{"paper_id":"2c9dbb97-5cf2-46cd-85d6-ef4661064910","body_text":"Perineal sling for the treatment of severe male incontinence, a cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perineal sling for the treatment of severe male incontinence, a cohort study Bassem S Wadie, Islam F. Eldiasty, Ahmed A. Selim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3934336/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Post radical cystectomy/post-traumatic incontinence is challenging. Albeit not life-threatening; it has significantly negative impact on patients’ quality of life. We studied the application of customized perineal sling in treatment of these two conditions. Methods Men after RCOD with significant daytime incontinence had MRI, basic laboratory testing and 1-hour pad test. Patients with post traumatic incontinence had anastomotic urethroplasty at least once. All had a median 5 pad/day. Tailored to the size of the patient’s bulb, Polypropylene mesh is fixed by 4 No 1. Ethilon sutures, to the inferior pubic ramus. Results Group 1 included 12 patients; mean age: 67 years. (56–80 years). No evidence of local recurrence prior to sling. Mean BMI: 25.62 (range: 22-32.4) Mean pad weight was 112.5 gm. (80–200). 12 months after surgery, pad test was negative in 6 patients (50%) and positive in 6, with mean increase of 17.8 gm. (range 1–80 gm.). Average pad use was 2 pads /day (1–3). Mean PVR was 15.3 ml (range: 1–82). Group 2: 4 patients. Mean age: 29.3 years. All had anastmotic urethroplasty for post- traumatic stricture. Median incontinence duration was 24 months (24–120). Median follow up was 50 months (32–70). At the time of last follow up, 3 out of 4 (75%) were either completely dry or showed significant improvement with only one pad /day. Conclusion At 1 year this customized perineal sling is a safe, easy to learn and effective mode of treatment of severe male incontinence. Perineal sling post-cystectomy post-traumatic incontinence Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Radical cystectomy and orthotopic diversion (RCOD) is the mainstay treatment of muscle-invasive bladder cancer . 5-year survival was reported as 40% to 64.5% . Adverse events following RCOD include metabolic acidosis, uretero-ileal and urethro- ileal stenosis, fistula, intestinal obstruction, erectile dysfunction and incontinence. The incidence of incontinence widely varies in the literature with lack of standardized reporting . In one study on 2238 patients with different orthotopic neobladders, daytime incontinence was 13% . In another study, based on mailed questionnaire, 139 of 179 responders used pads at least sometimes; half of them used pads day and night. 47% used pads in the day and 72% at night . Post-traumatic urethral injury is common after pelvic fractures; that was reported in 9.3% of 16,630 trauma registry patients with blunt trauma. In severe pelvic fractures (Severity > 4 in Abbreviated Injury Scale) the incidence of associated bladder and urethral injury was 14.6% . The incidence of PTI depends on several factors including the severity of trauma and whether the patient was initially managed by realignment . Incontinence usually results from sphincter damage but other causes may be involved such as denervation of the sphincter (due to pudendal/pelvic plexus injury) and detrusor overactivity. Following posterior urethroplasty, the incidence of urinary incontinence is ~ 10% in some reports , while in others the incidence is much lower The treatment options include injectables, artificial urinary sphincter (AUS), and slings. Given the non-durable response to the use of injectables and the high cost of AUS, the sling came to be an attractive option in these patients . In this study, we looked at men with post cystectomy and post traumatic incontinence who were treated by perineal sling at 1 year. Patients and methods Group 1: Men with RCOD and significant daytime incontinence; (defined as 5 pads at least or wearing an external collecting device during daytime) were included Normal pelvi-abdominal MRI and kidney function (normal serum creatinine) were inclusion criteria. Histopathology was transitional cell carcinoma in all. A 1-hour pad test was obtained. The procedure was carried out under spinal anesthesia. Urethroscopy was an initial step to exclude urethral pathology (recurrence/ stricture) The procedure is