2. A. Shahrazad MD Shahid Chamran hospital 2011 Iranian continence society

3. Khan URO. NOV 2009  45-50% Sole cause is DO  35-45% Sphincter mechanism damage  5-10% Mixed It appears that post- PPI is not always due to a surgical misadventure

4. SUI \  Post prostatectomy SUI due to sphincter dysfunction minimum delay of 6-12 mo before an active treatment  TUR 1% to 3% RP up to 33% Different degrees of INCONT.  QOL deeply affected by this side effect

5.  Mild Incont. : The use of one to two pads per day (<100cc) (Cornu)  Moderate Incont. : The use of three to four pads per day(100- 400cc) (Cornu)  Sever Incont. : The use of six pads per day( >400cc)/day

6.  Nonsurgical  Surgical

7.  Non surgical options: PFMT moderate success for mild incont. No pharmacologic success ( In PPI Duloxetine could be helpful ) schlen 2006 Pads, clamps, condom cath.

8.  Slings InVance AdVance Argus  Bulking agents  Artificial sphincter Pro Act ZSI AMS

9. Surgical options : per urethral injection of bulking agents weak success rate ( 10% cure & 35% improve ) J urol, 2006 sanches / USA Artificial urinary sphincter implantation ( AUS ) has good results in long term( GOLD STANDARD)

13. BUT  Expensive  Infection  Erosion & Pain  Certain skill is required  Mechanical failure 15% in 5/y  Require manual manipulation

14. SLING

15.  Date back to 1951 Berry & Kaufman  Failures let to AUS Two kinds Compressive Sling Stamey, Madjar 1994-2001 Repositioning or adjustable Sling Montague 2009

16. Male sling procedures helps men with UI due to sphincter weakness or insufficiency in the setting of prior pelvic surgery

17.  Short surgery  May be perform under G/A or S/A  Rapid recovery  Often no cath.  Restore Q/L

18. Male slings have been included Into The EAU guidelines For Treatment male SUI

19.  1-5 pads /d OR < 200g pad weight /d  Residual sphincter function

20.  Recurrent UTI  Blood coagulation disorders  Renal insufficiency  Upper tract urinary OB.  Previous RT

21. Infection OR erosion OR transient retention IS very low BUT Success continence rate is 80% Romano BJU 2009

22.  ( In Vance)  ( Ad Vance) U OR V Sling tension ( MUP, ALPP ) 100 cm H2O intraoperatively Jean Leval 2008  Repositioning Sling ( Adjustable) V OR U

23. A sling attached to the pubic bone Success rate in mild to moderate SUI 75% Success rate in sever incontinence 50% or less With pain and pubic osteitis Must perform sphincterometry during op. a pressure 50-70 cm H2O

26. Patients with mild, moderate UI without urodynamic anomalies nor previous RT are the ideal candidates Gomes,urol, 2009

27. Transobturator male sling or V  A new approach to treat PPI  Safe & satisfactory cure rate  An alternative for AUS  Simple J Urol, dec 2010 Wadie /Egypt  Few complications  Valid for mild to moderate incont…80%

28.  Mid- Term follow up, safe & a good alternative treatment for PPI ( SUI ) Bauer/Urol, 2010  50% Success rate in patients after adjuvant RT up to 18 mo Bauer / J Urol, 2010  Success after AUS operation failure Cornel J Urol, 2010

30.  Until recently, all male sling operations compressed the fixed bulbous urethra with different composition and method of anchoring…… Simple & less expensive  But how much compression? Too much== sling erodes, unable to void Too little Remains incontinence

31.  Repositioning sling : Repositions the bulbomembranous urethra 2-3 cm toward the bladder neck Free bulbo., By dividing bulbospongiosus M. and advanced by finger 2-3 cm deeper Sling is then fixed to the bulbous U. U or V arms advanced the sling

32.  It augment s existing sphincter function when it is incomplete rather than replacing it  Previous radiation is suggested as a exclusion criteria  Follow –up median 13months Success rate 80% Conu Baure Montague Urban 2009-2010