Abstract
Purpose
Prospective evaluation of independent risk factors for failure of the retrourethral transobturator sling suspension (RTS) with special attention on sphincter function and surgical technique.
Methods
A total of 189 patients with postprostatectomy stress urinary incontinence (SUI) were treated with RTS (AdVance® sling) in a prospective clinical study with a mean follow-up of 20.8 months. Eleven patients were lost to follow-up. Uni- and multivariate analyses were performed to identify independent risk factors for RTS failure. The success rate was defined as cured (no pad use or one dry ‘security’ pad) or improved (one to two pads and pad reduction ≥50%).
Results
At a mean follow-up of 20.8 months, the overall success rate was 73.1%. Multivariate analysis revealed that weak residual function and incomplete closure of the sphincter (OR, 29.0), no elongation of the coaptive sphincter zone (OR, 26.9), no sling tunnelling (OR, 22.6) and use of resorbable sutures with a small number (≤4) of stitches (OR, 8.4) are significant predictors for RTS failure.
Conclusions
Preoperative selection of the patients with regard to residual sphincter function and a special attention on better sling fixation may increase RTS efficacy.
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Abbreviations
- RTS:
-
Retrourethral transobturator sling
- SUI:
-
Postprostatectomy stress urinary incontinence
- AR:
-
Adjuvant pelvic radiotherapy
- PVR:
-
Postvoid residual urine
- EUS:
-
External urethral sphincter
- AUR:
-
Acute postoperative urinary retention
- ROC:
-
Receiver operating characteristic
- AUC:
-
Area under the receiver operating characteristic curve
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Acknowledgments
The study has not been financially supported.
Conflict of interest
Christian Gozzi holds the intellectual property as a co-inventor of the procedure. Christian Gozzi declares consultancy work, lectures and participation in clinical trials for AMS. Ricarda M. Bauer declares lectures for AMS. All authors declare that no funding or other agreement has limited their ability to fairly complete and publish this data, and they had full control of the primary data. There has been no extra-institutional funding for this study.
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Soljanik, I., Gozzi, C., Becker, A.J. et al. Risk factors of treatment failure after retrourethral transobturator male sling. World J Urol 30, 201–206 (2012). https://doi.org/10.1007/s00345-011-0671-6
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DOI: https://doi.org/10.1007/s00345-011-0671-6