Virtue Sling is Ineffective as Salvage for Failed AdVance Sling in Treating Male Stress Urinary Incontinence
Thomas Kishkovich, ScB; Madeline Cancian, MD; Kennon S. Miller, MD
Brown University, Providence, RI
Background: Male stress urinary incontinence (SUI) post-radical prostatectomy (RP) and post-transurethral resection of the prostate (TURP) remains a significant source of morbidity. While Artificial Urinary Sphincter (AUS) remains the gold standard for surgical management, the Male Sling was developed as an attractive treatment option for mild to moderate SUI. There are currently two slings on the North American market. The retroluminal transobturator device (AdVance) provides continence by moving the proximal urethra proximal into the pelvis. The quadratic sling (Virtue) provides both proximal urethra relocation as well as perineal urethral compression. The goal of this study was to investigate if Virtue sling could be used as a salvage treatment for AdVance sling failure.
Methods: Using CPT codes (53440, 53442) we identified all male patients undergoing urethral sling placement between 1/2011 and 10/2017. We excluded patients who had surgical intervention for SUI prior to receiving a sling. Surgical success was defined as post operative use of < 1 pad per day. Statistics were completed using Stata (StataCorp).
Results: We identified 48 patients who had urethral sling placement at our institution during the study period. Patient age ranged from 56 to 90, average 72. Causes of SUI included RP (N = 43), TURP (N = 4), and neurogenic bladder (N = 1). Primary intervention was quad-arm Virtue sling (Coloplast US) (N = 41) or bi-arm AdVance sling (Boston Scientific) (N = 7). 0/7 (0%) of the AdVance sling patients achieved success versus 27/41 (65.9%) of the Virtue sling patients (p=.001, Chi Square). 11 patients underwent salvage therapy to correct for persistent SUI. 0/4 (0%) achieved success with sling conversion from AdVance to Virtue sling, 3/4 (75%) with conversion to AUS, 2/2 (100%) with urinary diversion, and 0/1 (0%) with coaptite injection. A single patient failed sling conversion (AdVance to Virtue) but had successful salvage with AUS placement.
Conclusions: While conversion from AdVance to Virtue sling was technically feasible, none of the patients who were converted had meaningful improvement in their SUI. If a patient fails a male urethral sling, a different modality of incontinence surgery should be discussed as salvage therapy.
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