similar to what has been previously described . However, given a completely different set of patients, the retropubic route of the sling was replaced by a perineal approach. Polypropylene mesh of sufficient size is double- breasted. Tailored to the size of the bulbospongiosus muscles, Polypropylene mesh is fastened by 4 sutures (Ethilon, 1), 2 on each side. Ethilon sutures were fixed to the inferior pubic ramus, one to a proximal and the other to a distal location; about 3–4 cm apart. (Figs. 1& 2). The sling is adjusted to cover the bulbar urethra within its coverings (Fig. 3).The tightening is left as the final step (Fig. 4). Bladder was completely emptied and then filled with 200 ml of saline. The patient was asked to cough as strenuous as he can. In group 1, excessive tightening is avoided as the sling is designed to work against the pressure generated in the pouch by Crede voiding. In final adjustment, the sling is compressing the bulb of the urethra. The closure of the wound then ensues after insertion of a Foley catheter for 1 day and Yeates drain for 48 hours. The wound was checked next morning, the catheter was removed, PVR was assessed. Group 2: For study purposes, post-traumatic incontinence was defined as stress/ total incontinence following traumatic urethral injury after the final treatment of the urethral injury. To this end, 4 patients were eligible Clinical examination, basic laboratory investigations and 1-hour pad test were carried out. Retrograde urethrogram was performed before surgery to ensure the patency of the urethra and the presence or absence of associated anomalies. In those with recurrent strictures/pathology, a concomitant correction was contemplated. Adverse events were graded according to Clavien-Dindo system, results of follow up visits were analyzed including pad test and the number of postoperative pads used (if any). Follow up schedule included visit every 3 months for 1 year and then half annual thereafter. Results Group 1: 14 patients have completed 12 months follow up. Mean age of the patients is 67 year (56–80 years). Mean BMI was 25.98 (range: 22-32.4) All had radical cysto-prostatectomy and ileal neobladder, 2 were nerve-sparing. One patient had local recurrence for which he has received platinum-based chemotherapy with significant reduction in size. The interval between cystectomy and sling was 7 months (Range: 0.6–10 years). At time of surgery, none had evidence of local recurrence on MRI. All patients had severe incontinence with 8 of them using an average of 5 pads per day while 6 were putting on a condom catheter as a protective means. One- hour pad test was carried out before surgery. Mean pad weight gain was 109.5 gm. (80–200) Post-operative, 2 patients had superficial wound dehiscence in the early post- operative period (2 weeks) that was treated by simple sutures under local anesthesia. Clavien Dindo grade 1) PVR was estimated after the Foley catheter was taken out and was found to be in the range of 10–140 ml (mean: 85 ml). 1 year after surgery, pad test was negative in 6 patients (50%) and positive in 6. Mean increase of pad weight was 17.8 gm. (range 1–80 gm.). Mean PVR was 15.3 ml (range: 1–82). Average pad use was 2 pads /day (1–3) Only slight scrotal pain (2 patients) and a sensation of numbness in the scrotum (1 patient) were noted. Table 1 shows patients’ data. Group 2: 4 patients were included in the study so far. The mean age of patients at the time of sling surgery was 29.3 years (range: 18–43). The mean BMI was 26. All had post- traumatic injury of the urethra with post-traumatic incontinence following pelvic fracture. All had anastomotic urethroplasty (AU); 1of whom had re-do procedure. The median time from the initial trauma to the urethroplasty was 5 months (1–13). The median incontinence duration was 24months (24–120). All suffered from severe urinary incontinence (5 or more pads per day). Median pad number per day was 6 pads. 1 hour pad test showed an average increase of 70.6 gm. at baseline. Median follow up duration was 55 months (36–80). 