Improving Male Sling Selectivity and Outcomes-A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?

• Published in: Urology practice 2018-11, Vol.5 (6), p.458-465
• Main Authors: Viers, Boyd R, VanDyke, Maia E, Pagliara, Travis J, Shakir, Nabeel A, Scott, Jeremy M, Morey, Allen F
• Format: Article
• Language: English
• ISSN: 2352-0787
• DOI: 10.1016/j.urpr.2017.10.002

We reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery. Retrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale). Of the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p