Trattamento chirurgico dell'incontinenza urinaria da sforzo nel maschio:relazione tra posizione dello sling transotturatorio valutata con RMN 3T e risultati clinici.
Retrourethral transobturator sling is a new functional treatment of stress urinary incontinence after prostatectomy with reported success rate of 54 to 80% and a failure rate of 20 to 45%.
Objective: Aim of the study was to retrospectively analyze morphologic changes visible on MRI after sling procedure in continent patients compared with the incontinent ones, in order to detect possible factors explaining the different clinicoutcomes.
Design, Setting, and Participants: 21 male patients treated with the Advance ® sling, were enrolled: 13/21 had clinical recovery, while 8/21 had persistent incontinence. The procedure outcome was defined as cured patients (0 - 1 security pad) or incontinent ones (>2 pads).
The MRI protocol performed with a 3 T system included: 3D T2w sequence (CUBE) and a high temporal resolution Fiesta for dynamic sequence.
On the T2w sequence, we measured the length of the urethral bulb posterior to the sling (LB) and the distance of the sling from a line bisecting the pubic symphysis (LBPS). The bladder neck activity was evaluated with dynamic sequence. Results were analyzed with two-tailed Mann-Whitney test.
Results and Limitations: In the 8 incontinent patients the length of the urethral bulb posterior to the sling was 10mm (range 10-28mm) (p<0.0002). The sling was located posterior to the LBPS in 7/8 incontinent patients (4.4-12.6mm) and almost coincident with it in 8/13 continent patients (p=0.0549). On the dynamic study, during the Valsalva manoeuvre all incontinent patients showed urine leakage.
Conclusions: The failure of RTS, still poorly understood, can be related to inappropriate indications; based on our results, an incorrect sling placement seems to be another cause of failure. In particular, the LB posterior to the sling seems to be strongly correlated with continence
