Objective and quality-of-life outcomes with bone-anchored male bulbourethral sling.

OBJECTIVES: To investigate the success rates and quality-of-life outcomes with the male bulbourethral sling using the validated Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ). These validated incontinence questionnaires for men have not been reported in the sling population. METHODS: A total of 31 consecutive patients underwent placement of a male bulbourethral bone-anchoring sling from October 2002 through May 2005. The preoperative information included history and physical examination, pad history, urodynamic findings, and MUDI and MUSIQ results. Postoperatively, the patients were evaluated clinically and completed a MUDI and MUSIQ every 6 months. RESULTS: Of the 31 patients, 24 completed the questionnaires and follow-up protocol. Of the other 7 patients, 4 underwent sling removal and 3 were lost to follow-up. The average follow-up time was 15 months (range 9 to 21). After surgery, the pad use decreased from a median of 3.7 pads/day (range 1 to 12) to 1.3 pads/day (range 0 to 6). Of the 24 analyzed patients, 18 (75%) were dry or using 1 pad or less per day, and 9 (38%) no longer needed pads. Subjectively, 75% of the patients were satisfied. The mean MUDI and MUSIQ scores decreased from 56.8 and 29.9 preoperatively to 44.8 (P <0.0001) and 14.6 (P = 0.002) after sling placement, respectively. When all 31 patients were included, our clinical success rate of 1 pad/day or less decreased to 58%. CONCLUSIONS: Of the 24 patients with follow-up data, 75% were satisfied and were clinically cured. A significant improvement was seen after surgery in the MUDI and MUSIQ scores, severity of incontinence, and average pad use. The MUDI and MUSIQ scores paralleled patient satisfaction and clinical success after male bulbourethral sling placement.

Evaluation and management of malfunctioning sacral neuromodulator.

OBJECTIVES: To describe a strategy for revising the malfunctioning InterStim device and to provide an algorithm for evaluation and management. METHODS: We retrospectively reviewed 82 patients who had undergone InterStim placement. Ten patients (eight women and two men) experienced complications and subsequently underwent revision of their device between October 2001 and October 2003. Five patients had originally received a permanent implant after a successful percutaneous test stimulation trial, and five had undergone a test stimulation using the tined lead. Indications for revision included gradual onset of recurrent voiding dysfunction (n = 2), lead migration (n = 5), generator malfunction (n = 1), generator site pain and infection (n = 1), and genital/rectal pain with stimulation (sensory discomfort; n = 1). RESULTS: Of the 10 patients who underwent revision, 7 experienced complete resolution of their problem. Eight patients had lead site changes and two had generator replacements. No intraoperative or postoperative complications occurred in the revision cases. CONCLUSIONS: In our experience, 70% of patients who undergo revision of the malfunctioning InterStim can expect success. In this study, no difference in success appeared to be related to the original cause of malfunction. In the management of malfunctioning sacral neuromodulators, we recommend an attempt at revision before permanent explantation.