Retrograde leak point pressure measurement improves outcomes of the Virtue male sling for postprostatectomy incontinence

Introduction: We aimed to compare the efficacy of two different sling tensioning approaches, and to report our experience, including safety and impact on quality of life (QoL) of the Virtue (R) male sling for the treatment of postprostatectomy incontinence (PPI). Methods: From our prospectively maintained database, we retrospectively identified all men treated with the Virtue male sling for PPI between March 2009 and February 2014 by two urologists in two institutions. Baseline demographic data and the sling tensioning method were abstracted from the database. Likewise, the Patient Global Impression of Improvement (PGI-I) scale, severity of incontinence, and clinical outcomes were also abstracted. Results: 48 patients were treated with the Virtue quadratic male sling. Sling tensioning was done using cystoscopy in the first 18 patients (Group 1), while per-operative retrograde leak point pressure (RLPP) measurement was done in the last 30 patients (Group 2). The median (interquartile range [IQR]) followup from the day of surgery was 22 (15-41) months. At the last followup visit, 7 (39%) patients in Group 1 were cured or improved of their PPI, compared to 21 (70%) patients in Group 2 (p=0.03). The final median (IQR) RLPP in these patients was 41 (37-48) cm H2O. Transient pain was the most common adverse event, occurring in 23 (48%) of patients. Twenty-one (70%) patients in Group 2 were "much better" or "very much better" with their device, compared to 7 (39%) in Group 1 (p=0.0008). Conclusions: The Virtue male sling is a valuable treatment option for PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates.