Login to Access Video or Poster Abstract: MP46-18
Sources of Funding: None

Introduction

Urodynamic studies are often performed in the evaluation of post-prostatectomy stress urinary incontinence (PPSUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPSUI. Many have reported their results with the specific Valsalva leak point pressure (VLPP) that predicts a good response to the TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high volume, single center. We hypothesized that the preoperative VLPP of 60cmH2O may better predict successful outcomes in these patients.

Methods

We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 hours. Cox regression model and Kaplan Meier Survival analysis were performed.

Results

290 patients were included. All patients had undergone a radical prostatectomy for prostate cancer and presented with PPSUI. Average age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 1-15). Figure 1 shows an inverse prediction curve for sling failure versus VLPP. The hazard ratio for failure with a VLPP of ≤70 cm H2O compared with a VLPP of >70 cmH2O, adjusted for pelvic radiation and 24 hour pad weight was 0.5 (95%CI 0.27-0.98).

Conclusions

There have been numerous papers written on the importance of patient selection for male TOS. We also know that men prefer a sling over an AUS. In our cohort of patients with PPSUI, those with a pre-procedural VLPP of > 70 cmH2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤70 cmH2O. In our practice, we use this data to supports the use of VLPP cut off of 70 cm H2O as an indicator for success to help in the evaluation and counselling of patients.

Funding

None