Re: Intermediate-term results, up to 4 years, of a bone-anchored male perineal sling for treating male stress urinary incontinence after prostate surgery.

摘要

We read with interest this case series from Guimaraes etal. [1] describing further European experience with bone-anchored male perineal slings. Stress urinary incontinence after prostatectomy is an important complication affecting quality of life, and managing mild to moderate incontinence, which does not necessitate an artificial sphincter, is problematic [2]. In recent years the InVance(tm) (AMS, Minnetonka, Minnesota, USA) perineal bone-anchored sling has been developed [3], and several published case series in the USA and Europe describe favourable results with few complications [1,4-6], However, our experience with the InVance system has been disappointing. Following appropriate training and mentoring, six InVance slings were implanted by one surgeon at our institution. Two were removed in the short-term after surgery due to infection, and one patient developed significant pain and swelling requiring delayed removal. There were also technical problems with the bone-anchoring screws, and there was displacement of one or more of the screws on video cystometrograms after the procedure in two patients. It was therefore impossible to quantify a meaningfu functional outcome and due to unacceptable results the use of the InVance system has been discontinued.