UROLOGICAL SURVEY
Mid-term complications after placement of the male adjustable suburethral sling: a single center experience
Dalpiaz O; Knopf HJ; Orth S; Griese K; Aboulsorour S; Truss M
Department of Urology, Medical University of Graz, Graz, Austria
J Urol. 2011; 186: 604-9
PURPOSE: In recent years various sling systems have been proposed as a successful treatment option for male stress urinary incontinence. Reports about complication rates and failures are still scarce.
MATERIALS AND METHODS: We systematically reevaluated 29 male patients who received an Argus® suburethral sling for stress urinary incontinence between October 2006 and July 2007.
RESULTS: Overall 24 patients (83%) experienced a total of 37 complications at a median follow-up of 35 months (range 29 to 45), including 10 (35%) in acute urinary retention. The sling was removed in 10 patients (35%) due to urethral erosion (3), infection (2), system dislocation (2), urinary retention (2) and persistent pain (1). Eight men (27%) complained of significant perineal pain, necessitating continuous oral analgesics. In 1 patient ureteral reimplantation was done due to ureteral erosion from a dislocated sling. At follow-up only 5 men (17%) remained dry while 21 (72%) were dissatisfied with the clinical outcome. No available clinical variables were statistically significantly associated with any grade or high grade complications even on univariate analysis.
CONCLUSIONS: In our study cohort the Argus suburethral sling was associated with serious mechanical and infectious complications, and sparse functional results with negative impact on patient quality of life. Based on the results of this study significant changes are warranted in the sling system and in the implantation technique.
Editorial Comment
This report by Dalpiaz and cols. is strikingly important. They present a 35 month follow-up of male patients with SUI who underwent Argus sling placement. Their data point out an unacceptably high rate of complications (83%) of which more than half (58%) were grade 3 according to the Clavien system. Seventy-two percent of patients referred dissatisfaction with treatment. Only 17% remained dry, although 79% of subjects were dry when discharged home after the procedure, which shows the non sustainable efficacy of the device.
Ninety three percent of the studied population was classified as having a moderate / severe incontinence according to the number of pads used which may have influenced the low success rate. But the high complication rate obviates a need to review not only the device but the surgical technique for implantation itself.
Other reports on the Argus system are encouraged in order to corroborate these findings, but a red flag must be raised.
Dr. Ricardo Miyaoka
State University Campinas
Campinas, SP, Brazil
E-mail: rmiyaoka@uol.com.br
Publication Dates
-
Publication in this collection
19 Oct 2011 -
Date of issue
Aug 2011
