[Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance™]

Abstract

Objective: To analyze the functional and urodynamic results of a compressive sub-urethral sling with bone anchoring InVance™.

Methods: One hundred and six successive patients were operated with this system between August 2004 and March 2009. Urinary incontinence was classified according to the number of daily protections. All the patients have benefited from a clinical, endoscopic and urodynamic pre and post-operative evaluation. The results were classified in four groups, at three months and at one year, according to whether the patients were dry (A), very improved (B), little improved (C), or with no improvement (D).

Results: The average age of the patients during the installation of the strip was 67.4 years (46-82). At three months, the rate of dry (A) or very improved patients (B) was of 81.2% (A=75.5%; B=5.7%), and at one year: 75.5% (A=61%; B=14.5%). At three months, the rate of patients little improved (C) or not improved (D) was of 18.8% (C=16%; D=2.8%), and at one year: 24.5% (C=20.3%; D=4.2%). These results deteriorated according to the initial rank of incontinence II, III, and I. Six patients (5.7%) were explanted because of a prosthetic infection which perished at an average of 9 months (3-18). Infection was linked to operative time (p=0.02), and patients age. No osteitis nor urethral erosion were noted. There was a significant rise in the pressures of maximum fence at rest and maximum urethral pressures in reserve (p=0.01). At one year, score ICIQ-UI SF decreased overall by 7.1 points.

Conclusion: The medium-term results of under-urethral supporting with bone anchoring InVance™ are very encouraging. This technique presents an acceptable morbidity and a good tolerance. It can be proposed in first intention for a urinary incontinence whatever the rank is, even if the effectiveness is particularly present in incontinences of rank I and II.