Risk factors for male slings: a comparative study of two techniques.

OBJECTIVE: To improve patient selection for male slings. Our primary aim was to identify preoperative risk factors for failures. Our secondary aim was to compare bone-anchored male sling (BAMS) to transobturator male sling (TOMS) and patient satisfaction accordingly.

METHODS: A retrospective review was performed from 2000 to 2010 of males who received male slings. Exclusions had follow-up<1.5 months. Data examined included demographics, urodynamic parameters, pad usage, presence of detrusor overactivity (DO), and previous urethral diseases. Failure was defined as ≥4 pads used per day or ≤50% improvement by Patient Global Impression of Improvement (PGI-I). Preoperative risk factors for failure were analyzed for statistical significance.

RESULTS: Sixty-four patients (mean age, 69.8±9.2 years) were analyzed. Forty-one received BAMS and 23 received TOMS with median follow-up of 46 months (range, 1.5-112) and 18 months (range, 3-33), respectively (P=.01). Perioperative decrease in pad usage was statistically significant in the TOMS group (range, 4.0-1.8, P=.00) compared with the BAMS group (range, 4.3-3.9, P=.37). Failure rate was 68.3% (28/41) in BAMS and 30.4% (7/23) in TOMS (P=.01). The PGI-I demonstrated increased satisfaction with TOMS (P=.005). Preoperative risk factors suggest increased pad usage, low maximal urethral closure pressure (MUP), low abdominal leak point pressure (ALPP), decreased functional length (FL), and presence of DO and urethral disease favor failure.

CONCLUSIONS: Patients with preoperative risk factors, such as increased pad usage, low MUP, low ALPP, decreased FL, and presence of DO and urethral disease may not be appropriate sling candidates. Findings support TOMS, whichhas fewer failures and higher patient satisfaction but may be secondary to improved patient selection.