1 out of 4 was dry, 2 had significant improvement with an average increase in 1-hour pad test of 6.2 gm. 1 patient did not show any improvement. Table 2 demonstrates demographic and perioperative data of the patients. One patient had perineal wound infection and it was managed by frequent dressing in the ward (Clavien- Dindo grade I). However, this patient developed urethrocutaneous fistula two months later and required surgical correction Discussion The incidence of day-time continence ranged from 87–100% , and , after RCOD. The treatment options included pelvic floor muscle training , Duloxetine , perineal sling , artificial urinary sphincter (AUS) , pubovaginal sling or adjustable continence therapy . Grim ET al 17 noted that pelvic floor muscle training was an independent predictor of increased HRQOL (p = 0.009, OR = 10.459) in 178 patients at 61 months. Median daytime pad use was 1 and median daily urine loss based on pad testing was 4.0 g, with a daytime continence rate of 48.5%. Schlenker et al 18 studied 20 patients; 15 after radical prostatectomy and 5 after radical cystectomy and orthotopic ileal neobladder. Each had persistent SUI despite PFMT and received 40 mg duloxetine twice daily for a mean of 9.4week. The use of pads decreased significantly (p < 0.001) from 8.0 (± 6.5) to 4.2 (± 5.9). Seven patients were completely dry or used one pad/ day. Rajpurkar et al 19 studied 35 men with post-radical prostatectomy incontinence with In Vance bone anchored sling. Using Polypropylene, fascia lata and Stratasis with the most durable results noted after Polypropylene. At a mean follow-up of 24 months, 34 patients were either dry (37%) or utilizing 1–2 pads per day (37%). Based on questionnaire, 72% patients felt that their incontinence was ‘‘small to no problem’’, 59% patients were moderately or completely satisfied. We utilized Polypropylene, being commonly used in different male slings. Our technique is customizable as we noted that the size of the bulbospongiosus muscles varies from one patient to another . So, the sling is better “tailored” to the proper size of the muscle of each patient. Direct fixation of the sling using 5/8 circle robust needle of Ethilon 1 suture; with good bite into the inferior pubic ramus cortex, using a strong needle holder is more time- and money-saving than the bone screws and the special drill. AUS was tried with modest success in the treatment of incontinence following radical cystectomy. Vainrib et al studies 36 men with radical cystectomy and orthotopic diversion in whom AUS was fixed on average 28 months after surgery. Data were available for 29 patients only. Significant improvement was reported in 17 at 40 months follow up. The authors concluded that AUS provided good continence with an “acceptable” complication rate. However, the authors stated that 38 revision procedures were necessary in 21 patients, including 12 explantations. Only 2 out of 10 patients in our series had bothersome pain, 1 had superficial wound dehiscence that required secondary sutures under local anesthesia. The results of pubovaginal rectus fascia sling was not promising when tried in 4 women after RCOD 21 and the authors recommended against its further use while Pro Act was tried in a one case- report 22 Treatment of PTI is a challenge. The urethra is traumatized, usually its membrano-prostatic segment with damage to the internal sphincter and may be rhabdosphincter . 2-stage urethroplasty was associated with 12% permanent stress incontinence in a series of 33 men following prostatectomy 25 One- stage anastomotic urethroplasty was associated with a variable incidence of incontinence. One case of stress incontinence after 1 stage urethroplasty in 61 men in one report . However, continence was found to be maintained primarily by the proximal bladder neck mechanism with a significant contribution of the rhabdosphincter . The task to restore continence in those patients is painstaking and is met with limited success. Typically, when urethral bulking agents were utilized, the results were neither satisfactory nor durable. Moreover, some of the bulking agents were associated with significant complications, including urethral erosion and loss of the material The AUS is the modality with the longest reported follow up and was considered the gold standard in the treatment of post-prostatectomy incontinence (PPI). However, it is associated with a high rate of mechanical malfunction; 23% in some series. Moreover, men with PPI showed a tendency to avoid the use of a mechanical device recently and elected the use of suburethral slings . Male sling is gaining ground in the treatment of male incontinence. Many