PURPOSE: To compare continence outcomes in patients with post-prostatectomy stress urinary incontinence (PPSUI) treated with a salvage artificial urinary sphincter (AUS) versus a secondary transobturator sling.
MATERIALS/METHODS: We retrospectively reviewed patients undergoing salvage procedures after sling failure from 2006 to 2012. Post-operative success was defined as the use of 0-1 pad, negative stress test or pad-weight less than 8g/day. We performed the Wilcoxon test, Cox regression model and Kaplan-Meier survival analysis.
RESULTS: 61 men presenting with sling failure were included. 32 went directly to an AUS and 29 underwent a secondary sling. 47% of the AUS cohort received prior external beam radiation therapy versus 17% of the secondary sling cohort (p=0.01). Average pre-operative 24 hour pad-weight and pad number were higher in the AUS cohort. The median follow-up for the AUS and secondary sling patients was 4.5 (IQR 4-12) and 4 (IQR 1-5) months, respectively. Overall treatment failure was seen in 55% (16/29) of secondary sling versus 6% (2/32) of AUS patients with an unadjusted hazard ratio of 7 (95%CI 2-32) and an adjusted hazard ratio of 6 (95%CI 1-31).
CONCLUSION: In this cohort of PPSUI patients with a failed primary sling, those who underwent a secondary sling were up to 7 times more likely to have persistent incontinence versus those who underwent AUS placement. This data is useful in counseling patients and for surgical planning. We currently recommend placement of an AUS for patients who have failed an initial sling.
Written by:
Ajay D, Zhang H, Gupta S, Selph JP, Belsante MJ, Lentz AC, Webster GD, Peterson AC. Are you the author?
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina; School of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Urology, University of Kentucky, Lexington, Kentucky.
Reference: J Urol. 2015 May 8. pii: S0022-5347(15)03914-2.
doi: 10.1016/j.juro.2015.04.106
PubMed Abstract
PMID: 25963183