MD, Prof. Petrov S.B. EMERCOM of Russia PhD Nosov A.K. Karnaukhov I.V. Research Institute of Oncology named Petrov N.N. St. Petersburg 2011

Van Melick H.H. et al., 2003, Hu J.C. et al. 2003, Rassweiler et al., 2006 Burkhard F.C. et al., 2006, Penson D.F. et al. 2005, Bauer R.M. et al., 2009, Ficarra et al., 2009 Radical prostatectomy (retropubic, laparoscopic, robot-associated ): % average: 10-15% Other: transurethral resection of the prostate (TURP), adenomectomy.

Mechanisms of postprostatectomy stress urinary incontinence (PPSUI) Sphincter weakness Direct sphincter fibers damage Sphincter muscles innervation damage Groutz A. et al., 2000, Carlson K.V. et al., 2001, Noguchi N. et al., 2006, Hubner W.A., 2009

2-4 pads per day MILD MODERATE Artificial urinary sphincter Slings, ProAct Conservative treatment >4 pads per day SEVERE 1 pad per day

Year-to-market: 1999 г. First publication: 2005 г. (W.A. Hübner, O.M. Schlarp).

Average: 64.6

synthetic biological Material compressive (obstructive) supporting Mechanism screws (bone anchored) surgical filaments friction and tissue resistance Method of fixation Sub-(mid) urethral Retrourethral Localization fixed re-adjustable Tension retropubic transobturator Passage

Average: 62,2 Year-to-market: 2000 First publication: 2001 (Franco N. et al.)

Average: 68,9 Year-to-market: 2003 First publication: 2006 (Romano SV et al.)

Average: 68 Year-to-market: 2000 First publication: 2001 (S. Madjar et al.)

Retrourethral Transobturator Sling AdVance ® (American Medical Systems, USA) First publication: (P. Rehder et al.)

Sling AdVance ® Average: 51,2

Results (N = 57) Totally continence: 29 (51%) patients; Improvement: 18 (31%) patients - 1 pad/day Adjustable hydraulic System A.M.I. ® ATOMS First mention of the system: 2009 (Bauer W. et al.,) Bauer W. et al., 2009

Transobturator Sling System I-Stop ® TOMS First publication: 2008 (P. Grise et al.) Results (N=122) Total continence: % Improvement: 93% (1pad/day)

Transobturator Synthetic Sling UroSling Male (Lintex, Russia) Year-to-market: 2009 First publication: 2010 (Petrov S.B., et al.) Russian patent ( )

Сentral area Arms of sling Ligature tapes for passing arms of sling

UroSling Male: implantation technique Hind arms of sling - for the lower branches of the pubic bone, the front – before and then - stitching Petrov S.B. et al., 2010

Information Grade of urinary incontinence MildModerate N = Mean age62 (54-73)69 (53-77) Prostate surgery Radical prostatectomy 4 (80 %)24 (85,8%) Prostatic adenomectomy -2 (7,1%) TURP1 (20,0%)2 (7,1%) Operating time (mins)32,631,8 Mean bloodloss (мl)65,866,9 Mean interval from RP to Urosling Male implantation (мo) 28,7 (7-68)42,2 (11-83) UroSling Male: patient characteristics

Information Grade of urinary incontinence Mild (n=5) Moderate (n=28) Total continence3 (60%)17 (60,7%) Improved1 (20%)6 (21,4%) Non effective1 (20%)5 (17,9%) UroSling Male: results

Total continence\cost

Who the best candidate for the sling? Mild and average forms of urinary incontinence (pad-test no more than 400 ml) Presence of residual sphincter function: - ability to reach the toilet with a sufficient volume of urine (200 ml) - ability to close urination - "Dry" night - better continence of urine daytime

Better continence of urine with prolonged sitting than when standing and walking Exclusion of urethral strictures and / or vesico- urethral anastomosis (urethrocystoscopy) Exclusion of overactive bladder (cystometry) Exception of hypo contractility detrusor ("pressure-flow") Who the best candidate for the sling?

Artificial urinary sphincter (AUS) Artificial urinary sphincter (AUS) - «gold standard" surgical treatment of male urinary incontinence Fulford S.C. et al., 1997; Hajivassiliou C.A., et al., 1999; Venn S.N. et al., 2000; Trigo Rocha F, et al., 2008; Bauer R.M. et al., 2009 Year-to-market: 1973 First publication: 1974 (Scott F.B. et al.) The highest efficiency (average 79%) Recommended for severe urinary incontinence

Artificial urinary sphincter E xpensive P atient must be mentally and physically able to handle the sphincter Risk in urgent situations (when the patient is unconscious and can not tell the artificial sphincter) High risk of re-revision and replacement of spincter (mechanical damage, infection, erosion) % Fulford S.C. et al., 1997; Hajivassiliou C.A., et al., 1999; Venn S.N. et al., 2000; Trigo Rocha F, et al., 2008; Bauer R.M. et al., 2009 But!

Sphincteric deficiency as a result of operations on the prostate - the main cause of stress urinary incontinence in men; Radical prostatectomy - the most common operation is the development of stress urinary incontinence;

For early PPSUI recommended non-invasive methods of treatment. The combination of pelvic floor muscles training (PFMT) with duloxetin - the most effective; Injection therapy is not widely used because of its low clinical efficacy, the need for repeated injections and the relatively high cost;

Patients with mild to moderate urinary incontinence sling surgery are recommended. For patients with severe incontinence recommend implantation of artificial sphincter, which is still the "gold standard" treatment for men with PPI, despite the high risk of complications.