Skip to main content

Advertisement

Log in

Evaluation of Postprostatectomy Incontinence: Determining Candidacy for the Transobturator Sling

  • Voiding Dysfunction Evaluation (JT Anger, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Success rates for the male transobturator sling can be influenced by many variables. Determining who is a good surgical candidate will improve patient counseling, management of expectations, and outcomes. The extent of the currently published literature in this subject describes variable inclusion and exclusion criteria, patient evaluation strategies, and definitions of treatment success. As such, there is controversy regarding prognostic factors. Herein we review the literature to guide patient evaluation and discuss our current strategy for selecting patients who are good candidates for the male transobturator sling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Peterson AC, Chen Y. Patient reported incontinence after radical prostatectomy is more common than expected and not associated with the nerve sparing technique: results from the center for prostate disease research (CPDR) database. Neurourol Urodyn. 2012;31(1):60–3.

    Article  PubMed  Google Scholar 

  2. Tan GY, El Douaihy Y, Te AE, Tewari AK. Scientific and technical advances in continence recovery following radical prostatectomy. Expert Rev Med Devices. 2009;6(4):431–53.

    Article  PubMed  Google Scholar 

  3. Potosky AL, Miller BA, Albertsen PC, Kramer BS. The role of increasing detection in the rising incidence of prostate cancer. JAMA. 1995;273(7):548–52.

    Article  PubMed  CAS  Google Scholar 

  4. Cooperberg MR, Broering JM, Kantoff PW, Carroll PR. Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol. 2007;178(3 Pt 2):S14–19.

    Article  PubMed  Google Scholar 

  5. Kollmeier MA, Stock RG, Cesaretti J, Stone NN. Urinary morbidity and incontinence following transurethral resection of the prostate after brachytherapy. J Urol. 2005;173(3):808–12.

    Article  PubMed  CAS  Google Scholar 

  6. Buckley BS, Lapitan MC, Glazener CM. The effect of urinary incontinence on health utility and health-related quality of life in men following prostate surgery. Neurourol Urodyn. 2012.

  7. Bauer RM, Bastian PJ, Gozzi C, Stief CG. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol. 2009;55(2):322–33.

    Article  PubMed  Google Scholar 

  8. •• Bauer RM, Gozzi C, Hubner W, Nitti VW, Novara G, Peterson A, Sandhu JS, Stief CG: Contemporary management of postprostatectomy incontinence. Eur Urol 2011, 59(6):985-996. This article presents a nice review of available treatment options for PPI.

  9. Lepor H, Kaci L. The impact of open radical retropubic prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments. J Urol. 2004;171(3):1216–9.

    Article  PubMed  Google Scholar 

  10. Smither AR, Guralnick ML, Davis NB, See WA. Quantifying the natural history of post-radical prostatectomy incontinence using objective pad test data. BMC urology. 2007;7:2.

    Article  PubMed  Google Scholar 

  11. Kumar A, Litt ER, Ballert KN, Nitti VW. Artificial urinary sphincter versus male sling for post-prostatectomy incontinence–what do patients choose? J Urol. 2009;181(3):1231–5.

    Article  PubMed  Google Scholar 

  12. Rehder P, Gozzi C. Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol. 2007;52(3):860–6.

    Article  PubMed  Google Scholar 

  13. De Ridder DR, Rehder P. The advance male sling: anatomic features in relation to mode of action. Eur Urol Suppl. 2011;10:383–9.

    Article  Google Scholar 

  14. •Rehder P, Freiin von Gleissenthall G, Pichler R, Glodny B: [The treatment of postprostatectomy incontinence with the retroluminal transobturator repositioning sling (Advance): lessons learnt from accumulative experience]. Arch Esp Urol. 2009, 62(10):860–870. This article describes the theory regarding how the transobturator AdVance sling works.

  15. Davies TO, Bepple JL, McCammon KA. Urodynamic changes and initial results of the AdVance male sling. Urology. 2009;74(2):354–7.

    Article  PubMed  Google Scholar 

  16. Grimsby GM, Tyson MD, Wolter CE. Early outcomes of the transobturator male sling based on body mass index. Can J Urol. 2012;19(1):6088–93.

    PubMed  Google Scholar 

  17. Leruth J, Waltregny D, de Leval J. The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. Eur Urol. 2012;61(3):608–15.

    Article  PubMed  Google Scholar 

  18. Daly T, Hickey BE, Lehman M, Francis DP, See AM: Adjuvant radiotherapy following radical prostatectomy for prostate cancer. Cochrane database of systematic reviews (Online). 2011;12:CD007234.

  19. •• Cornu JN, Sebe P, Ciofu C, Peyrat L, Cussenot O, Haab F: Mid-term evaluation of the transobturator male sling for post-prostatectomy incontinence: focus on prognostic factors. BJU Int. 2011;108(2):236-240. This study assessed factors associated with failed AdVance sling surgery. Given limited exclusion criteria, it is a practical guide on which to base patient counseling.

  20. Rapoport D, Walter JR, Borawski KM, Webster GD. The AdVance male sling: predictors of success [abstract]. J Urol Suppl. 2009;181:619.

    Article  Google Scholar 

  21. Zuckerman JM, Tisdale B, McCammon K. AdVance male sling in irradiated patients with stress urinary incontinence. Can J Urol. 2011;18(6):6013–7.

