Outcomes of sling, artificial sphincter similar

May 15, 2006

Paris-For most men who have urinary incontinence afterradical prostatectomy, a sling and an artificial urinary sphincter(AUS) offer equally good outcomes, according to findings from aretrospective, double-cohort study reported at the EuropeanAssociation of Urology annual congress here.

Reductions in pad counts, scores on an incontinence assessment instrument, and improvements in quality of life were similar with the two techniques. Additionally, sling insertion and the AUS were associated with comparable rates of complications and revisions.

The AUS did achieve better results in men who had severe incontinence prior to treatment.

Dr. Herschorn and colleagues retrospectively reviewed records of patients who underwent AUS or sling insertions between February 2002 and September 2004. Preoperative characteristics of interest included patient age, previous radiation, bladder neck contractures, previous transurethral injections, and urodynamic parameters.

Use of absorbent pads before and after surgery was determined. The quality-of-life question of the International Prostate Symptom Score (IPSS-QoL) was administered before and after surgery. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) was administered after surgery.

The chart review identified 57 patients (31 sling, 26 AUS) whose mean age was 67 years. They had been followed for an average of 30 months. Preoperative demographics and urodynamic parameters did not differ between the two groups with the exception of bladder neck contracture, which was more common in the AUS patients (46% vs. 16%, p=.01).

Preoperative daily pad use was significantly higher in the AUS group (6.5 vs. 4.5, p=.02). Responses to the IPSS-QoL question showed that patients in both groups were "unhappy" with their state of incontinence prior to surgery.

Following surgery, daily pad usage declined to 1.4 in the AUS group and 1.5 in the sling group, both of which were significantly different from baseline (p<.01). More than 70% of patients in both groups were using 0 to 1 pad per day. The ICIQ-SF and IPSS-QOL scores were similar in the two patient groups.

Three sling patients (10%) required tightening procedures, and slings were removed from four patients because of erosion and infection. Among the AUS patients two (8%) required AUS removal because of erosion, and two others (8%) required surgical revision procedures.

Early experience with sling insertions showed that severely incontinent patients did not fare as well as their counterparts who received an AUS, Dr. Herschorn observed. As a result, he counseled later patients with particularly heavy urine leakage to opt for an AUS. Otherwise, the two procedures provided equivalent results, he added.