V8-12: Measuring the retrograde leak point pressure improves outcomes of the Virtue Male Sling

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Introductions and Objectives
Male slings were introduced in the 1990s and have been shown to be safe and effective alternatives to the artificial urinary sphincter. We report our experience with the Virtue Male Sling. Objectives of the study are to evaluate the efficacy and complication rate of the Virtue Male Sling for the treatment of post-prostatectomy incontinence (PPI) with and without per-operative retrograde leak point pressure (RLPP) measurement, and to evaluate the subjective satisfaction rate from patients regarding quality of life after treatment.

Methods
Retrospective evaluation of continence rate and complications in 42 men consecutively treated with the Virtue Male Sling for PPI between March 2009 and October 2013. Adequate sling tensioning was verified with cystoscopy in the first 18 patients, while per-operative measurement of RLPP was carried out in the last 24 patients. Follow-up schedule was at 2, 6, and 12 months, then yearly. Patient Global Impression of Improvement (PGI-I) scale was used to measure subjective satisfaction at the last follow-up visit.

Results
Mean (range) follow-up was 15.3 (0.5 - 45) months. Mean (range) age was 67 (53 - 83) years. 12 (28%) patients had mild, 20 (48%) patients had moderate, and 10 (24%) patients had severe PPI. Of the first 18 patients who did not have RLPP measured during the surgery, 11 (61%), 3 (17%), and 4 (22%) patients had no improvement ( 50% pad reduction), and cure (0 pad per day) of their PPI respectively, compared to 6 (25%), 4 (17%), and 14 (58%) of the last 24 patients who did have RLPP measured. Final mean (range) per-operative RLPP measurement was 43.6 (35 - 58) cm H2O. 11 (61%) of the 18 patients who did not, compared to 5 (20%) of 24 patients who did have RLPP measured had subsequent surgical treatments for unimproved PPI. Transient pain occurred in 7 (39%) of the 18 who did not, compared to 15 (62%) of the 24 patients who did have RLPP measured. In the group with RLPP measurement, 1 patient had a wound dehiscence which was debrided and primarily closed, and 3 patients had urinary retention, all of which resolved within 1 week. 6 (33%) of the 18 patients who did not, compared to 16 (67%) of the 24 patients who did have RLPP measured were ‘satisfied’ or ‘very satisfied’ with their device.

Conclusions
The Virtue Male Sling is a safe and valuable treatment option for mild and moderate PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates.

Funding: None