V411: Spiral Sling Procedure in Male Incontinence
VideoIntroduction and Objectives
Treatment of male urinary incontinence has shifted towards simpler and minimally-invasive procedures due to the increased cost, infection and revision risks of artificial urinary sphincters. We evaluated our results with transobturator spiral sling procedures to obtain circular coaptation in patients.
2008 and 2011, 22, 6, and 1 male patients received transobturator spiral sling for incontinence after radical prostatectomy, transvesical prostatectomy, and orthotopic neobladder surgeries, respectively. Surgical technique: After a midline 4 cm perineal incision, bulbospongios muscle was separated from surrounding tissues. 1-1.5 cm width prolen mesh tape was placed in form of ventral to dorsal urethra in 360 ° rotating spiral to provide circular coaptation to the bulber urethra after liberalization of the bulber urethra. This procedure performed for mild and modererate urinary incontinence. Under spinal anesthesia, residual external sphincter was endoscopically obseved by cough provacation, and stricture of the bladder neck was ruled out.
Time of preoperative incontinence 8- 72 months. Time of postop follow-up: 3-26 months. Patients used 3.8±1.1 pads/day preoperative. Seven patients had complete dryness. Clinical improvement in 6 cases. Four patients had numbness in the perineum. Complete dryness was achieved in 14 patients who underwent transobturator sling. Nine cases required anticholinergic treatment. No patient had urethral erosion. In three patients who had unsuccesful sling operation, artificial sphicter was performed by penoscrotal incision. Other patients either unwanted to reoperation or pleasure to gradual improvement because of sling operation. More acceptable cost of spiral sling than artificial sphincter and endoscopically observed residual external sphincter, Number of pad usage in a day clearly was decreased by spiral sling.
Our experience has revealed prominent success rates in transobturator sling procedures in male incontince. Assessment of post-radical prostatectomy and posttransvesical prostatectomy results should be done separately.