modifications were introduced rendering the procedure safe, effective, durable and adjustable . Its effectiveness in the treatment of post- traumatic urinary incontinence in males is not well-studied in literature. Our modification devised for post cystectomy and post traumatic incontinence was tried in this sub-set of patients with promising result. Our sample size and follow up duration are modest. Enrollment of more patients and following them for years longer is underway. Our study shows that a customizable bone-fixed sling is safe and effective in the treatment of post-radical cystectomy and post-traumatic incontinence. More patients have been enrolled and we plan a longer follow up report. Declarations Clinical registration number: was not obtained, as the study represents a compilation of data from multiple clinical routine work Data of this study is available upon request Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Contribution of the authors: Wadie B S: Design, performance of surgery and drafting the manuscript Salim, A A: Enrollment of patients and follow up Fakhr, I: Enrollment of patients and follow up Conflict of interest: None of the authors has relevant financial or non-financial interests to disclose. Ethical considerations: Written informed consent was obtained from each patient. Approval of the research protocol: IRB approved the study as part of the clinical work for patients subject matter of the study. Approval # 138 Registration # in public trials registry: NA Animal studies NA References Zhong J, Switchenko J, Jegadeesh NK, et al: Comparison of Outcomes in Patients with Muscle-invasive Bladder Cancer Treated with Radical Cystectomy Versus Bladder Preservation. Am J Clin Oncol .; 2019, 42(1):36. Fedeli U, De Paoli A, Corti MC, et al: Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients. Urol Int .; 2020,1-8. el-Mekresh M, Akl A, Mosbah A, et al: Prediction of survival after radical cystectomy for invasive bladder carcinoma: risk group stratification, nomograms or artificial neural networks?. J Urol.; 2009, 182(2):466. Daneshmand S.: Orthotopic urinary diversion. Curr Opin Urol.; 2015, 25(6):545. Steers WD.: Voiding dysfunction in the orthotopic neobladder. World J Urol .; 2000, 18(5):330. Ahmadi H, Skinner EC, Simma-Chiang V, et al: Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol.; 2013, 189 (5):1782. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L.: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. JACS. 2002, 195(1):1- 10. Mouraviev VB, Coburn M, Santucci RA: The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J. Urol. 2005, 173(3):873-6. Pratap A, Agrawal CS, Tiwari A, Bhattarai BK, Pandit RK, Anchal N: Complex posterior urethral disruptions: management by combined abdominal transpubic perineal urethroplasty. J. Urol. 2006, 175: 1751- 4. Jordan GH, Schlossberg SM: Surgery of the penis and urethra. In Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA eds.: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders, 1054–84, 2007. Shindel A: Bulbourethral sling in male incontinence. IJU. 2007, 23(1):32- 33. Wadie BS.: A novel technique of bulbourethral sling for post-prostatectomy incontinence. Scand J Urol Nephrol . ; 2007, 41(5):398. Elmajian DA, Stein JP, Esrig D et al: The Kock ileal neobladder: updated experience in 295 male patients. J Urol.; 1996, 156(3):920. Cancrini A, De Carli P, Pompeo V et al: Lower urinary tract reconstruction following cystectomy: experience and results in 96 patients using the orthotopic ileal bladder substitution of Studer et al. Eur Urol.; 1996, 29(2):204. Hautmann RE, de Petriconi R, Gottfried HW et al: The ileal neobladder: complications and functional results in 363 patients after 11 years of follow up. J Urol.; 1999, 161(2):422. Steven K, Poulsen AL: The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol.; 2000, 164(2):288. Grimm T, Grimm J, Buchner A et al: Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol.; 2019, 37(11):2385. Schlenker B, Gratzke C, Reich O et al: Preliminary results on the off-label use of duloxetine for the treatment of stress incontinence after radical prostatectomy or cystectomy. Eur Urol.; 2006, 49(6):1075. Rajpurkar AD, Onur R, Singla A: Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol.; 2005, 47(2):237. Simma-Chiang V, Ginsberg DA, Teruya KK et al: Outcomes of artificial urinary