1. Surgery treatment of male urinary incontinence
MD, Prof. Petrov S.B.
EMERCOM of Russia
PhD Nosov A.K.
Karnaukhov I.V.
Research Institute of Oncology named Petrov N .N.
St. Petersburg
2011

2. The incidence of urinary incontinence after prostate surgery
Radical prostatectomy (retropubic, laparoscopic, robot-associated): %
average: 10-15%
Other: transurethral resection of the prostate (TURP), adenomectomy.
Van Melick H.H. et al., 2003, Hu J.C. et al. 2003,
Rassweiler et al., Burkhard F.C. et al., 2006,
Penson D.F. et al. 2005, Bauer R.M. et al., 2009,
Ficarra et al., 2009

3. Mechanisms of postprostatectomy stress urinary incontinence (PPSUI)
Sphincter weakness
Direct sphincter fibers’ damage
Sphincter muscles’
innervation damage
Groutz A. et al., 2000, Carlson K.V. et al., 2001,
Noguchi N. et al., 2006, Hubner W.A., 2009

4. Choice of treatment depending on the grade of urinary incontinence
>4 pads per day
1 pad per day
2-4 pads per day
Conservative treatment
Slings,
ProAct
Artificial urinary
sphincter
MILD
MODERATE
SEVERE

5. Surgical treatment

6. ProACT system (Uromedica, USA)
Year-to-market: 1999 г.
First publication: 2005 г.
(W.A. Hübner, O.M. Schlarp).

7. System ProACT: results
Average: 64.6

8. SLINGS

9. Slings: classification
Material
synthetic
biological
Mechanism
compressive (obstructive)
supporting
Method of fixation
screws (bone anchored)
surgical filaments
friction and tissue resistance
Localization
Sub-(mid) urethral
Retrourethral
Tension
fixed
re-adjustable
Passage
retropubic
transobturator

10. Readjustable Sling Systems Remeex ® (Neomedic, Ltd)
Year-to-market: 2000 First publication: 2001 (Franco N. et al.)
Average: 62,2

11. Adjustable sling System Argus ® (Promedon SA, Cordoba, Argentina)
Year-to-market: 2003 First publication: 2006 (Romano SV et al.)
Average: 68,9

12. Bone-anchored Sling Systems In Vance ® (American Medical Systems, Inc)
Year-to-market: 2000 First publication: 2001 (S. Madjar et al.)
Average: 68

13. Retrourethral Transobturator Sling (American Medical Systems, USA)
AdVance®
(American Medical Systems, USA)
First publication:    (P. Rehder et al.)

14. Sling AdVance®
Average: 51,2

15. Adjustable hydraulic System
A.M.I. ® ATOMS
Results (N = 57)
Totally continence: 29 (51%) patients;
Improvement: 18 (31%) patients - 1 pad/day
First mention of the system: 2009 (Bauer W. et al.,)
Bauer W. et al., 2009

16. Transobturator Sling System
I-Stop ® TOMS
First publication: 2008 (P. Grise et al.)
Results (N=122)
Total continence: %
Improvement: 93% (1pad/day)

17. Transobturator Synthetic Sling UroSling Male (Lintex, Russia)
Year-to-market: 2009 First publication: 2010     (Petrov S.B., et al.)
Russian patent №
( )

18. UroSling Male: structure
Ligature tapes for passing arms of sling
Сentral area
Arms of sling

19. UroSling Male: implantation technique
Hind arms of sling - for the lower branches of the pubic bone, the front – before and then - stitching
Petrov S.B. et al., 2010

20. UroSling Male: patient characteristics Grade of urinary incontinence
Information
Grade of urinary incontinence
Mild
Moderate
N = 33 5 28
Mean age
62 (54-73)
69 (53-77)
Prostate surgery
Radical prostatectomy
4 (80 %)
24 (85,8%)
Prostatic adenomectomy -
2 (7,1%)
TURP
1 (20,0%)
Operating time (mins)
32,6
31,8
Mean bloodloss (мl)
65,8
66,9
Mean interval from RP to Urosling Male implantation (мo)
28,7 (7-68)
42,2 (11-83)

21. UroSling Male: results Grade of urinary incontinence
Information
Grade of urinary incontinence
Mild (n=5)
Moderate (n=28)
Total continence
3 (60%)
17 (60,7%)
Improved
1 (20%)
6 (21,4%)
Non effective
5 (17,9%)

22. Total continence\cost

23. Who the best candidate for the sling?
Mild and average forms of urinary incontinence (pad-test no more than 400 ml)
Presence of residual sphincter function:
- ability to reach the toilet with a sufficient volume of urine (200 ml)
- ability to close urination
- "Dry" night
- better continence of urine daytime
Who the best candidate for the sling?

24. Who the best candidate for the sling?
Better continence of urine with prolonged sitting than when standing and walking
Exclusion of urethral strictures and / or vesico-urethral anastomosis (urethrocystoscopy)
Exclusion of overactive bladder (cystometry)
Exception of hypo contractility detrusor ("pressure-flow")

25. Artificial urinary sphincter (AUS)
Artificial urinary sphincter (AUS) - «gold standard" surgical treatment of male urinary incontinence
Year-to-market: 1973 First publication: 1974 (Scott F.B. et al.)
The highest efficiency (average 79%)
Recommended for severe urinary incontinence
A U S
Fulford S.C. et al., 1997; Hajivassiliou C.A., et al., 1999;
Venn S.N. et al., 2000; Trigo Rocha F, et al., 2008;
Bauer R.M. et al., 2009

26. Artificial urinary sphincter
But!
Expensive
Patient must be mentally and physically able to handle the sphincter
Risk in urgent situations (when the patient is unconscious and can not tell the artificial sphincter)
High risk of re-revision and replacement of spincter (mechanical damage, infection, erosion) %
Fulford S.C. et al., 1997; Hajivassiliou C.A., et al., 1999;
Venn S.N. et al., 2000; Trigo Rocha F, et al., 2008;
Bauer R.M. et al., 2009

28. Conclusions
Sphincteric deficiency as a result of operations on the prostate - the main cause of stress urinary incontinence in men;
Radical prostatectomy - the most common operation is the development of stress urinary incontinence;

29. Conclusions
For early PPSUI recommended non-invasive methods of treatment. The combination of pelvic floor muscles training (PFMT) with duloxetin - the most effective;
Injection therapy is not widely used because of its low clinical efficacy, the need for repeated injections and the relatively high cost;

30. Conclusions
Patients with mild to moderate urinary incontinence sling surgery are recommended.
For patients with severe incontinence recommend implantation of artificial sphincter, which is still the "gold standard" treatment for men with PPI, despite the high risk of complications.

31. Thank you !