CONTINENCE AFTER ROBOTIC PROSTATECTOMY: THE IMPACT OF NERVE SPARING TECHNIQUE

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of those choosing MS did not want a mechanical device. No patient went against the physician recommendation for MS, 21 (88%) stated that their incontinence was not severe enough to warrant an AUS and 3 (12%) had stricture disease and were at high risk for an AUS complication. CONCLUSIONS: When faced with a choice of AUS vs. MS, most, but not all adhere to urologist recommendation. When faced with no urologist preference 88% choose MPS. The primary reason for not choosing an AUS when it is preferred by the urologist is the desire to avoid a mechanical device. Source of Funding: None

1497

Source of Funding: None

Urodynamics/Incontinence/Female Urology : Incontinence: Evaluation & Therapy (II) Moderated Poster Session 53 Tuesday, May 20, 2008

1:00 - 3:00 pm

1496 ARTIFICIAL URINARY SPHINCTER VS MALE PERINEAL SLING FOR TREATMENT OF POST PROSTATECTOMY INCONTINENCE: WHAT DO PATIENTS CHOOSE? Elana Rosenberg Litt, Katie N Ballert*, Angelish Kumar, Victor W Nitti. New York, NY. INTRODUCTION AND OBJECTIVE: Currently there are two surgical procedures to treat post prostatectomy incontinence 33, DUWL¿FLDOXULQDU\VSKLQFWHU$86 DQGPDOHVOLQJ06 ,QDODUJH incontinence practice we sought to determine the patient and physician reasons for choosing an AUS or MS and compare the surgeon’s primary recommendation to the actual procedure chosen by the patient. METHODS: The charts of 133 consecutive men with PPI who XQGHUZHQWWKHLU¿UVWVXUJLFDOSURFHGXUHWRFRUUHFWLQFRQWLQHQFHGXULQJ a time period when both AUS (AMS 800) and MS (InVance sling) were being preformed (April 2004 - Feb. 2007) were reviewed. Secondary procedures and revisions are not included. Patients were informed of the long-term satisfaction rates for AUS as well as the available, shorterterm data on MS. After evaluation, the surgeon made a recommendation for the preferred operation for the patient’s condition: high grade PPI JUDYLWDWLRQDORUSDGWHVW!JPVKUV $86PRGHUDWHJUDGH33, SDGWHVWJPVKUV $86RU06PLOG33,SDGWHVW gms/24 hrs) or recurrent uncontrolled stricture - MS. Based on surgeon’s recommendation, expected outcomes, and other factors related to surgery and the devices, patients chose the procedure they wanted. Surgeon’s preferred procedure and patient choice were compared and reasons for patient choice were determined. RESULTS: 84 MS (63%) and 49 AUS (37%) were preformed. There was no difference in the mean age (68.0 vs. 67.5, p=0.73) or time from surgery/radiation until treatment (55.1 vs. 48.8 months, p=0.46). Surgeon recommendation was AUS in 63(47%), MS in 46 (35%), and either in 24 (18%). When AUS was recommended, 47 PHQ FKRVH$86 FKRVH062IWKRVHJRLQJDJDLQVW the AUS recommendation 13 (81%) did not want a mechanical device DQG ZDQWHGWRWU\DQRQPHFKDQLFDOSURFHGXUH¿UVW:KHQWKH urologist had no preference, 22/24 (92%) chose MS and 2 (8%) chose $867KHFKRRVLQJ$86ZDQWHGWKHPRUHGH¿QLWLYHSURFHGXUH$OO

