Retropubic urethral sling placement does not improve early return of continence

17 Jan 2017

Placement of an autologous urethral sling at robotic-assisted radical prostatectomy shows no benefit on early return of urinary continence at 6 months, a recent study has found. Moreover, continence is associated with patient age in adjusted models rather than sling placement.

To determine whether placement of a retropubic urethral sling fashioned from autologous vas deferens would improve continence recovery, researchers randomly assigned age-stratified patients to undergo robotic-assisted radical prostatectomy by multiple surgeons with or without sling placement.

Complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, assessed by the Fisher exact test and logistic regression, were the main outcomes.

Researchers used the Kaplan-Meier method and the log rank test to assess time to continence. They also evaluated EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) by mixed models 1, 3 and 6 months after catheter removal for repeated measures.

Of the 203 recruited patients, 195 were randomly assigned to undergo either sling (n=95) or no sling (n=100) placement, and completed postoperative interviews.

There were comparable proportions reporting complete and near continence (66 and 87 percent, respectively) and times to complete and near continence in both groups 6 months after surgery.

Adjustments for clinical, urinary and surgical factors revealed that younger age was correlated to a greater likelihood of complete continence (OR, 1.74 per decreasing 5-year interval; 95 percent CI, 1.23 to 2.48; p<0.01) and near continence (OR, 2.18 per decreasing 5-year interval; 1.21 to 3.92; p<0.01).

Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the two groups. There were no serious adverse events observed.

“Follow-up is ongoing to determine the long-term impact of sling placement on return of continence,” said researchers. “Surgical innovation, like most medical technology, should be subjected to rigorous testing before undergoing widespread adoption.”

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