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A modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for male stress urinary incontinence: a pilot study

  • Urology - Original Paper
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Abstract

Objectives

The aim of this study was to demonstrate the feasibility of a modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence and to preliminarily evaluate the short-term clinical efficacy of this technique.

Patients and methods

The clinical data of patients treated with the modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique using a Pelvimesh pelvic floor repair patch as a sling were collected. The primary evaluation criteria were surgery-related indicators and daily urinal pad usage before and after treatment, and the secondary evaluation criteria were the corresponding incontinence scores and the results of surgery-related questionnaires.

Results

After 1–12 months of follow-up, seven patients were clinically cured. Follow-up 1 month after surgery showed that one patient (14.3%) used one pad daily, and six patients (85.7%) did not need pads. The incontinence quality of life questionnaire (I-QOL) scores at 3 days and 1 month postoperatively were 89.4 ± 2.5 and 88.1 ± 6.7, respectively, which were significantly higher than the preoperative scores (31.5 ± 18.9) (P < 0.05). The scores of the International Continence Control Association Incontinence Questionnaire Short Form (ICI-Q-SF) at 3 days and 1 month postoperatively were 3.2 ± 0.9 and 4.2 ± 1.7, respectively, which were significantly lower than the preoperative scores of 19.4 ± 5.0 (P < 0.05). In addition, the results of the surgery-related questionnaires were positive. No serious complications occurred in any of the patients.

Conclusion

The modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence patients is safe, effective, minimally invasive, and has few complications. However, further validation in large sample, randomized, comparative, and longer-term follow-up studies is still needed.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Nelson M, Dornbier R, Kirshenbaum E et al (2020) Use of surgery for post- prostatectomy incontinence [J]. J Urol 203:786–791. https://doi.org/10.1097/JU.0000000000000618

    Article  PubMed  Google Scholar 

  2. MacDonald S, Colaco M, Terlecki R (2017) Waves of change: national trends in surgical management of male stress incontinence [J]. Urology 108:175–179. https://doi.org/10.1016/j.urology.2017.04.055

    Article  PubMed  Google Scholar 

  3. Doudt AD, Zuckerman JM (2018) Male slings for post-prostatectomy incontinence [J]. Rev Urol 20:158–169. https://doi.org/10.3909/riu080

    Article  PubMed  PubMed Central  Google Scholar 

  4. Campeau L, Tu LM, Lemieux MC et al (2007) A multicenter, prospective, randomized clinical trial comparing tension-free vaginal tape surgery and no treatment for the management of stress urinary incontinence in elderly women [J]. Neurourol Urodyn 26:990–994. https://doi.org/10.1002/nau.20440

    Article  CAS  PubMed  Google Scholar 

  5. Athanasopoulos A, Konstantinopoulos A, Mcguire E (2010) Efficacy of the InVance male sling in treating stress urinary incontinence: a three-year experience from a single center [J]. UrolInt 85(4):436–442. https://doi.org/10.1159/000314918

    Article  Google Scholar 

  6. Athanasopoulos A, Mcguire EJ (2010) Efficacy of the bulbourethral autologous sling in treating male stress urinary incontinence: a three-year experience from a single center [J]. IntUrolNephrol 42(4):921–927. https://doi.org/10.1007/s11255-010-9742-7

    Article  CAS  Google Scholar 

  7. Mühlstӓdt S, Friedl A, Mohammed N et al (2017) Five-year experience with the adjustable transobturator male system for the treatment of male stress urinary incontinence: a single-center evaluation [J]. World J Urol 35(1):145–151. https://doi.org/10.1007/s00345-016-1839-x

    Article  CAS  Google Scholar 

  8. Sousa-Escandón A, Cabrera J, Mantovani F et al (2007) Adjustable suburethral sling (male remeex system) in the treatment of male stress urinary incontinence: a multicentric European study [J]. EurUrol 52(5):1473–1479. https://doi.org/10.1016/j.eururo.2007.05.017

    Article  Google Scholar 

  9. Bauer RM, Mayer ME, Gratzke C et al (2009) Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year [J]. EurUrol 56(6):928–933. https://doi.org/10.1016/j.eururo.2009.07.028

    Article  Google Scholar 

  10. Milios JE, Ackland TR, Green DJ (2019) Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence [J]. BMC Urol 19:116. https://doi.org/10.1186/s12894-019-0546-5

    Article  PubMed  PubMed Central  Google Scholar 

  11. Van der Aa F, Drake MJ, Kasyan GR et al (2013) The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence [J]. Eur Urol 63(4):681–689. https://doi.org/10.1016/j.juro.2014.03.071

    Article  PubMed  Google Scholar 

  12. Sacco E, Gandi C, Marino F et al (2021) Artificial urinary sphincter significantly better than fixed sling for moderate post-prostatectomy stress urinary incontinence: a propensity score-matched study [J]. BJU Int 127(2):229–237. https://doi.org/10.1111/bju.15197

    Article  PubMed  Google Scholar 

  13. Leon P, Chartier-Kastler E, Roupret M et al (2015) Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence [J]. BJU Int 115(6):951–957. https://doi.org/10.1111/bju.12848

    Article  PubMed  Google Scholar 

  14. Boswell TC, Elliott DS, Rangel LJ et al (2020) Long-term device survival and quality of life outcomes following artificial urinary sphincter placement [J]. Transl Androl Urol 9:56–61. https://doi.org/10.21037/tau.2019.08.02

    Article  PubMed  PubMed Central  Google Scholar 

  15. Grabbert M, Mumm JN, Klehr B et al (2018) Extended follow-up of the Advance XP male sling in the treatment of male urinary stress incontinence after 48 months: results of a prospective and multicenter study [J]. Neurourol Urodyn 38:1973–1978. https://doi.org/10.1002/nau.24101

