The Retrourethral Transobturator Sling Suspension in the Treatment of Male Urinary Stress Incontinence: Results of a Single Institution Experience

Objective. To evaluate functional outcome of the retrourethral transobturator sling suspension (RTS) in the treatment of stress urinary incontinence (SUI) caused by prior prostate surgery. Methods. The RTS (AdVance male sling) was implanted in 32 patients who suffered from mild to severe postsurgical-treatment incontinence at the University Hospital Ulm from September 2010 to September 2011 including 10 patients with prior radiation therapy. Functional data (uroflowmetry, daily pad use, and postvoid residual urine) as well as quality of life with impact of urinary problems (ICIQ-UI SF) were prospectively assessed at baseline and during followup. Results. After a median followup of 9 months (range, 3–14) the incontinence cure rate (no pad usage) was 56.2% and the improvement rate (1-2 pads/day or ≥50% reduction) was 21.9%. No improvement was observed in 21.9%. Daily pad use and ICIQ-UI SF score improved significantly. No major perioperative complications occurred. Postoperatively, 15.6% of the patients exhibited transient acute urinary retention which resolved without further treatment after a maximum of 3 weeks. One patient underwent sling explantation due to dislocation and persistent perineal pain. Conclusions. The implantation of the RTS is a safe and effective procedure in selected patients with SUI resulting from prostate surgery. 1. Introduction Radical prostatectomy is regarded as the gold standard surgical treatment for organ confined prostate cancer. Even though the surgical technique has been improved steadily stress urinary incontinence is a well-known side effect of this procedure with reported incidence rates of up to 20% [1, 2]. Another rare reason for postsurgery incontinence is the transurethral resection (TUR) of the prostate [3]. The artificial urinary sphincter is still considered to be the standard surgical treatment for stress incontinence after prostate surgery with good long-term results in terms of continence and quality of life [4, 5]. However, besides patients’ requirement of mental capacity and fine-motor control to operate the implanted pump, the significant reoperation rate ≥35% due to well-known complications such as cuff erosion, infection, or mechanical problems lead to an establishment of minimal invasive sling systems for treatment of urinary incontinence in the last years [6]. The retrourethral transobturator sling suspension (RTS), (AdVance male sling, American Medical Systems, Minnetonka, MN, USA), introduced in 2006, offers a functional approach by relocating the descent proximal urethra into the original anatomic