sphincter placement in men after radical cystectomy and orthotopic urinary diversions for the treatment of stress urinary incontinence: the University of Southern California experience. Urology; 2012, 79(6):1397. Quek ML, Ginsberg DA, Wilson S et al: Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women. J Urol.; 2004, 172(1):219. Riccetto C, Palma P, Herrmann V et al: Adjustable continence therapy for the treatment of urinary incontinence after radical cystectomy and orthotopic neobladder in women. Int Urogynecol J Pelvic Floor Dysfunct.; 2007, 18 (9):1101. Peikert K, Platzek I, Bessède T et al: The male bulbospongiosus muscle and its relation to the external anal sphincter. J Urol.; 2015, 193(4):1433. Vainrib M, Simma-Chiang V, Boyd SD, Ginsberg DA: Potential risk factors and outcomes of artificial urinary sphincter placement after radical cystectomy and orthotopic neobladder urinary diversion. Neurourol Urodyn. 2013; 32(7):1010-3. Colapinto,V McCallum, RW: Urinary Continence After Repair of Membranous Urethral Stricture in Prostatectomized Patients. J. Urol. 1976,115 (4) 392- 396. Johnson, E.K and Latini, J. M: The Impact of Urethroplasty on Voiding Symptoms and Sexual Function. Urology. 2011, 78: 198 - 201. 34 Whitson, J. M, McAninch,J. W., Tanagho, E A, Metro, M. J. and Rahman, N U: Mechanism of Continence After Repair of Posterior Urethral Disruption: Evidence of Rhabdosphincter Activity. J Urol. 2008, 179,1035- 1039. Hurtado EA, McCrery RJ, Appell RA: Complications of ethylene vinyl alcohol copolymer as an intraurethral bulking agent in men with stress urinary incontinence. Urology. 2008, 71(4):662- 665. Kumar A, Litt ER, Ballert KN, Nitti VW: Artificial urinary sphincter versus male sling for post-prostatectomy incontinence--what do patients choose? J Urol. 2009, 181(3):1231- 5. Wadie BS: Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. J. Urol. 2010, 184(6):2446- 2451. Tables Table 1: Group 1: RCOD patients’ data # Age Co morbid Date of cystectomy Histopathology MRI Pre Pad test date of sling Post pad test PVR Complications 1 62 DM,Hypertension 3/1/2014 TCC, pt2a Free 89 22/6/2019 1 10 Wound dehiscence 2 63 - 30/3/2014 TCC, pt3b Free 71 4/2/2020 0 8 3 56 Hepatic, IDDM 27/12/2010 TCC, pt3a Free 82 19/2/2020 20 5 Wound dehiscence 4 71 - 21/6/2017 TCC, pt2b Free 160 29/7/2019 20 82 Nil 5 72 - 11/6/2005 TCC, pt 2a Free 120 7/6/2020 20 6 Nil 6 80 Hypertension 26/2/2012 TCC, pt3b Free 100 4/1/2020 0 10 Nil 7 62 - 15/4/2017 TCC, pt4a Free 90 7/6/2020 0 45 Nil 8 57 - 17/4/2014 TCC, pt3b Free 130 5/7/2020 0 1 Nil 9 65 - 8/9/2003 TCC, pt2b Free 200 27/9/2020 80 1 Nil 10 72 Hypertension, IDDM 10/6/2015 TCC, pt2a Free 15 14/10/2020 0 3 Nil 11 59 Hypertension 12/5/2016 TCC, pt3b Free 180 15/11/2020 0 18 Nil 12 55 - 01/8/2018 TCC, pt3a Free 110 21/12/2020 30 55 Nil 13 62 Hypertension 2/5/2019 TCC, pt3a Free 120 08/12/2019 25 34 Nil 14 76 IDDM 14/9/2020 TCC, pt3b Free 140 02/4/2021 70 40 Nil Table (2): Group 2: PTI. Patients’ demographics, perioperative data and results of follow up Age Type of trauma Duration of incontinence in years Number of preoperative pads Postoperative catheter duration Need for postoperative CIC Need for retightening Last follow up (months) 1 15 PFUDI 10 4 2 No No 80 2 36 PFUDI 4 5 2 No Yes 56 3 34 PFUDI 16 5 2 No No 48 4 19 PFUDI 2 5 2 No No 36 Additional Declarations No competing interests reported. Supplementary Files Supplementaryfigure1.pdf Supplementaryfigure2.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3934336\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":271587743,\"identity\":\"b7e966cb-5784-4bdf-822a-24bdb425f2a8\",\"order_by\":0,\"name\":\"Bassem S Wadie\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYBACewQzsYHhA5QpgU+LYQOSFsYZxGgxOABnJjAw8xBlS/vxxx8+5jAk9rcnNz62zbHLk29gPnibh8HGrgGHFnueHDPJmdsYEmecedhsnLstudjgAFuyNQ9DWjIuLYYNOWzMvNsYchtuJLZJ525jTtzAwGMmzcNwOBmnX84/f/z5L1DL/BuJ7b8tt9Unzm/g/wbU8h+3lhsJBtKMQC0bgLYwM247nNhwgIcNqOWAHU7vz3hjJtm7jaF+I9AvQMbxxA2H2Ywt5xgkJ+DSYs+f/vjDz20MxnLH0x8CGdWJ89ubH954U2Fnj0sLFPxHYjODHQxKDKQCQraMglEwCkbByAEApzhcBVpTAk0AAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Mansoura University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Bassem\",\"middleName\":\"S\",\"lastName\":\"Wadie\",\"suffix\":\"\"},{\"id\":271587744,\"identity\":\"feb7c186-4027-4628-a745-684f8bbbbf0c\",\"order_by\":1,\"name\":\"Islam F. Eldiasty\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mansoura University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Islam\",\"middleName\":\"F.