Risk factors for male slings: a comparative study of two techniques.

OBJECTIVE: To improve patient selection for male slings. Our primary aim was to identify preoperative risk factors for failures. Our secondary aim was to compare bone-anchored male sling (BAMS) to transobturator male sling (TOMS) and patient satisfaction accordingly. METHODS: A retrospective review was performed from 2000 to 2010 of males who received male slings. Exclusions had follow-up<1.5 months. Data examined included demographics, urodynamic parameters, pad usage, presence of detrusor overactivity (DO), and previous urethral diseases. Failure was defined as ≥4 pads used per day or ≤50% improvement by Patient Global Impression of Improvement (PGI-I). Preoperative risk factors for failure were analyzed for statistical significance. RESULTS: Sixty-four patients (mean age, 69.8±9.2 years) were analyzed. Forty-one received BAMS and 23 received TOMS with median follow-up of 46 months (range, 1.5-112) and 18 months (range, 3-33), respectively (P=.01). Perioperative decrease in pad usage was statistically significant in the TOMS group (range, 4.0-1.8, P=.00) compared with the BAMS group (range, 4.3-3.9, P=.37). Failure rate was 68.3% (28/41) in BAMS and 30.4% (7/23) in TOMS (P=.01). The PGI-I demonstrated increased satisfaction with TOMS (P=.005). Preoperative risk factors suggest increased pad usage, low maximal urethral closure pressure (MUP), low abdominal leak point pressure (ALPP), decreased functional length (FL), and presence of DO and urethral disease favor failure. CONCLUSIONS: Patients with preoperative risk factors, such as increased pad usage, low MUP, low ALPP, decreased FL, and presence of DO and urethral disease may not be appropriate sling candidates. Findings support TOMS, whichhas fewer failures and higher patient satisfaction but may be secondary to improved patient selection.

The role of synthetic slings in male stress incontinence.

OBJECTIVE: Our primary aim was to compare the outcomes of synthetic bone-anchored male slings (BAMS) and transobturator male slings (TOMS), to identify preoperative risk factors for failure, and to evaluate patient satisfaction with each procedure. PATIENTS AND METHODS: Charts were reviewed retrospectively of patients who underwent synthetic BAMS or TOMS from 2000 to 2011. Data were categorised into groups based on outcomes of 'dry', 'improved' and 'failure'. Success was defined as completely dry or an improvement by >50% in daily pad use. The data analysed included demographics, daily pad use before and after surgery, previous urethral insult, type of prostatectomy, and urodynamic study variables. Data were analysed using logistical regression, the t-test and chi-square analysis, where appropriate. RESULTS: Sixty-eight men were analysed (30 in each group; eight patients were excluded). Daily pad use for the TOMS group changed from 3.5 before to 1.5 after surgery (P = 0.001), whilst the BAMS group was unchanged from 3.9 to 3.5 (P = 0.747). The TOMS group had a success rate of 23/30 (77%) and a mean (SD) patient global impression of improvement score of 1.67 (0.90), whilst the BAMS group had a success rate of 11/30 (37%) and mean (SD) score of 2.64 (1.12). Urethral insult (P = 0.001) and preoperative pad use (P = 0.047) were significant predictors of failure. CONCLUSION: TOMS gave better outcomes than BAMS in both performance and patient satisfaction. Patients with a greater severity of incontinence and evidence of urethral insult before surgery should be counselled about the likelihood of suboptimal outcomes with any type of sling placement.

Bladder mass "collagenoma".

Large bladder masses are typically found to be malignant in nature. We present a case of a large bladder neck mass as a result of previous imprecise collagen injection for urethral bulking. The patient was successfully treated as an outpatient with transurethral excision of the collagen mass combined with post-operative anticholinergic therapy.