1601INSIGHTS INTO MECHANISM OF ACTION OF THETRANSOBTURATOR MALE SLING IN A CADAVERIC MODEL

William Jaffe*, Philadelphia, PA; Jaspreet Sandhu, New York, NY

INTRODUCTION AND OBJECTIVES: The mechanism of ac-tion of male slings is poorly understood. We report on insights gainedon the possible mechanism of action of the transobturator male sling(AdVance) in a cadaveric model via the study of Valsalva and retro-grade leak point pressures (VLPP and RLPP) and urethral pressureprofilometry (UPP).

METHODS: 3 human cadaver pelvic sections were used toinvestigate the effect of AdVance placement on VLPP, RLPP and UPP.An open suprapubic tube was placed and connected to a manometer.The bladder was filled with 200mL of fluid. VLPP’s were determined bymanual bladder compression. RLPP’s were measured with a 16Fcatheter in the meatus connected to a manometer and a fluid column.UPP’s were performed before and after sling placement with an air-charged catheter and automatic puller device connected to a commer-cially available urodynamic machine. VLPP’s, RLPP’s and UPP’s weremeasured before and after AdVance placement. At least 2 separaterecordings were made for each cadaver before and after sling.

RESULTS: In all specimens, the average native VLPP’s wereclustered fairly close to the average native RLPP’s. The average nativeVLPP’s (in cm H2O) were 30.5 for specimen 1, 22.5 for specimen 2 and21 for specimen 3, while the corresponding average RLPP’s (in cmH2O) were 25.5, 14.5 and 11, respectively. The placement of anAdVance sling consistently resulted in significant increases in theaverage VLPP of all specimens, as compared to average native VLPPbaseline, with no leaks observed under Valsalva pressures (in cm H2O)greater than 170 in specimen 1, greater than 160 in specimen 2 andgreater than 170 in specimen 3. The placement of the AdVance slingcaused the average RLPP (in cm H2O), as compared to average nativeRLPP baseline, to decrease by 4.5 in specimen 1, decrease by 4.0 inspecimen 2 and to increase by 1.5 in specimen 3. UPP showed noconsiderable change from baseline after sling placement in specimens1 and 2, and a short area of a small increase in intraurethral pressureto 30 cm H2O above baseline in specimen 3.

CONCLUSIONS: The AdVance sling in a cadaver model ap-pears to act preferentially during valsalva conditions causing highVLPP’s but minimal changes in RLPP’s and UPP’s compared to re-spective baselines. This study suggests that this sling does not aug-ment continence by urethral compression but rather by increasingVLPP’s only during increases in intrabdominal pressure. Further studyis required to determine the exact mechanism of action for the AdVancemale sling.

Source of Funding: American Medical Systems, Inc.

1602CHANGES IN THE MRI MORPHOLOGY OF THE MALE PELVICFLOOR AFTER THE REPEAT FUNCTIONAL SLING SUSPENSIONIN MEN: PRELIMINARY FINDINGS

Irina Solyanik*, Karin Herrmann, Ricarda Bauer, Margit Mayer, ArminBecker, Christian Stief, Christian Gozzi, Munich, Germany

INTRODUCTION AND OBJECTIVES: The functional sling sus-pension (FSS) is often performed as a repeat treatment option of malestress urinary incontinence (SUI) because of its initial failing or insuffi-cient effect on continence. MRI was used to investigate whether therepeat functional sling suspension (RFSS) leads to any functionalchanges of the male pelvic floor.

METHODS: Eight men (mean age 69 years) with mild (1-2pads) to moderate (3-5 pads) SUI after initial failed FSS were examinedby functional cine MRI before and 6 months after RFSS. On the sagittalMRI images the relationship of the bladder posterior wall (BPW) andBN to the pubococcygeal reference line (PCL), rotation of these struc-tures in relation to the symphysis as well as involving of the pelvic floormuscles during micturition were evaluated. Non-parametrical statisticalanalysis as well as the Fisher’s exact test were performed.

