Repeat retrourethral transobturator sling in the management of recurrent postprostatectomy stress urinary incontinence after failed first male sling.
BACKGROUND
A failure rate between 20% and 45.5% after retrourethral transobturator sling (RTS) is reported. Recommendations for the management of persistent or recurrent postprostatectomy stress urinary incontinence (SUI) after failed male sling do not exist.


OBJECTIVE
The aim of this study was the prospective evaluation of the efficacy of repeat RTS (RRTS) in patients after failed first RTS.


METHODS
Between March 2007 and August 2009, 35 patients with mild to severe SUI after failed first RTS were treated with a second AdVance sling (American Medical Systems, Minnetonka, MN, USA).


METHODS
Preoperative and postoperative evaluation included daily pad use, 1-hr pad test, postvoiding residual (PVR) urine, uroflowmetry, and quality-of-life (QoL) scores.


CONCLUSIONS
After 6 mo, 45.5% (15 of 33 patients) showed no pad use; 30.3% (10 of 33 patients), one dry "security" pad; 3% (1 of 33 patients), one wet pad; 6.1% (2 of 33 patients), two pads; 3% (1 of 33 patients), pad reduction ≥50%; and 12.1% (4 of 33 patients), treatment failure. After 16.6 mo, 34.5% (10 of 29 patients) showed no pad use; 37.9% (11 of 29 patients), one dry "security" pad; 3.4% (1 of 29 patients), one wet pad; 3.4% (1 of 29 patients), two pads; 10.3% (3 of 29 patients), pad reduction ≥50%; and 10.4% (3 of 29 patients), treatment failure. Daily pad use and pad weight decreased significantly. PVR and uroflowmetry results showed no significant change. QoL improved significantly. Postoperative acute urinary retention was observed in 23.6% of patients.


CONCLUSIONS
RRTS is an effective and safe treatment option for the management of SUI after failed first RTS.
Soljanik
Irina
I
Department of Urology, Klinikum Grosshadern, Ludwig-Maximilian-University Munich, Munich, Germany. Irina.Soljanik@med.uni-muenchen.de
Becker
Armin J
AJ
Stief
Christian G
CG
Gozzi
Christian
C
Bauer
Ricarda M
RM
D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000706:statistics & numerical data; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000601:surgery*