869 THE TRANSOBTURATOR APPROACH FOR TREATING POSTPROSTATECTOMY URINARY INCONTINENCE WITH ARGUS T, THE ADJUSTABLE MALE SLING. EARLY RESULTS OF A MULTICENTER TRIAL

Following the needles: an anatomical study to evaluate the postoperative safety and symptoms of patients receiving a transobturator male sling implant

PURPOSE

Implanting a transobturator male sling is a valid option to manage urinary incontinence after prostatectomy. We evaluated the trajectory of Argus T™ needles blindly introduced into the retropubic space to determine the safety and etiology of postoperative symptoms that can arise from this implant.

MATERIALS AND METHODS

Needles were implanted and perineal dissection was performed in 20 fixed, adult human male cadavers. The distance was measured from the upper and lower extremities of the needles in the internal pelvic wall up to the obturator neurovascular bundle. Anatomical variations identified in this area proximal to the needles were characterized. The inguinocrural region was also dissected from the needles positioned there. Statistical analysis of the results was done.

RESULTS

All needles transfixed the obturator internus muscle. Of the needles 90% were completely immersed in its fibers and not visible in the inner wall of the pelvis. The distance to the obturator neurovascular bundle and anatomical variations were noted. In the inguinocrural region the pectineus and adductor longus muscles were perforated in all cadavers.

CONCLUSIONS

The needle sling implant preserves the obturator neurovascular bundle and obviates the potential for postoperative pelvic hematoma. The anatomical trajectory of the needles used for this implant account for the groin and perineal pain side effects. Based on similarities between the Argus T and other types of outside-in transobturator male slings the results of the current study could be extrapolated to the latter slings.

[Adjustable systems for the treatment of male incontinence]

The principle of adjustment with the possibility to react to changing needs of specific patients even years after placing an implant is convincing. Experience has taught that urodynamic parameters as well as personal demands of a patient may change individually for instance as a result of resuming physical activities. Such demands can be met by simple adjustment.Results of Argus and Remeex can be considered equally sustainable as first publications date back from 2006 and 2004. With follow-up periods of more than 2 years realistic success rates of up to 90% have been observed. Adjustment will be needed in one third of cases.The ProAct balloons are attractive by virtue of the low invasiveness of both implantation and adjustment. A series published in 2005 revealed a success rate of 77%; these experiences have been confirmed by several other papers. Limiting factors for ProAct are irradiation therapy and scarred bladder neck.