RESULTS: 7 of 8 patients achieved continence (0 pads) afterRFSS. Their MRI findings showed that the BPW and BN were movedabove PCL during micturition (from -10 mm to � 8 mm in relation to thePCL; p�0,05). There was no more rotation of these structures accord-ing to the symphysis postoperatively. The pelvic floor muscles wereinvolved significantly during miscturition. In 1of 8 patients RFSS wasfailed. The MRI parameters of his pelvic floor did not differ neitherbefore nor after RFSS and showed similar MRI features to preopera-tively findings of other 7 patients.

CONCLUSIONS: MRI findings of our study propose that conti-nence after RFSS is associated with the changes in functional topo-graphic relations within the male pelvic floor. Incontinence after initialfailed FSS seems to be related to the BN and BPW descent below thePCL.

Source of Funding: None

1603PATIENT-REPORTED PAD USE ALLOWS ACCURATEDISCRIMINATION BETWEEN PATIENTS EXHIBITING VARIOUSDEGREES OF INCONTINENCE AFTER RADICALPROSTATECTOMY

Michael Musch*, Ulla Roggenbuck, Mara Mosters, MichaelaVanberg, Darko Kroepfl, Essen, Germany

INTRODUCTION AND OBJECTIVES: Determination of conti-nence status after radical prostatectomy (RP) is frequently based onthe pad-free definition. We examined the correlation between patient-reported pad use and the corresponding incontinence symptom scores(ICSmaleIS) of ICSmaleSF questionnaires in patients who underwentretropubic RP.

METHODS: All data were recorded prospectively on the basisof ICSmaleSF questionnaires and additional questions concerningdaytime and nighttime pad use before and 3, 6, 12, 18 and 24 monthsafter RP. Only patients with a minimum follow up of 12 months wereincluded. Based on the reported pad use, defined subgroups werecreated and correlated with the corresponding ICSmaleIS. Differencesbetween subgroups were analyzed using the two-sided Wilcoxon testand Kruskal-Wallis test.

RESULTS: Of 896 patients (median 66 years) undergoing RPbetween 03/04 and 08/09, 570 with a minimum follow up of 12 monthswere eligible for analysis. These 570 patients filled in 1159 question-naires at 12 (n�463), 18 (n�385) and 24 months (n�311), respec-tively. Comparing the two most common pad-free definitions revealed asignificant difference (p�0.0001) in the mean ICSmaleIS of patientsreporting the use of no pads (1.71) and of only one safety pad in thedaytime and at night (2.76), respectively. However, there was a strik-ingly higher ICSmaleIS in patients using one pad in the daytime and atnight, respectively, due to urinary loss (5.11) than in aforementionedpatients using only one safety pad in the daytime and at night (2.76),respectively, (p�0.0001). Furthermore, the ICSmaleIS depended onthe number of pads patients reported using due to daytime urinary loss.The mean ICSmaleIS was 1.82 for patients using no pads in thedaytime, 5.13 for patients using one pad, 8.03 for patients using twopads and 10.66 for patients using more than two pads (p�0.0001). Inthe latter patient’s subgroups the number of pads used during the daycorrelated positively with the mean number of pads used at night: nopad/day (0.00 pads/night), one pad/day (0.65 pads/night), two pads/day (1.13 pads/night) and �2 pads/day (1.41 pads/night) (p�0.0001).

CONCLUSIONS: The correlation with the ICSmaleIS demon-strates that the patient-reported pad use allows accurate discriminationbetween patients exhibiting various degrees of incontinence. The fre-quently used pad-free definition including patients, who report use ofone safety pad, appears not to be a valid method for identifying patientswith completely preserved urinary continence after radical prostatec-tomy.

Source of Funding: None

Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010 THE JOURNAL OF UROLOGY� e619