Comparison of the male sub-urethral sling versus the artificial urinary sphincter for treatment of stress urinary incontinence
Author(s):
Miss Judith Dockray
,
Miss Judith Dockray
Affiliations:
Mr Richard Chang
,
Mr Richard Chang
Affiliations:
Mr Matthew Archer
,
Mr Matthew Archer
Affiliations:
Mr Rowland Rees
Mr Rowland Rees
Affiliations:
BAUS ePoster online library. Dockray J. 06/27/17; 177375; P4-9 Disclosure(s): Mr Rees has acted as a paid mentor for Coloplast and Boston Scientific.
Ms. Judith Dockray
Ms. Judith Dockray
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Abstract
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Introduction
Male stress urinary incontinence (SUI) is increasing in incidence. The dominance of the Artificial Urinary Sphincter (AUS) has been challenged by the less invasive sub-urethral slings..
We have reviewed our prospective series from a regional referral centre.

Methods
26 patients had undergone sling surgery and 31 had undergone AUS.
There was no significant difference in age between the two groups. Medical treatment with duloxetine had been trialed in 7/31 (22.6%) of the AUS group and 11/23 (47.8%) of the sling group.

Results
Table 1.

However if you compare complications
Table 2.

Sling group – 3 minor skin level complications. 1 patient was unable to void post catheter removal and returned to theatre for loosening.
AUS group - 12/31 (38.7%) patients required surgical revision at some point.

The major risk factor for complications, in both groups, was the combination of radical prostatectomy and radiotherapy. In the AUS group, 8 patients had undergone both. 4/8 (50%) had complications and 2/8 (25%) suffered erosions requiring challenging, staged reconstruction.
In the sling group, 3 patients had undergone dual treatment and 2/3 (66%) of them failed to improve sufficiently.

Conclusions
Improvement in pad usage was equal in both groups, although dryness was significantly higher with the AUS. This is counterbalanced by the much higher complication and revision rate.
The most challenging group is those patients who have undergone the combination of surgery and radiotherapy who have both a higher rate of failure with slings, and a higher risk of erosion with AUS insertion.
Introduction
Male stress urinary incontinence (SUI) is increasing in incidence. The dominance of the Artificial Urinary Sphincter (AUS) has been challenged by the less invasive sub-urethral slings..
We have reviewed our prospective series from a regional referral centre.

Methods
26 patients had undergone sling surgery and 31 had undergone AUS.
There was no significant difference in age between the two groups. Medical treatment with duloxetine had been trialed in 7/31 (22.6%) of the AUS group and 11/23 (47.8%) of the sling group.

Results
Table 1.

However if you compare complications
Table 2.

Sling group – 3 minor skin level complications. 1 patient was unable to void post catheter removal and returned to theatre for loosening.
AUS group - 12/31 (38.7%) patients required surgical revision at some point.

The major risk factor for complications, in both groups, was the combination of radical prostatectomy and radiotherapy. In the AUS group, 8 patients had undergone both. 4/8 (50%) had complications and 2/8 (25%) suffered erosions requiring challenging, staged reconstruction.
In the sling group, 3 patients had undergone dual treatment and 2/3 (66%) of them failed to improve sufficiently.

Conclusions
Improvement in pad usage was equal in both groups, although dryness was significantly higher with the AUS. This is counterbalanced by the much higher complication and revision rate.
The most challenging group is those patients who have undergone the combination of surgery and radiotherapy who have both a higher rate of failure with slings, and a higher risk of erosion with AUS insertion.
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