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Management of recurrent male stress urinary incontinence after a previous failed retrourethral male sling.
Jessica DeLong, MD, Casey Kowalik, MD, Arthur Mourtzinos, MD.
The Lahey Clinic, Burlington, MA, USA.
BACKGROUND: A failure rate between 20% and 40% after retrourethral transobturator sling (RTS) is reported in the literature. Recommendations for the management of persistent or recurrent stress urinary incontinence (SUI) after a failed RTS do not exist. The objective of this study was the prospective evaluation of the efficacy of a repeat male perineal sling or artificial urinary sphincter (AUS) in patients after failed first RTS.
METHODS: From February 2008 to October 2011, 102 men with SUI were implanted with a RTS (90 patients with an AdVance sling, 12 with a Virtue perineal sling). Prior to sling placement, 22 patients had undergone transurethral bulking agent injections. The surgical outcome was determined by clinical history and physical examination and, primarily, by patient self-assessment and included validated symptom, bother, and quality-of-life questionnaires.
RESULTS: Seventy percent of the patients were completely dry postoperatively. Eleven patients (10.8%) did not have significant improvement based on patient-perceived questionnaires and were considered failures. These patients had a preoperative pad count between 2 and 7. As a second procedure, three patients underwent a Virtue perineal sling. One patient had no improvement, another had 65% improvement, and a third had 80% improvement. The remaining 8 patients underwent placement of an AUS uneventfully. Seven of the eight patients are completely dry after their second procedure. In both groups, quality of life improved significantly. No major complications were encountered in either group.
CONCLUSIONS: A repeat male perineal sling procedure and/or placement of an AUS are viable treatment options for recurrent or persistent male SUI. Longer-term follow up is needed.
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