A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months. .

Estudo comparativo entre sling pubovaginal de parede vaginal e sling de fáscia do reto abdominal no tratamento da incontinência urinária de esforço / Comparative study between vaginal wall sling and rectus fascia pubovaginal sling in the treatment of stress urinary incontinence

OBJETIVO: A cirurgia de sling pubovaginal é utilizada no tratamento da incontinência urinária de esforço (IUE) do tipo III e como resgate na falha de procedimentos anteriores. Tem índice de sucesso variando de 73 a 89 por cento. Podem ser utilizados diversos materiais autólogos e sintéticos com semelhantes resultados. Nosso objetivo foi comparar o sling de parede vaginal com o de fáscia do reto abdominal quanto à eficácia e às complicações. MÉTODO: Foram estudadas 27 pacientes no período de 04/98 a 09/00, divididas em dois grupos: grupo I com nove pacientes submetidas a sling de parede vaginal; grupo II com 18 pacientes submetidas a sling de fáscia do reto abdominal. Todas foram submetidas a um estudo urodinâmico completo, classificadas quanto ao tipo de IUE, e seguidas no ambulatório de urologia. RESULTADOS: grupo I com média de idade de 51,4 anos, tempo de seguimento médio de 14,3 meses. Pressão de Perda aos Esforços (PPE) variando de 50 a 100cmH2O com média de 81,1cmH2O. Houve 66 por cento de complicações. Taxa de sucesso de 88,8 por cento e índice de satisfação 85 pontos. Grupo II com média de idade de 54,2 anos, seguimento médio de 19,3 meses. PPE variando de 45 a 92cmH2O, média de 65,5cmH2O. Houve 72 por cento de complicações e sucesso de 88,8 por cento. Índice de satisfação de 74 pontos. CONCLUSÕES: Os dados encontrados estão de acordo com a literatura, sendo os dois grupos comparáveis quanto à eficácia em período curto de seguimento. O grupo II apresentou maior número de complicações, assim como maior tempo de cateter vesical e menor índice de satisfação geral.

BACKGROUND: Pubovaginal sling is being currently used for the treatment of type III Stress Urinary Incontinence (SUI) and for recurrences after previous procedures. Success rates vary from 73 to 89 percent. Many autologous and allogênic materials have being used with a variable rate of complications. Our objective was to compare the vaginal wall sling to the rectus fascia pubovaginal sling concerning effectiveness and complications. METHOD: Twenty seven patients submitted to pubovaginal sling between 04/98 and 09/00 were divided into two groups: Group I includes 9 patients submitted to vaginal wall sling while Group II with 18 patients submitted to rectus fascia pubovaginal sling. All patients underwent a complete urodinâmic study. They were classified according to the type of SUI and followed at the urology clinic where complications and patient satisfaction index were registered. RESULTS: Group I: The mean age was of 51.4 years. The a mean follow-up period was 14,3 months. The Valsalva leak point pressure (VLPP) varied from 50 to 100cmH2O, with a mean pressure of 81.1cmH2O. Six patients (66 percent) presented postoperative complications. Curative rate was 88.8 percent and patient satisfaction index was 85 points. Group II: The mean age was of 54.2 years; the mean follow-up period was 19,3 months. The VLPP varied from 45 to 92cmH2O, with a mean pressure of 65,5cmH2O. Thirteen patients (72 percent) presented postoperative complications. The curative rate was 88.8 percent and the patient of satisfaction index was 74 points. CONCLUSIONS: Both techniques have a comparable effectiveness during a short follow-up period. The use of rectus fascia pubovaginal sling was associated with more postoperative complications, longer urethral catheterization and lawer patient satisfaction index.