MP88-06 THE MECHANISM OF ACTION OF THE MALE TRANSOBTURATOR SLING IS VIA INCREASED FUNCTIONAL LENGTH OF THE MEMBRANOUS URETHRA: A PROSPECTIVE, CONTROLLED STUDY USING DYNAMIC MRI

INTRODUCTION AND OBJECTIVES: We describe the first retropubic suburethral autologous sling created and placed during robotic radical prostatectomy (RARP). Surgical technique and preliminary data regarding its effectiveness in improving early urinary continence (UC) recovery are presented. METHODS: Between November 2013 and February 2014 a cohort of 60 continents and neurologically healthy patients affected by localized prostate cancer and submitted to RARP at single highvolume center were prospectively randomized into sling and non-sling group. Sling technique was performed in the following steps: 1) at the beginning of right pelvic lymphadenectomy, vas deferens was isolated and removed 2) on scrub nurse table the vas deferens specimen was shaped in a 5-cm section and inserted at the middle of 14cm absorbable double end wire 3) the autologous sling obtained was positioned before the time of bladder-urethral anastomosis, immediately below the plane of the reconstructed recto-uretralis muscle and fixed to the periosteum of the pubic branch bilaterally 4) after completion of the vesico-urethral anastomosis, the sling was anchored definitively pulling further and fixing its wire ends in order to give the wanted urethral support. Early UC recovery was assessed at 5 (catheter removal), 10 and 30 days postoperatively through the record of the daily number of pads used and the collection of International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF). Chisquare test and Indipendent Sample T-test were used to investigate UC recovery between the two groups. RESULTS: Complete data collection was available for 60/60 (100%) patients. Mean SD age was 63 9.0 years. Mean SD number of pads daily used in non sling and sling group were at 5 days 1.9 1.2 vs 1.7 1.4 (p1⁄40.5); at 10 days 1.8 1.3 vs 1.3 1.3 (p1⁄40.1) and at 30 days 1.1 1.2 vs 0.4 0.8 (p1⁄40.01) respectively. At 1 month mean SD ICIQ-UI-SF score was 1.8 3.4 vs 4.8 4.6 (p1⁄40.01) in sling and nonsling group; moreover sling patients were found to be associated with a pad-free status ( 2: 4.7; p1⁄40.03). CONCLUSIONS: Our initial experience indicates that new designed suburethral autologous sling is technically feasible and may represent a reliable intraoperative solution in order to improve early UC recovery in patients undergoing RARP. Because the improvement in the percentage of UC recovery at one month post-operatively and the absence of surgical complications this technique has become standard in our department.