Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success.

Autor: Shakir NA; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., Fuchs JS; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., McKibben MJ; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., Viers BR; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., Pagliara TJ; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., Scott JM; Department of Urology, UT Southwestern Medical Center, Dallas, Texas., Morey AF; Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Jazyk: angličtina
Zdroj: Neurourology and urodynamics [Neurourol Urodyn] 2018 Nov; Vol. 37 (8), pp. 2632-2637. Date of Electronic Publication: 2018 May 01.
DOI: 10.1002/nau.23703
Abstrakt: Aims: To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms.
Methods: We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated.
Results: Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001).
Conclusions: MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI.
(© 2018 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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