VIRTUE MALE SLING FOR STRESS URINARY INCONTINENCE IN MEN WITH SPINAL CORD INJURY: A PROSPECTIVE EVALUATION WITH SHORT-TERM OUTCOMESVIRTUE MALE SLING FOR STRESS URINARY INCONTINENCE IN MEN WITH SPINAL CORD INJURY: A PROSPECTIVE EVALUATION WITH SHORT-TERM O
Introduction and Objective: There are few options for the surgical treatment of neurogenic stress urinary incontinence (nSUI) in men. The use of synthetic tapes has been described, but little data is available. We present short-term efficacy and safety data of the Virtue(R) male sling in a cohort of patients with nSUI due to spinal cord injury.
Methods: Nine consecutive men with a mean age of 40.3 ± 12 years (range 20-57 years) with urodynamically proven nSUI were treated with a Virtue sling between February 2016 and Octuber 2018 and included in this prospective study. All performed clean intermittent catheterization. Efficacy outcomes included the number of pads used per day, the Patient Global Impression of Improvement Questionnaire (PGI-I) and a quality of life (QOL) question regarding their lower urinary tract symptoms consisting of a five point Likert scale ranging from “pleased” to “unhappy” (0 = pleased; 1 = mostly satisfied; 2 = equally satisfied/unsatisfied; 3 = mostly unsatisfied; 4 = unhappy). We also evaluated the safety profile of the sling and complications.
Results: Preoperatively, all patients had severe urinary incontinence, using a mean of 4.1 ± 1.6 diapers/day (2-6 diapers/day). The average cystometric capacity was 403.4 ± 83.9 mL, all had normal compliance and the mean Valsalva leak point pressure was 49.1 ± 19.9 cmH2O. The mean time from SCI to sling surgery was 66.6 ± 25.8 months. The patients with myelomeningocele had previously undergone bladder augmentation, with no improvement of urinary incontinence. At a mean follow-up of 16.4 ± 7.3 months (range 7 to 30) the number of diapers/day decreased to 1.2 ± 0.97 (p= 0.003). Based on the PGI-I, the overall success rate was 70.5%, with a median score of 2 (much better). Regarding QOL, three patients was pleased, four were mostly satisfied, one were mixed satisfied/unsatisfied and one was mostly unsatisfied. There were no intraoperative complications. Two patients had an afebrile urinary tract infection requiring antibiotics in the early postoperative period. No patients complained of pain after the procedure and no patients had urethral erosion or needed sling explantation.
Conclusion: With median-term follow-up, the Virtue(R) male sling seems to be a feasible option to treat neurogenic stress urinary incontinence in properly selected men. Longer follow-up and larger cohorts will be needed to further confirm these results and refine the selection criteria for the optimal patient.
male sling, stress urinary incontinence, neurogenic bladder
Uroneurologia / Disfunção Miccionais / Urodinâmica
Hospital das Clínicas de São Paulo - São Paulo - Brasil
luccas soares laferreira, Cristiano Mendes Gomes, Julio C Bissoli, Rubens Pedrenho Neto, João Vitor Henriques, Julyana Kanate Mazzoni Moromizato, Homero Bruschini, MIguel Srougi