title: Suburethral sling at the time of radical prostatectomy in patients at high risk of postoperative incontinence.
abstract: OBJECTIVE
  To evaluate the insertion of a urethral sling at the time of radical prostatectomy (RP) in men at high risk of urinary incontinence after RP.
  
  
  METHODS
  Between 1998 and 2000, 49 of 871 men undergoing RP at The University of Texas M.D. Anderson Cancer Center, were identified as at risk of urinary incontinence after RP, based on their age (>65 years), previous transurethral resection of the prostate, previous radiation therapy, clinical stage, and obesity (body mass index of > or = 30 kg/m2). These 49 men had a suburethral sling inserted at the time of RP, and incontinence after surgery was evaluated using pad counts and patient-completed questionnaires. Retrospectively, incontinence rates and complications in these men were compared with 122 men also at high risk of urinary incontinence after RP who did not have a sling inserted at the time of RP (control group).
  
  
  RESULTS
  In all, 29 of 49 men (59%) with a suburethral sling reported using either no pad or one pad per day for urinary leakage at 6 months after RP, compared with 83 of 118 (70%) in the control group. At 12 months after RP, 34 of 46 (74%) men with a suburethral sling reported using no or one pad, compared with 75 of 89 (84%) in the control group. Seventeen (35%) men were treated for urethral stricture in the sling group and 17 (14%) in the control group (P = 0.001).
  
  
  CONCLUSIONS
  The urethral sling modification concurrent with RP is feasible, but does not decrease incontinence compared with a similar group of high-risk patients who did not have the sling modification. In addition, the stricture rate in the sling group was unacceptably high. Currently, we do not recommend the use of a urethral sling at the time of RP.
authors.affiliation: Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: O Lenaine
authors.initials: OL
authors.lastname: Westney
authors.forename: Shellie
authors.initials: S
authors.lastname: Scott
authors.forename: Christopher
authors.initials: C
authors.lastname: Wood
authors.forename: Teresa
authors.initials: T
authors.lastname: Eddings
authors.forename: Marcella M
authors.initials: MM
authors.lastname: Johnson
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Taylor
authors.forename: Edward
authors.initials: E
authors.lastname: McGuire
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D017568:Rectus Abdominis / Q000637:transplantation; D013524:Surgical Flaps; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery; D014549:Urinary Incontinence / Q000517:prevention & control*