Efficacy of the InVance™ Male Sling in Men with Stress Urinary Incontinence

Abstract

Objectives

To evaluate the efficacy and safety of the InVance™ bulbourethral sling in male stress urinary incontinence.

Materials and methods

Between June 2003 and April 2005, the InVance™ bulbourethral sling was implanted into 50 patients with urinary incontinence after prostate surgery in 49 cases and pelvic trauma in 1 case. The patients were monitored and evaluated in a prospective manner (continence, tolerance, and satisfaction). The treatment was considered to be successful if the patient stopped wearing any kind of continence pad (patient cured) or only one pad per day (patient improved), with no de novo urinary disorders and without significant postvoid residual urine. Patient satisfaction with the procedure was assessed.

Results

After a median follow-up of 6 mo, 50% of patients were dry, 26% had improved, and 24% suffered treatment failure. The success rates for the patients with severe incontinence and those who had undergone radiation therapy were 50% and 25%, respectively. All patients who were dry or had improved were satisfied and presented no obstructive or irritative de novo urinary disorders. The overall success rate for the 51 procedures conducted was 74.5%. Six cases of transitory acute urine retention and six cases of persistent perineal pain were reported. Explantation was necessary because of suppuration of the sling in three patients and of a de novo irritative urinary disorder in one patient. No cases of pubic osteitis or urethral erosion were reported.

Conclusions

The InVance™ bulbourethral sling procedure makes it possible to treat stress urinary incontinence after prostate surgery with satisfactory and lasting short-term results. Severe incontinence and a past history of pelvic radiation therapy seem to be factors contributing to the failure of this procedure.

Introduction

Male stress urinary incontinence is the result of de novo sphincter insufficiency and is a potential complication of prostate surgery. It is particularly common after radical prostatectomy, but can also occur after surgical adenomectomy or endoscopic resection of the prostate. Regardless of the severity of the incontinence observed in the postoperative period, the condition often improves during the subsequent period of months. In addition, recovery can be accelerated by means of bladder training/sphincter reeducation. A minimum delay of 6 mo to 1 yr is needed before envisaging an active treatment for any incontinence resulting from surgery that the patient feels is a handicap. The artificial sphincter is currently preferred treatment in this patient group [1], [2]. The technique involved has been largely standardized, but is complex and not without risk [3]. Although excellent results are obtained in terms of quality of life, there is still a degree of residual incontinence [4]. Currently, periurethral injections, whose action is often incomplete and transitory, tend to be used less frequently. New techniques such as periurethral balloons [5] and bulbourethral slings [6], [7] have also been developed in recent years and have shown encouraging results.

The concept of bulbourethral compression as a treatment for male stress urinary incontinence was first introduced by Berry [8] and developed by Kaufman [9]. The technique consisted of compressing the bulbar urethra by means of a silicone pad attached to the corpus cavernosum by several strips. The poor results obtained and a high level of complication resulted in abandonment of this procedure [10]. The success first of bladder neck suspension techniques using the vaginal approach [11], [12] and then of urethral support by means of a synthetic sling in women [13] breathed new life into the concept of urethral compression in men as a means of treating stress urinary incontinence after prostate surgery. The first publications [14], [15], [22] reported encouraging results. From a technical point of view, two approaches were described. The first consisted of making a urethral support using one or more suspended slings with a retropubic approach and, the second, using a purely perineal approach, of performing bulbourethral compression by means of a sling attached to the pubic bone. The InVance™ bulbourethral sling is made of synthetic mesh and exerts pressure on the urethra, reducing the possibility of urinary leakage. We previously described our preliminary results using this procedure [16]. Hence, we report a series of 50 patients with stress urinary incontinence treated consecutively with the InVance™ bulbourethral sling with regards to short-term follow-up.