UroToday - At the centennial meeting of the Societe Internationale D'Urologie in Paris, a symposium on recent innovations in the treatment of stress urinary incontinence was held. The symposium was sponsored by American Medical Systems.

Professor Graeme Urwin from the United Kingdom first began with a discussion on innovations in the management of stress urinary incontinence in women. He spoke of the growing body of data to support the use of the transobturator approach (TOT), specifically the Monarc sling, and then on the new MiniArc single incision sling variation of the Monarc. There is clear data to suggest that the Monarc compares favorably to the retropubic mid urethral slings such as the TVT and that potential complications such as bladder injury, which happen as high as 6% of cases can be avoided. There was also discussion that the management of the rare obstructed patient by urethrolysis may be technically easier in the TOT patients than the TVT patients or those done retropubically.

The MiniArc is a variation of the Monarc in that complete passage of the passer needle through the obturator foramen is not necessary. A single midurethral incision is made, and dissection is carried laterally to the fascia which is not pierced. The sling is then attached to the passer needle and the device is "popped" thorough the fascia from inside to out. The device is then attached to the sling and then passed on the contralateral side. Sling tension can be adjusted if need be. Preliminary data suggest similar efficacy to the Monarc in a procedure that takes less than 10 minutes to perform.

Karl Kreder from Iowa in the US then discussed innovations in the management of stress urinary incontinence in the male. The transobturator Advance male sling was described in detail in early data was examined. The birth of the Advance was discussed and surgical video was reviewed which showed the theme of repositioning the proximal bulbar urethra into the pelvis rather than compressing it. Doctors Christian Gozzi and Peter Rehder from Austria developed the technique. The sling comes thorough the triangular ligament between the corporal body and the bulbar urethra and tension applied of the tape pulls the urethra into the pelvis for a distance of 2 to 4 cm once the central tendon of the perineal body is divided. The passer needles are passed outside to in and the sling is then attached. Tension is adjusted to achieve adequate movement of the urethra into the pelvis and it is anatomically impossible to have a sling that is too tight owing to the bony obturator foramen limiting the tension. The sling seems indicated for men with mild to moderate stress urinary incontinence and evidence of some residual sphincter function on cystoscopic examination. Preliminary data on 30 European and 50 US patients show a success rate of over 75% with the vast majority being completely dry.

Reported by UroToday Contributing Editor Michael Metro, MD

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