Titanised Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-Out Single-Incision Technique: Minimum 12-Months Follow-Up Study

OBJECTIVE: To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence. MATERIALS AND METHODS: From 01/2013 to 06/2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or TURP (5) underwent transobturator two-arm titanium-coated sling (TiLOOP Male®) implantation with an inside-out, single-incision technique, leaving the bulbourethral muscle in place. Patients have been assessed postoperatively with uroflowmetry, pad count, ICIQ-SF, IIQ-7, PGI-I, OABq, IPSS, satisfaction (yes/no). Successful outcome included cure (no pad use or one dry "security" pad) or improvement (reduction of at least 50% of the pad count). RESULTS: Evaluated patients were suffering from mild (11/44, 25%), moderate (26/44, 59%) or severe (7/44, 16%) incontinence. After a median follow-up of 25 months (range 12-55, minimum 12 months), 24(54.6%) patients were cured and 10(22.7%) were improved, which was a global success rate of 77.3%. There were 10(22.7%) failures in the first 6 months. Zero pad rate was 50%. Subjective success (PGI-I very much/much improved) was achieved in 33(75%) patients. Mean scores of ICIQ-SF, ICIQ-QoL and IIQ-7 improved to a statistical significant extent. Satisfaction was reported by 33(75%) patients. Uroflowmetry parameters were unchanged postoperatively, and most of complications were Clavien-Dindo grade I. BMI≥30 and previous irradiation/HIFU were independent predictors of failure. CONCLUSIONS: TiLOOP Male® provided favourable and stable midterm continence outcomes. The inside-out approach was safe, and the tolerability of the sling and the single-incision technique was satisfactory. Patients with obesity and previous irradiation/HIFU should be aware of their higher risk of failure.