\",\"lastName\":\"Eldiasty\",\"suffix\":\"\"},{\"id\":271587745,\"identity\":\"2aa879ce-8d8a-4964-ab97-712a4c878b20\",\"order_by\":2,\"name\":\"Ahmed A. Selim\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mansoura University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ahmed\",\"middleName\":\"A.\",\"lastName\":\"Selim\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-02-06 15:26:43\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3934336/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3934336/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":50926146,\"identity\":\"56f806fb-160a-4408-a2fa-84891cff308d\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3310933,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSee image above for figure legend\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/abcf0e45bf75fbca606aec9e.png\"},{\"id\":50926147,\"identity\":\"01adcdf7-3c6d-4d6d-b3e8-10e9fee26077\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3160901,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSee image above for figure legend\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/72ce9d97f484476fb28745ea.png\"},{\"id\":50926152,\"identity\":\"19712fa5-5349-4ed0-8b12-b08194437520\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3155772,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSee image above for figure legend\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/cf417d6814eae206a6fe2328.png\"},{\"id\":50926150,\"identity\":\"b52d134a-694c-452b-a38e-739ccc5d67c3\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":3008096,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSee image above for figure legend\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/db9e18976a0b89324b571cfe.png\"},{\"id\":50929107,\"identity\":\"0063c373-8ea4-40ee-965a-f5fe2ea26b7a\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:34:13\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":4299844,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/daefc154-f9b4-48fb-8953-57c6ca06e6b2.pdf\"},{\"id\":50926148,\"identity\":\"441a985b-b1f7-4cc5-abec-461d3ec83111\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":326190,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementaryfigure1.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/ab57953f6668d380565b5fa9.pdf\"},{\"id\":50926149,\"identity\":\"8f5252f3-2123-4f1f-b1fd-48c23df1c6bc\",\"added_by\":\"auto\",\"created_at\":\"2024-02-09 17:10:08\",\"extension\":\"pdf\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":298652,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"Supplementaryfigure2.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3934336/v1/dfd4e2b65eae6b249183a393.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Perineal sling for the treatment of severe male incontinence, a cohort study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRadical cystectomy and orthotopic diversion (RCOD) is the mainstay treatment of muscle-invasive bladder cancer\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn1\\\" id=\\\"#FNLinkFn1\\\"\\u003e\\u003c/a\\u003e. 5-year survival was reported as 40%\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn2\\\" id=\\\"#FNLinkFn2\\\"\\u003e\\u003c/a\\u003e to 64.5%\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn3\\\" id=\\\"#FNLinkFn3\\\"\\u003e\\u003c/a\\u003e. Adverse events following RCOD include metabolic acidosis, uretero-ileal and urethro- ileal stenosis, fistula, intestinal obstruction, erectile dysfunction and incontinence. The incidence of incontinence widely varies in the literature with lack of standardized reporting\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn4\\\" id=\\\"#FNLinkFn4\\\"\\u003e\\u003c/a\\u003e. In one study on 2238 patients with different orthotopic neobladders, daytime incontinence was 13%\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn5\\\" id=\\\"#FNLinkFn5\\\"\\u003e\\u003c/a\\u003e. In another study, based on mailed questionnaire, 139 of 179 responders used pads at least sometimes; half of them used pads day and night. 