Presentation Authors: Michael Chua*, Jack Zuckerman, James Bradley Mason, Jessica DeLong, Ramon Virasoro, Jeremy Tonkin, Kurt McCammon, Norfolk, VA
Introduction: Long term outcomes of transobturator male sling evaluated according to baseline urinary incontinence severity has not been reported. We aim to present the long-term outcome of transobturator sling for male stress urinary incontinence clustered according to baseline urinary incontinence severity and further determine the predictors for durability of treatment success.
Methods: After IRB approval, a non-concurrent study was performed on a prospectively maintained database for all males with stress urinary incontinence (SUI) who underwent transobturator sling at our institution from August 2006 to June 2012. Patient demographics and perioperative data such as co-morbidities, history of pelvic radiation, prior treatments, concomitant urge incontinence, concomitant procedure, and urodynamic (UDS) findings were extracted. Baseline SUI severity was clustered into mild (â‰¤2 ppd), moderate (3-4 ppd) or severe (â‰¥5 ppd). The treatment outcomes such as post-treatment pads per day (ppd), outcome satisfaction and need for subsequent procedures were extracted up to 5 years post-op. Success was defined as complete dryness with zero wet pad used (cured) and patient satisfaction without further procedures needed. Bivariate analysis was performed to determine difference between groups and significant clinical variables associated with treatment success. Time to event (treatment failure) analysis was performed using Kaplan-Meier analysis with log-rank test. Predictors for long-term treatment outcome were determined using Multiple Cox regression analysis.
Results: A total of 215 patients (mild 59, moderate 94, severe 62) with mean follow-up duration of 56.4Â±41.6 were included for analysis. On last clinic follow-up evaluation, 96 (44.7%) patients were determined to have post-procedural success. When clustered according to baseline SUI severity as mild, moderate and severe, the outcome success was 67.8%, 46% and 19.4%, respectively. Bivariate analysis showed that pelvic radiation (p=0.044), concomitant urgency symptoms (p=0.003), SUI severity clusters (p < 0.0001), detrusor overactivity on UDS (p=0.001) and Valsalva leak point pressure (p=0.033) were significantly associated with successful outcome. Kaplan-Meier with Log-rank test and Multiple Cox regression determined that baseline SUI severity (p=0.002) is the only independent predictor for long-term durability of outcome success.
Conclusions: Given our strict criteria on successful outcome as perceived by the patient, our study data gives a more realistic representation of long-term outcome of transobturator sling for the treatment of male SUI. Furthermore, the time to event analysis up to 5-year postoperative follow-up has determined that baseline SUI severity is the only independent predictor for treatment success sustainability. Hence, we suggest that transobturator male sling is an appropriate option for patients with mild incontinence, who may benefit with better long-term success rates.