Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature

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• Zemp L, Tong S, Hoy N, Rourke KF. Preoperative pad usage is independently associated with failure of non-adjustable male trans-obturator slings in otherwise well-selected patients. Can Urol Assoc J. 2019;13(4):120–4. https://doi.org/10.5489/CUAJ.5468While subjective, number of pads per day (PPD) is a very useful tool in predicting who may fail slings. The use of more than 3 ppd is correlated with increased risk of failing a transobturator sling.

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• Mumm J, Abrarova B, Schütz J, et al. Age at surgery is not a prognostic factor for the AdVance‐XP male sling efficacy: a post‐hoc analysis of a prospective 7‐year multicentric study Neurourology and Urodynamics. 2021;40:1616–1624. https://doi.org/10.1002/nau.24727Age does not impact success rates associated with transobturator slings.

Fuller TW, Ballon-Landa E, Gallo K, et al. Outcomes and risk factors of revision and replacement artificial urinary sphincter implantation in radiated and nonradiated cases. J Urol. 2020;204(1):110–4. https://doi.org/10.1097/JU.0000000000000749.

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• Toia B, Leung LY, Saigal R, et al. Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence? World J Urol. 2021;39(4):1227–32. https://doi.org/10.1007/S00345-020-03288-8Urodynamics has a role in helping guide patient selection. Detrusor overactivity and low cystometric capacity (< 337 cc) are associated with lower success rates for transobturator slings.

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•• Ajay D, Kahokehr AA, Lentz AC, Peterson AC. Valsalva leak point pressure (VLPP) greater than 70 cm H2O is an indicator for sling success: a success prediction model for the male transobturator sling. Int Urol Nephrol. 2022;54(7):1499–503. https://doi.org/10.1007/S11255-022-03222-4This paper highlights that a valsava leak point pressure greater than 70 can help predict success with male transobturator slings.

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Morey AF, Singla N, Carmel M, Klein A, Tausch TJ, Siegel J, Tachibana I, Scott J. Standing cough test for evaluation of post-prostatectomy incontinence: a pilot study. Can J Urol. 2017;24(1):8664–9 PMID: 28263134.

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