Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy

Abstract

Objective: To study the anatomical effects of placing a transobturator tape (TOT) in cadavers as well as determining the clinical outcome in men with urinary incontinence.

Methods: The study was a two stage study. The first phase was a cadaver study to examine the placement of the sling. The second part involved the placement of the sling in 20 men with incontinence, which occurred post-radical prostatectomy in 15 men. All patients had pre-operative and post-operative videourodynamics, maximum flow rate (Qmax) and residual urine measurement. Urethral pressure profiles and membranous urethral length were measured in five patients pre- and postoperatively. Incontinence was assessed on the basis of pad usage. Patients' satisfaction was recorded using a non-validated patient questionnaire at 6 weeks post-operatively.

Results: The cadaver study revealed that a leak point pressure of 60cmH(2)O was achieved on tensioning of the tape. In the clinical series, the mean (range) urethral closure pressure improved from 13.2 (8-22) to 86.4 (70-100) cmH(2)O following placement of the TOT. The membranous urethral length increased from a mean (range) of 3 (0-7) to 17.2 (10-22) mm following tensioning of the tape. No significant differences in Qmax pre- and postoperatively were observed. Incontinence cure rate (no pad usage) was 40% and improved rate (1-2 pads per day) was 30%. The majority of patients (12/20) were very satisfied with the procedure.

Conclusions: The TOT, a novel procedure for treatment of post-radical prostatectomy incontinence, was shown to be effective and well accepted by patients.