Parameters of 2-Dimensional Perineal Ultrasonography Before and After Male Sling Procedure for Urinary Incontinence After Radical Prostatectomy.

OBJECTIVE: To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature. METHODS: Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest. RESULTS: Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024). CONCLUSION: The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.

Proposal of a new way to evaluate the external sphincter function prior male sling surgey

ABSTRACT Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

Proposal of a new way to evaluate the external sphincter function prior male sling surgey.

OBJECTIVE: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. MATERIALS AND METHODS: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to preoperative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. RESULTS: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. CONCLUSIONS: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.