V402: LONG-TERM OUTCOMES OF PATIENTS UNDERGOING THE STANDARD VERSUS MODIFIED (5 POINTS OF FIXATION, 1 POINT OF PLICATION) TECHNIQUE FOR VIRTUE MALE SLING PLACEMENT
VideoIntroduction and Objectives
The male sling has become increasingly utilized over the past decade for low-volume stress urinary incontinence. Although various sling designs and materials are currently available, little data has been reported to date on the Virtue male sling. Our group sought to report initial results as well as outcomes following modifications to placement of the Virtue male sling.
A retrospective analysis was performed of patients undergoing male sling placement for low-volume stress incontinence from 2009-2011. Mid-way through the study period, the standard technique for placement of the Virtue male sling was modified by adding five points of fixation (bilateral obturator and suprapubic arms, crossing over of suprapubic arm) and one point of plication (plication sutures in the ventral portion of the sling) to provide additional sling tension and improve outcomes. Data were reviewed for demographic material, pre- and post-operative factors, and long-term post-operative outcomes.
Twenty-six patients were identified having undergone sling placement via the standard (n=15) or modified techniques (n=11) with a median follow-up 22 months.
Pre-operative pad requirements (2 vs 2, p=0.40) and radiation (20% [3/15] vs 9% [1/11], p=0.61) were statistically similar between the standard and modified technique groups, respectively. Patients undergoing the modified technique experienced a higher rate of incontinence resolution requiring no pads (45% [5/11] vs 7% [1/15], p=0.05), while the standard technique group experienced a higher percentage of patients with no post-operative improvements (47% [7/15] vs 9% [1/11], p=0.08). Post-operative retention rates were similar between groups (standard 42% [5/12] vs modified 63% [5/8], p=0.65). Persistent pain at most recent follow-up trended towards an increase in the modified technique group (45% [5/11] vs 13% [2/15], p=0.09).
Modifications to the Virtue male sling placement with 5-points of fixation and 1-point of plication result in improved post-operative continence. Additional study and validation is required prior to routine implementation.