    Article  Google Scholar 

  16. Tutolo M, Cornu JN, Bauer RM et al (2019) Efficacy and safety of artificial urinary sphincter (AUS): results of a large multi-institutional cohort of patients with mid-term follow-up [J]. Neurourol Urodyn 38:710–718. https://doi.org/10.1002/nau.23901

    Article  PubMed  Google Scholar 

  17. Traverso P, Mantica G, Gallo F et al (2019) Risk factors for resurgery in men with artificial urinary sphincter: role of urethral strictures [J]. Low Urin Tract Symptoms 16:11–20. https://doi.org/10.1111/luts.12205

    Article  Google Scholar 

  18. Constable L, Cotterill N, Cooper D et al (2018) Male synthetic sling versus artificial urinary sphincter trial for men with urodynamic stress incontinence after prostate surgery (MASTER): study protocol for a randomized controlled trial [J]. Trials 19:131. https://doi.org/10.1186/s13063-018-2501-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hermans B, Van der Aa F (2019) Surgery for male stress incontinence: which technique and when? [J]. EurUrol Focus 5:310–311. https://doi.org/10.1016/j.euf.2019.03.017

    Article  Google Scholar 

  20. Ricarda MB, Markus TG, Benedikt K et al (2017) 36-month data for the AdVance XP male sling: results of a prospective multicenter study [J]. BJ U int 119:626–630. https://doi.org/10.1111/bju.13704

    Article  Google Scholar 

  21. Hübner WA, Gallist H, Rutkowski M et al (2011) Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence [J]. BJU Int 107(5):777–782. https://doi.org/10.1111/j.1464-410X.2010.09619.x

    Article  PubMed  Google Scholar 

  22. Bauer RM, Grabbert MT, Klehr B et al (2017) 36-month data for the advance XP (R) male sling: results of a prospective multicenter study[J]. BJU Int 119(4):626–630

    Article  PubMed  Google Scholar 

  23. Collado A, Domiinguez-Escrig J, Ortiz Rodriiguez IM et al (2019) Functional follow-up after advance and XP male sling surgery: assessment of predictive factors [J]. World J Urol 37:195–200. https://doi.org/10.1007/s00345-018-2357-9

    Article  PubMed  Google Scholar 

  24. Oktay U, Serra S, Osman ZK et al (2021) Urinary continence after high urogenital sinus repair conducted with posterior prone approach: electromyography-uroflowmetric assessment [J]. Int Urol Nephrol 53(9):1813–1818. https://doi.org/10.1007/s11255-021-02895-7

    Article  Google Scholar 

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Acknowledgements

This study was sponsored by the Top-level Clinical Discipline Project of Shanghai Pudong (No.PWYgf 2021-06); Key Medical Specialties of Shanghai Health and Health System (ZK2019A09).

Author information

Author notes

  1. Yingxiu Chen, Xin Song contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, 54 Youdian Road, Hangzhou, 310000, Zhejiang, China

    Yingxiu Chen & Jiasheng Yan

  2. Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China

    Yingxiu Chen & Jiasheng Yan

  3. Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China

    Yingxiu Chen

  4. Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China

    Xin Song, Tingting Lv, Jin Huang, Zhikang Cai & Jiasheng Yan

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  1. Yingxiu Chen
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  2. Xin Song
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  4. Jin Huang
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Contributions

YC and XS designed the study with the help of ZC and and JY. YC and ZC performed the surgical operation. TL and JH analyzed the data, and JY also contributed to the data. The manuscript was written by YC and JY. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Jiasheng Yan.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest to declare.

Research involving human participants and disclosure

The study involved human participants (not applicable to animal studies) and was approved by the Ethics Committee of Shanghai Pudong New Area Gongli Hospital (Medical ethics approval number: GLYYls2023-010), and all patients signed an informed consent form. The procedures followed in this study followed the Declaration of Helsinki of the World Medical Association, as amended in 2013 and the study was registered with Chinese Clinical Trial Registry (ChiCTR2300072254).

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Additional file 1 (DOCX 15 KB)

Appendices

Appendices

Specific evaluation scores used to assess the surgical treatment.

Appendix 1

Daily urine pad usage questionnaire.

Please tick a number between 0 (no urine pads) and 10 or above (use 10 or more pads):

figure a

Note: the higher the value, the higher was the number of pads used daily (day/tablet).

Appendix 2

The Patient Satisfaction Quality Scores (PSQ).

Please tick a number between 1 (completely dissatisfied) and 10 (completely/ considerably satisfied):

figure b

Note: 1–2 is completely dissatisfied; 3–4 is moderately dissatisfied; 5–6 is halfway satisfied; 7–8 is moderately satisfied; 9–10 is completely/considerably satisfied. Higher scores indicate higher satisfaction.

Appendix 3

The surgical expectation conformity scores (TSEC-S).

Please tick a number between 1 (not meet expectations at all) and 10 (completely /considerably met expectations):

figure c

Note: 1–2 is not meet expectations at all; 3–4 is not meet expectations moderately; 5–6 is met expectations halfway; 7–8 is met expectations moderately; 9–10 is completely/considerably met expectations. Higher scores indicate higher completely/considerably met expectations.

Appendix 4

Preoperative anticipation score questionnaire.

figure d

Appendix 5

Surgical efficacy satisfaction score questionnaire.

figure e

Appendix 6

Recommendation score questionnaire.

figure f

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Chen, Y., Song, X., Lv, T. et al. A modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for male stress urinary incontinence: a pilot study. Int Urol Nephrol 56, 901–912 (2024). https://doi.org/10.1007/s11255-023-03822-8

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