[Which patients with stress urinary incontinence after radical prostatectomy benefit from the indication of an Invance?].

OBJECTIVES: Stress urinary incontinence alter radical prostatectomy is one of the most worrisome sequelae for the patient and urologist. The aim of this paper is to evaluate the indications of the suburethral mesh Invance, giving details on our preoperative evaluation and indication, surgical technique, and the correlation between preoperative findings and functional results.

METHODS: Between February 2006 and January 2009 27 patients underwent surgery. All of them had more than one year of follow up after prostatectomy, urodynamic study and preoperative cystoscopy. Continence was evaluated by the number of pads/day and the ICIQ-UI SF questionnaire. Through a perineal incision three titanium screws with a polipropylene suture were inserted in each ischiopubic rami, and a silicon/polipropylene mesh (Invance) is affixed to them, compressing the bulbar urethra. Patients were divided into two groups: good prognosis (1-2 pads/day without urodynamic anomalies in the filling phase) and bad prognosis (3 pads/day, history of radiotherapy or bladder neck incision, and urodynamic anomalies). Cure was defined as a patient not needing pads, and improvement was defined as decrease in the number of pads per day.

RESULTS: Median follow up after Invance was 18 months (4-38). Nine patients used one pad/day, 10 used two, and eight used three pads /day. Six cases had underwent previous bladder neck incision and three radiotherapy. Globally, 20 patients (74% ) were cured and five (19% ) had improved. Cure rate was 100% in the good prognosis group and 61% in the bad prognosis group (p=0.03). No intraoperative complications were registered. During the immediate postoperative period,one patient required cystostomy tube for 10 days. Seven patients (26% ) presented perineal discomfort; neither de novo urgency nor urethral erosion nor sling explants due to infection were registered.

CONCLUSIONS: Invance is a safe technique that guarantees a high continence rate in selected patients. It is a reproducible operation and, with a midterm follow up, no loss of continence has been observed, and the risk of urethral erosion is null in our experience. Patients with mild-moderate incontinence, without urodynamic anomalies nor previous radiotherapy are the ideal candidates.