KEYS TO PATIENT SELECTION PROVIDING EARLY SUCCESS WITH THE MALE ADVANCE SLING IN MANAGEMENT OF POSTPROSTATECTOMY INCONTINENCE Jack R Walter*, Neil H Grafstein, Jill S Smith, George D Webster. Durham, NC. INTRODUCTION AND OBJECTIVE: The male AdVance sling has recently been introduced to manage post-prostatectomy incontinence. Early results are promising in a selected population. We present preoperative evaluation criteria leading to early success. METHODS: A prospective review was performed of all men (44) implanted with the Male AdVance sling by one surgeon (GDW) between March 2006 to October 2007. Preoperative evaluation included history with particular interest in prior genitourinary surgery, physical exam, 24 hour pad weights, urodynamics, and cystoscopy. $WRI¿FHF\VWRVFRS\VSKLQFWHUDFWLYHXUHWKUDIXQFWLRQDQGDSSHDUDQFH as well as vesicourethral anastomosis characteristics were noted. Patients were followed with history, exams, and 24 hour pad weights postoperatively. RESULTS: Forty-four men underwent surgery. Preoperative incontinence pad numbers averaged 3.6 (range 1-8) and pad weights averaged 245 grams (0-802) per 24 hours. Preoperative cystoscopy revealed poor sphincter coaptation in 3 of 44 patients. Two patients had anterior sector defects in the sphincter active urethra but still showed good coaptation. Four patients had evidence of postoperative vesicourethral distraction defect at the posterior wall. Three patients had mild anastomotic contraction. Average follow up is 6.5 months. Postoperative incontinence pad numbers and weights per 24 hours were 0.6 (0-5) and 50 gm (0-712 gm) respectively. Thrity-eight men (86%) have no incontinence postoperatively. The failures had noted differences: 1 with radiation and poor sphincter coaptation, 1 with 2 prior InVance slings and anterior sector defect in the sphincter active urethra, ZLWKSULRUDUWL¿FLDOXULQDU\VSKLQFWHUDQGZLWKSRRUFRDSWDWLRQRIWKH sphincter active urethra and an anterior sector defect of the sphincter. Bladder neck anastomotic appearance did not correlate with success. Preoperative pad weights did not correlate with success. CONCLUSIONS: The AdVance sling provides a reliable DOWHUQDWLYH WR WKH DUWL¿FLDO XULQDU\ VSKLQFWHU IRU PDQDJHPHQW RI SRVW prostatectomy incontinence. While it does not successfully manage all patients, success is high with strict patient selection. Currently, we are excluding patients with prior surgery that could lead to scarring and ¿[DWLRQRIWKHXUHWKUDODUJHVHFWRUGHIHFWVLQWKHVSKLQFWHUDFWLYHXUHWKUD and poorly contractile sphincter active urethra. Caution should be used in patients with prior pelvic radiation as success in this population is yet to be determined. Source of Funding: None

1498 CONTINENCE AFTER ROBOTIC PROSTATECTOMY: THE IMPACT OF NERVE SPARING TECHNIQUE Donald L Pick*, Douglas Skarecky, Thomas E Ahlering. Orange, CA. INTRODUCTION AND OBJECTIVE: Nerve sparing (NS) dissection is linked to postoperative potency. Some authors suggest a relationship between NS and early return to continence. We examine the correlation between NS and continence after robotic prostatectomy. 0(7+2'6PDWFKHGSDLUVZHUHLGHQWL¿HGIURPDGDWDEDVH RIURERWLFSURVWDWHFWRPLHV&RQWLQHQFHGH¿QHGDV]HURSDGVZDV obtained from self-administered validated questionnaires. The rate and time to continence were compared for NS status in all patients

Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008

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and matched pairs. Pairs were matched by age, AUA symptom score, IIEF-5 and BMI. Table analysis and Kaplan-Meier curves were done for the entire cohort and matched pairs. Uni and multivariate analysis was done. RESULTS: 425 of 500 (85%) returned questionnaires. 387  ZHUHFRQWLQHQWE\RQH\HDUDIWHUVXUJHU\$YHUDJHWLPHWR]HUR pads was 71 days. For the entire cohort, average age was 61.1, AUA symptom score was 8.5, IIEF-5 was 19.0, and BMI was 26.8. For the matched pairs, the average age was 66.6, AUA symptom score was 8.3, IIEF-5 was 10.0, and BMI was 27.9. In univariate analysis, continence DWPRQWKVZDVVLJQL¿FDQWO\EHWWHUIRU%16816DQG116 S  .0FXUYHVKRZHYHUVKRZHGQRVLJQL¿FDQWGLIIHUHQFH (p=0.4863). When matched for age, AUAss, IIEF-5 and BMI, nerveVSDULQJVWDWXVKDGQRHIIHFWRQWLPHWR]HURSDGV CONCLUSIONS: In univariate analysis, NS status GHPRQVWUDWHGDVLJQL¿FDQWGLIIHUHQFHLQFRQWLQHQFHDWPRQWKV:KHQ other factors known to impact sexual function such as age, AUAss, IIEF-5 and BMI were matched, nerve preservation had no impact on time to continence or overall continence at 3, 6 or 12 months. In our experience, IDFWRUVNQRZQRUVXVSHFWHGWRLQÀXHQFHEODGGHUDQGGHWUXVRUIXQFWLRQ have a greater impact on time to continence and overall continence than nerve sparing status at surgery. 1HUYH6SDULQJ6WDWXV$QG7LPHWR=HUR3DG&RQWLQHQFH % continent at % continent at % continent at Nerve Sparing Status 30 days 90 days 180 days 217/290 Bilateral: all patients 119/290 (41.0%) 258/290 (90.0%) (74.8%) Unilateral: all patients 39/106 (36.8%) 74/ 106 (69.8%) 87/106 (82.1%) Non: all patients 10/29(34.5%) 19/29 (65.5%) 22/29(75.9%) P value: all patients 0.63 0.39 0.049 Bilateral or Unilateral: 3/21 (14.3%) 10/21 (47.6%) 12/21 (57.1%) matched Non: matched pairs 5/21 (23.8%) 11/21 (52.4%) 13/21(61.9%) P value: matched pairs 0.70 1.00 1.00

% continent at 365 days 262/290(91.7%) 93/106 (88.9%) 26/29 (89.7%) 0.78 13/21 (61.9%) 15/21(71.4%) 0.74

Source of Funding: None

1499 INTERNATIONAL LONG TERM EVALUATION OF THE ADJUSTABLE CONTINENCE THERAPY (ProACT™) FOR MALE POST PROSTATECTOMY STRESS URINARY INCONTINENCE Wilhelm Huebner*, Ervin Kocjancic, Flavio Trigo Rocha, Peter J Gilling. Korneuburg, Austria, Udine, Italy, Sao Paulo, Brazil, and Tauranga, New Zealand. INTRODUCTION AND OBJECTIVE: The Adjustable Continence Therapy (ProACT™) has been used in Europe, South America and Australasia since 2000 as a minimally invasive treatment option for male stress urinary incontinence. We evaluated patients with incontinence arising from multiple aetiologies who were implanted at HDFK RI IRXU LQWHUQDWLRQDO FHQWUHV (I¿FDF\ ZDV DVVHVVHG EDVHG RQ subjective and objective parameters. METHODS: Implantation of the ProACT device involves the insertion of two balloons on either side of the urethra at the level of anastamosis in post radical prostatectomy patients and at the membraneous urethra for those patients with a prostatic remnant. Each balloon is attached to a port placed in the scrotum facilitating post operative adjustment by percutaneous injection in the clinic Between 2001 and 2005, 329 patients have been implanted. Minimum follow up is 24-months. Baseline assessment included completion of the Incontinence Quality of Life score (IQoL) and daily pad usage. These investigations were repeated at 1,3, 6 and 12 months and annually thereafter. RESULTS: IQoL improved from 41.6 (range 11.3- 94.3) at EDVHOLQHWRUDQJH DWPRQWKV DW PRQWKV DWPRQWKVDQG DWPRQWKV3DG XVDJHUHGXFHGIURPDPHDQRIDWEDVHOLQHWRDWPRQWKV DWPRQWKVDWPRQWKVDQGDWDWPRQWKV6L[W\¿YHSHUFHQW of patients were dry (<1 pad per day) at 2 years. Balloon adjustments were performed as required in order to achieve and maintain continence. Eighty two percent of patients required adjustments with a mean of 4.7  &RPSOLFDWLRQVLQFOXGHGHURVLRQPLJUDWLRQRUQRQUHVSRQVHWR

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initial surgery. Device removal was easily performed without adverse sequelae allowing for reimplantation or further surgical intervention. CONCLUSIONS: ProACT is a safe, effective and durable treatment for male stress urinary incontinence. The ability to titrate the balloons over time facilitates sustained improvement as demonstrated by the improvement in Quality of Life and reduction in pad usage. Source of Funding: Uromedica, Inc

