U J All Final for WEB.pdf 802 | Adjustable Male Sling Our Experiences with Placement of Adjustable Male Sling, Including a Case of Exstrophy-Epispadias Initial Report Abbas Basiri, Hossein Kilani Purpose: - Materials and Methods: - - - Results: - - Conclusion: Argus is a simple and good device to control incontinence in men. It may also be Keywords: urinary stress incontinence, suburethral slings, treatment outcome Corresponding Author: Abbas Basiri, MD Urology and Nephrology Research Center, No.103, 9th Boustan St., Pasdaran Ave., Tehran, Iran Tel: +98 21 2256 7222 Fax: +98 21 2256 7282 E-mail: Basiri@unrc.ir Received August 2012 Accepted December 2012 Urology and Nephrology Research Center, Shahid Lab- bafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran MISCELLANEOUS Miscellaneous 803Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L INTRODUCTION Male stress urinary incontinence (SUI) is mostly due to iatrogenic causes, particularly prostate surgeries. - plantation has long been accepted as the gold standard for the treatment of male patients suffering from stress incontinence. In recent years, several adjustable and non-adjustable de- vices have been introduced to treat male incontinence, from adjustable device, has been used in several centers, and its - - tions and the possibility of medical treatment of prosthesis infection. MATERIALS AND METHODS radical prostatectomy, adenomectomy, transurethral resec- tion of the prostate, neurogenic bladder secondary to my- Pre-operative evaluations included history taking, physi- Thereafter, those patients affected by SUI due to sphincteric Argus device is actually a synthetic silicone sling for males - - indirectly measured via reverse leak point pressure (RLPP). Reverse leak point pressure is measured by the height of nor- saline through the urethra is begun. 2 2O, regardless of pre-operative RLPP. In 2O 2 mainly because RLPP changed disproportionately during Ar- 2 2O in myelomenin- symptoms, irritative symptoms, and complications, such as prosthesis infection, perineal pain, and device erosion. RESULTS to non-prostatectomy surgeries (one patient had neurogenic 2 and 3. Urodynamic study could not be implemented in one Figure 1. Argus device containing silicon pad, silicone columns, and washers. Adjustable Male Sling | Basiri and Kilani 804 | patient due to urethral pathology. - 2O. clean intermittent catheterization), 6 had mild urinary incon- because of irritative urinary symptoms and perineal pain. after Argus implantation, 6 became dry (including one pa- mild urinary incontinence. totally incontinent before Argus implantation. Although this - undergone ileocystoplasty, bladder neck reconstruction, and fascial sling. This patient had continuous incontinence before Argus placement, but regained complete daily urinary conti- - ance of incontinence. At the second procedure, the device - at the point of the crossing to keep the columns crossed (Fig- ure 2). This patient is currently completely dry using clean intermittent catheterization three months after the procedure. 2 cmH2O postoperatively. In one patient, RLPP had actually 2 2O in spite of reappear- ance of incontinence symptoms. - cmH2 2O, and in both patients RLPP had in- - - to raise RLPP. - Miscellaneous Table 1. Incontinence etiologies. Etiology Number Radical prostatectomy 6 Adenomectomy 5 Transurethral resection of the prostate 4 Neurogenic bladder 1 Exstrophy-epispadiasis 1 Total 17 Table 2. Urodynamic findings of post prostatectomy incontinent patients. nParameter Filling phase Capacity 1 Low 13 Normal Compliance 1 Low 13 Normal Voiding phase Contractility 3 Hypocontractile 11 Stable normocontractile 805Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Figure 2. Silicone columns crossed using hem-o-lok. Adjustable Male Sling | Basiri and Kilani patient. After complete response to antibiotic and infection up accordingly. DISCUSSION (7) But high costs, compli- cated surgical procedure, and the need for patient manipula- tion for an acceptable void have prompted manufacturers to are either adjustable or non-adjustable. Adjustable devices have the advantage of making surgeon able to change the In most of the studies on Argus device, the improvement rate In - - - - 2O). - alized. Reverse leak point pressure measurement before and after - crease or decrease in time. This change in RLPP might be bulbar urethra. Assessment of the impact of the pelvic and prostatectomy incontinence. Stress urinary incontinence in men might be due to other causes, such as neurogenic blad- Table 3. Urodynamic findings of non-post prostatectomy incontinent patients. nParameter Filling phase Capacity 0 Low 2 Normal Compliance 0 Low 2 Normal Voiding phase Contractility 0 Hypocontractile 2 Stable normocontractile 806 | der and some congenital anomalies affecting the bladder bulbourethral sling procedure on incontinent patients suffer- ing from neurogenic bladder has been evaluated. It has achieved after Argus readjustment in the second procedure. Wound and prosthesis infection occurred in 2 patients in our the device in this complication. - naires. CONCLUSION Using adjustable sling in men results in acceptable conti- nence rates in spite of the need for readjustments. Our study debridement. CONFLICT OF INTEREST None declared. REFERENCES 1. Steiner MS, Morton RA, Walsh PC. Impact of anatomi- cal radical prostatectomy on urinary continence. J Urol. 1991;145:512-4; discussion 4-5. Miscellaneous 2. Kao TC, Cruess DF, Garner D, et al. 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