    PubMed  Google Scholar 

  22. Bauer RM, Soljanik I, Fullhase C, Buchner A, May F, Stief CG, Gozzi C. Results of the AdVance transobturator male sling after radical prostatectomy and adjuvant radiotherapy. Urology. 2011;77(2):474–9.

    Article  PubMed  Google Scholar 

  23. Rehder P, Webster G. The AdVance male sling: patient selection and workup. Eur Urol Suppl. 2011;10:390–4.

    Article  Google Scholar 

  24. Tuygun C, Imamoglu A, Keyik B, Alisir I, Yorubulut M. Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence. Urology. 2006;68(6):1308–12.

    Article  PubMed  Google Scholar 

  25. Tuygun C, Imamoglu A, Gucuk A, Goktug G, Demirel F. Comparison of outcomes for adjustable bulbourethral male sling and artificial urinary sphincter after previous artificial urinary sphincter erosion. Urology. 2009;73(6):1363–7.

    Article  PubMed  Google Scholar 

  26. Soljanik I, Becker AJ, Stief CG, Gozzi C, Bauer RM. Repeat retrourethral transobturator sling in the management of recurrent postprostatectomy stress urinary incontinence after failed first male sling. Eur Urol. 2010;58(5):767–72.

    Article  PubMed  Google Scholar 

  27. Rehder P, Mitterberger MJ, Pichler R, Kerschbaumer A, Glodny B. The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence. BJU Int. 2010;106(11):1668–72.

    Article  PubMed  Google Scholar 

  28. •• Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM: Treatment of Postprostatectomy Male Urinary Incontinence With the Transobturator Retroluminal Repositioning Sling Suspension: 3-Year Follow-up. Eur Urol. 2012. This article is the largest study with the longest follow-up and reports sling outcomes, complications, and risk factors for AdVance sling failure in patients who could contract their sphincters completely with a pelvic floor contraction during preoperative evaluation and had no stricture disease.

  29. Li H, Gill BC, Nowacki AS, Montague DK, Angermeier KW, Wood HM, Vasavada SP. Therapeutic durability of the male transobturator sling: midterm patient reported outcomes. J Urol. 2012;187(4):1331–5.

    Article  PubMed  Google Scholar 

  30. Borawski KM, Rapoport D, Webster GD. Large volume pad weight is predictive of failure in treating Post-prostatectomy Incontinence with the AdVance sling. J Urol Suppl. 2010;183(4):587.

    Article  Google Scholar 

  31. Bauer RM, Mayer ME, Gratzke C, Soljanik I, Buchner A, Bastian PJ, Stief CG, Gozzi C. Prospective evaluation of the functional sling suspension for male postprostatectomy stress urinary incontinence: results after 1 year. Eur Urol. 2009;56(6):928–33.

    Article  PubMed  Google Scholar 

  32. Dylewski DA, Jamison MG, Borawski KM, Sherman ND, Amundsen CL, Webster GD. A statistical comparison of pad numbers versus pad weights in the quantification of urinary incontinence. Neurourol Urodyn. 2007;26(1):3–7.

    Article  PubMed  Google Scholar 

  33. Thuroff JW, Abrams P, Andersson K-E, Artibani W, Chapple CR, Drake MJ, Hampel C, Neisius A, Schroder A, Tubaro A. EAU Guidelines on Urinary Incontinence. Eur Urol. 2011; 59:387-400.

  34. Soljanik I, Becker AJ, Stief CG, Gozzi C, Bauer RM. Urodynamic parameters after retrourethral transobturator male sling and their influence on outcome. Urology. 2011;78(3):708–12.

    Article  PubMed  Google Scholar 

  35. Winters JC, Appell RA, Rackley RR. Urodynamic findings in postprostatectomy incontinence. Neurourol Urodyn. 1998;17(5):493–8.

    Article  PubMed  CAS  Google Scholar 

  36. Crites MA, Sorial A, Ghoniem GM. Risk factors for male slings: a comparative study of two techniques. Urology. 2011;78(1):192–6.

    Article  PubMed  Google Scholar 

  37. • Han JS, Brucker BM, Demirtas A, Fong E, Nitti VW. Treatment of post-prostatectomy incontinence with male slings in patients with impaired detrusor contractility on urodynamics and/or who perform Valsalva voiding. J Urol. 2011;186(4):1370–1375. This study demonstrates that slings can be safely placed in this patient population.

  38. •• Lentz AC, Peterson AC, Webster GD. Outcomes following artificial sphincter implantation after prior unsuccessful male sling. J Urol. 2012;187(6):2149–53. This study shows that slings can be offered in any patient who is willing to accept the risk of failure without compromising the chance for success with salvage surgery.

Download references

Disclosure

Dr. Peterson has served as a consultant for, received grant support from, and received honoraria and payment for development of educational presentations (including service on speakers’ bureaus) for serving as a course instructor from American Medical Systems.

Dr. Bernal reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raymond M. Bernal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bernal, R.M., Peterson, A.C. Evaluation of Postprostatectomy Incontinence: Determining Candidacy for the Transobturator Sling. Curr Bladder Dysfunct Rep 7, 215–221 (2012). https://doi.org/10.1007/s11884-012-0145-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-012-0145-8

Keywords

Navigation