| Researchers at the Department of Urology, University of Michigan, Ann Arbor, Michigan evaluated the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency.
The researchers reviewed 119 men who had undergone 140 BAS procedures from May 2000 to May 2009. All complications were recorded during the follow-up visits. Mean patient age was 65.8 years (range 23-89). Main etiologies for SUI included previous treatment of prostate cancer (82.4%), neurologic dysfunction (12.6%), and previous transurethral resection of the prostate (3.6%). 1- Recurrent SUI, de novo urge incontinence, and wound infection were the most frequent complications encountered (25.2%, 17.6%, and 16%, respectively). 2- The 3 most common reasons for reoperation included bulking agent injection for recurrent SUI (5.9%), sling revision for bone screw dislodgement (5.9%), and sling revision for recurrent SUI (5.0%). 3- Overall complication and reoperation rate for the index cases was 58.8% and 26.9%, respectively. In my opinion the incidence of complications after male BAS is higher than often thought. Adequate counseling prior to surgery regarding the potential complications is important. Additionally, it should be more clearly explained to men making treatment for prostate cancer the high risk they do face of experiencing recurrent SUI. Reference: Urology. 2010 Sep 1. [Epub ahead of print]
doi: 10.1016/j.urology.2010.06.014; Styn NR, McGuire EJ, Latini JM.
Bone-Anchored Sling for Male Stress Urinary Incontinence: Assessment of Complications Researchers from the Department of Urology, University of Michigan, Ann Arbor, Michigan evaluated the complications associated with the male bone-anchored sling (BAS) to determine the appropriate preoperative counseling for men considering surgery. The BAS is a surgical option for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. The researchers reviewed 119 men who had undergone 140 BAS procedures from May 2000 to May 2009. All complications were recorded during the follow-up visits. Mean patient age was 65.8 years (range 23-89). Main etiologies for SUI included previous treatment of prostate cancer (82.4%), neurologic dysfunction (12.6%), and previous transurethral resection of the prostate (3.6%). 1- Recurrent SUI, de novo urge incontinence, and wound infection were the most frequent complications encountered (25.2%, 17.6%, and 16%, respectively). 2- The 3 most common reasons for reoperation included bulking agent injection for recurrent SUI (5.9%), sling revision for bone screw dislodgement (5.9%), and sling revision for recurrent SUI (5.0%). 3- Overall complication and reoperation rate for the index cases was 58.8% and 26.9%, respectively. In my opinion the incidence of complications after male BAS is higher than often thought. Adequate counseling prior to surgery regarding the potential complications is important. Additionally, it should be more clearly explained to men making treatment for prostate cancer the high risk they do face of experiencing recurrent SUI. Reference: Urology. 2010 Sep 1. [Epub ahead of print] doi: 10.1016/j.urology.2010.06.014; Styn NR, McGuire EJ, Latini JM. PubMed Abstract Joel T Nowak, M.A., M.S.W. |
I have some concerns about thinning skin of scrotum during “mail sling” implanting . Seven month passed after this procedure took place, but I still have painful sensation when I’m touching scrotum skin. The implanting of sling was complete failure. Prior to this procedure I had injection of collagen, which was perfectly working for two days. After the sling implanting the incontinence become worst from the first day. Herein my thoughts:
During preps, prior to surgery, the scrotum was pooled up and taped to the body. Than surgeon began procedure. Everything went well, except stretching sling to required condition. Theoretically it suppose to hold 60 cm of water pressure. In reality it depends on surgeon’s experience of making the judgment, which based on resistance to the stretch of sling material. What does resist to the stretch? – Urethra with muscles around. But what if the “urethra with muscles around” is already pre-stressed (see scrotum during preparations)? Any pressure applied by sling will be reduced after procedure is completed and scrotum un-taped. Keep in mind that 60 cm of water pressure is 3 times larger than pressure may developed from bladder. Therefore, surgeon’s judgment should be eliminated and pressure test shall be mandatory.
But my question: is it possible to make correction of sling stretch or any other error which may occur?