Perineal Sling Relieves Urinary Incontinence after Prostate Surgery

Of these, 58 cases were in men who underwent radical prostatectomy, and four were in men who had benign prostatic hyperplasia prostatectomy. All patients were implanted, largely under spinal anesthesia, with the bone-anchored InVance bulbourethral sling, a product of American Medical Systems (Minnetonka, MN, USA).

The researchers found that after a mean follow-up of 28 months, 40 men (65%) no longer wore continence pads and were therefore considered "cured", and 14 men (23%) had decreased by at least 50% the daily number of pads used, and were considered "improved". At three and four years follow-up, the urinary incontinence cure rates were 70% and 66%, respectively. In subgroup analyses, patients who had undergone adjuvant radiotherapy, had previous urinary incontinence surgery, or had severe forms of stress urinary incontinence (defined as using more than five pads per day), had lower success rates. Transient scrotal or perineal pain or numbness--the most common side effect--affected 12 patients (19%). Six patients (10%) experienced a prolonged post void residual urine volume of greater than 100 mL, which resolved within 2 weeks of indwelling catheterization. Two patients (3%) required removal of the device due to infection. The study was published in the February 2009 issue of the British Journal of Urology International (BJUI).

"The persistence of a high intermediate-term success rate with InVance should be attributed to the firm and durable anchorage provide by the six screws inserted into the pubic bone," concluded lead author Miguel Guimares and colleagues of the department of urology.

The InVance system uses a mesh sling to provide compression of the urethra, and is anchored with bone screws for secure fixation. The system is comprised of three parts: an inserter - a sterile, single-use, battery powered device that drives the screws at low speed with uniform torque, supplied with an 8-cm shaft that locks in. An optional shaft sleeve is also included, which helps to prevent tissue from being wrapped around the shaft during screw insertion. The second part of the system is a set of small, self-tapping titanium bone screws with a preattached polypropylene suture to enable secure fixation. The third part of the system is the InteMesh silicone-coated polyester mesh sling with a knit structure that helps to ensure resistance to high suture pullout forces.

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