1500 THE PREDICTIVE VALUE OF SUBJECTIVE SEAPI SCORES IN MALES WITH VOIDING DYSFUNCTION Veronica Triaca*, Christian O Twiss, Ariana Smith, Ja-Hong Kim, Larissa V Rodriguez, Shlomo Rodriguez. Los Angeles, CA. INTRODUCTION AND OBJECTIVE: The predictive value of subjective SEAPI scoring in the assessment of males with voiding dysfunction remains unknown. The purpose of this study was to correlate the subjective SEAPI scores (S-SEAPI) in males with voiding dysfunction to chief voiding complaint, objective SEAPI (O-SEAPI) values and ¿QGLQJVRQPXOWLFKDQQHOXURG\QDPLF8'6 HYDOXDWLRQ METHODS: Between November 2006 and September 2007, 112 males with voiding dysfunction underwent evaluation with history, physical exam, and UDS. UDS were performed as recommended by the ,&666($3,FODVVL¿FDWLRQZDVREWDLQHGDWWKHWLPHRIHYDOXDWLRQ:H correlated the primary voiding complaints with S-SEAPI values. Further, S-SEAPI and O-SEAPI values were compared. S-SEAPI scores were DOVRFRUUHODWHGWR8'6¿QGLQJVRILQVWDELOLW\YRLGLQJSUHVVXUHV93  LQWXEDWHGÀRZYDOXHV4PD[ DQGSRVWYRLGUHVLGXDOV395 6WDWLVWLFDO analysis was performed via Pearson Chi-Square (Chi2) and Spearman FRUUHODWLRQFRHI¿FLHQWDQDO\VLV6&  RESULTS: The median age of the cohort was 70 years. Chief complaints included overactive bladder with or without urge incontinence    VWUHVV LQFRQWLQHQFH    RU REVWUXFWLRQ   $OO 66($3, SDUDPHWHUV FRUUHODWHG ZLWK WKH SDWLHQW¶V primary voiding complaint (Chi2S 66($3,VFRUHVFRUUHODWHG ZLWK 26($3, VFRUHV IRU VWUHVV LQFRQWLQHQFH 6&  S  HPSW\LQJ6& S DQGLQVWDELOLW\6& S  Subjective emptying scores correlated with VP (Chi2S 4PD[ (Chi2S DQG395&KL2S )XUWKHUVXEMHFWLYHEODGGHU overactivity correlated with the presence of instability on UDS (Chi2 p<0.0001). CONCLUSIONS: Subjective SEAPI values are an adequate representation of a patient’s primary voiding complaint. Further, subjective SEAPI scoring strongly correlates with objective SEAPI values DQG¿QGLQJVRQ8'6 Source of Funding: None

1501 THE RESULTS OF SPARC PROCEDURE FOR FEMALE STRESS URINARY INCONTINENCE STRATIFIED BY PREOPERATIVE VALSALVA LEAK POINT PRESSURE Luck Hee Sung*, Joon Myoung Park, JiHyeong Yu, Jae Yong Chung, Choong Hee Noh. Seoul, Republic of Korea. INTRODUCTION AND OBJECTIVE: There were variant results for correlation between the postoperative cure rate and VLPP for female stress urinary incontinence. Therefore the aim of this study was to DVVHVVWKHLQÀXHQFHRI9/33RQWKHRXWFRPHRI63$5&SURFHGXUH METHODS: 246 women with SUI underwent SPARC procedure between January 2000 and June 2006. The patients were divided into 2 groups by VLPP: group A(VLPP<60cmH2O) and group B(VLPP•60cmH2O) and then the objective success rate and subjective success rate were assessed. Before surgery, the patients were evaluated with history taking, physical examination, and urodynamic studies. The objective outcome was evaluated with an 1-hour pad test in 6 month postoperatively and the subjective satisfaction rate was assessed using questionnaires for the patients’ satisfaction and evaluating by recommendation rates of SPARC to other patients. The objective success rate included cure and improvement, the subjective success rate satisfaction and fair.