Proposal of a new way to evaluate the external sphincter function prior male sling surgey

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0146


Daniel Carlos Moser 1, Carlos Arturo Levi D’ancona 1, Brunno Raphael Iamashita Voris 1, Daniel Lahan 1, Kavina Jani 2, Gerard D. Henry 1
1 Departamento de Cirurgia Urológica, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 2 Department of Urology, Ark-La-Tex Urology, Shreveport, Louisiana, USA


Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery.
Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to preoperative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent.
Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm.
Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

Keywords: Urinary Incontinence; Prostatectomy; Transurethral Resection of Prostate

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