprostatectomy incontinence. Material and methods:, Using fluoroscopic control two percutaneous balloons are placed at the vesico-urethral anastomosis (Prostatectomy; Ablatherm) or the apex (TURP) and filled with isotonic solution. Postoperatively, 1 ml can be titrated monthly until optimum continence is achieved. Results:, Fifty-eight patients were implanted, 52 postcancer treatment (51 Radical Prostatectomy with 11/51 postradiotherapy and 1/52 Ablatherm) and six following benign surgery (four TURP and two other prostatectomies). Mean age was 70.8 years old (56.6,87.2) with time since initial surgery 5.3 years (6 months,20.6 years). Prior surgical incontinence treatments included artificial urinary sphincters (eight), bulking agent injections (three) and male sling (one). Mean urethral closure pressure (n = 36) was 49 cm of H2O at baseline. Average pads/day was 2.9 (1 to 10). Mean quality of life (I-QoL) was 45 (2,85). At median follow-up (14 months), 11 patients (19%) were dry, 21 (36%) improved, 17 (29 %) unchanged; 2 (3.4%) worse and seven (12%) had undergone explanation. Quality of Life increased to 61 (17,100). Of the 24 postradical prostatectomy patients without radiotherapy, 92 % are improved, 38 % being completely dry. However six (55%) of postradiotherapy patients failed. Sixteen patients required explanation due to infection (two); urinary retention (one); urethral erosion (one); pain (one), defective balloons (two); other (one) non-response (eight). Four patients were successfully re-implanted. Conclusion:, ProACT is an effective treatment option as an alternative to the artificial urinary sphincter. [source] Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinenceBJU INTERNATIONAL, Issue 6 2005Nadeem U. Rahman OBJECTIVE To describe a technique of externally bulking the urethra with a soft-tissue graft before placing another artificial urinary sphincter (AUS), as when placing another AUS for recurrent male stress urinary incontinence (SUI) other manoeuvres, e.g. placing a tandem cuff or transcorporal cuff, must be used to obtain urinary continence in an atrophic urethra, and each is associated with morbidity. PATIENTS AND METHODS From January 2003 to July 2004, five patients (mean age 74 years, range 62,84) treated by radical prostatectomy were referred for recurrent SUI after placing an AUS (four, including one with urethral erosion) or a male sling (one, with a resulting atrophic urethra). Each patient was treated with an external urethral bulking agent (Surgisis® ES, Cook Urological, Spencer, Indiana) and had an AUS placed. RESULTS In each patient the greatest urethral circumference was <4 cm. To place a functional 4 cm cuff, the diameter of the urethra was enhanced by wrapping it with Surgisis ES. Continence was significantly improved in all patients except one 84-year-old man who had the replanted artificial sphincter removed because of erosion 14 months after surgery. CONCLUSION In cases of severe recurrent SUI from urethral atrophy after placing an AUS, externally bulking the urethra with Surgisis ES before placing another AUS is well tolerated, and gives satisfactory results. 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