47% used pads in the day and 72% at night\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn6\\\" id=\\\"#FNLinkFn6\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003ePost-traumatic urethral injury is common after pelvic fractures; that was reported in \\u003cb\\u003e9.3%\\u003c/b\\u003e of 16,630 trauma registry patients with blunt trauma. In severe pelvic fractures (Severity\\u0026thinsp;\\u0026gt;\\u0026thinsp;4 in Abbreviated Injury Scale) the incidence of associated bladder and urethral injury was \\u003cb\\u003e14.6%\\u003c/b\\u003e\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn7\\\" id=\\\"#FNLinkFn7\\\"\\u003e\\u003c/a\\u003e. The incidence of PTI depends on several factors including the severity of trauma and whether the patient was initially managed by realignment\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn8\\\" id=\\\"#FNLinkFn8\\\"\\u003e\\u003c/a\\u003e. Incontinence usually results from sphincter damage but other causes may be involved such as denervation of the sphincter (due to pudendal/pelvic plexus injury) and detrusor overactivity. Following posterior urethroplasty, the incidence of urinary incontinence is \\u003cb\\u003e~\\u0026thinsp;10%\\u003c/b\\u003e in some reports\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn9\\\" id=\\\"#FNLinkFn9\\\"\\u003e\\u003c/a\\u003e, while in others the incidence is much lower\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn10\\\" id=\\\"#FNLinkFn10\\\"\\u003e\\u003c/a\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe treatment options include injectables, artificial urinary sphincter (AUS), and slings. Given the non-durable response to the use of injectables and the high cost of AUS, the sling came to be an attractive option in these patients\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn11\\\" id=\\\"#FNLinkFn11\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003eIn this study, we looked at men with post cystectomy and post traumatic incontinence who were treated by perineal sling at 1 year.\\u003c/p\\u003e\"},{\"header\":\"Patients and methods\",\"content\":\"\\u003cp\\u003eGroup 1: Men with RCOD and significant daytime incontinence; (defined as 5 pads at least or wearing an external collecting device during daytime) were included Normal pelvi-abdominal MRI and kidney function (normal serum creatinine) were inclusion criteria. Histopathology was transitional cell carcinoma in all. A 1-hour pad test was obtained.\\u003c/p\\u003e \\u003cp\\u003eThe procedure was carried out under spinal anesthesia. Urethroscopy was an initial step to exclude urethral pathology (recurrence/ stricture)\\u003c/p\\u003e \\u003cp\\u003eThe procedure is similar to what has been previously described\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn12\\\" id=\\\"#FNLinkFn12\\\"\\u003e\\u003c/a\\u003e. However, given a completely different set of patients, the retropubic route of the sling was replaced by a perineal approach. Polypropylene mesh of sufficient size is double- breasted. Tailored to the size of the bulbospongiosus muscles, Polypropylene mesh is fastened by 4 sutures (Ethilon, 1), 2 on each side. Ethilon sutures were fixed to the inferior pubic ramus, one to a proximal and the other to a distal location; about 3\\u0026ndash;4 cm apart. (Figs.\\u0026nbsp;1\\u0026amp; 2). The sling is adjusted to cover the bulbar urethra within its coverings (Fig.\\u0026nbsp;3).The tightening is left as the final step (Fig.\\u0026nbsp;4). Bladder was completely emptied and then filled with 200 ml of saline. The patient was asked to cough as strenuous as he can. In group 1, excessive tightening is avoided as the sling is designed to work against the pressure generated in the pouch by Crede voiding. In final adjustment, the sling is compressing the bulb of the urethra. The closure of the wound then ensues after insertion of a Foley catheter for 1 day and Yeates drain for 48 hours. The wound was checked next morning, the catheter was removed, PVR was assessed.\\u003c/p\\u003e \\u003cp\\u003eGroup 2: For study purposes, post-traumatic incontinence was defined as stress/ total incontinence following traumatic urethral injury after the final treatment of the urethral injury. To this end, 4 patients were eligible\\u003c/p\\u003e \\u003cp\\u003eClinical examination, basic laboratory investigations and 1-hour pad test were carried out. Retrograde urethrogram was performed before surgery to ensure the patency of the urethra and the presence or absence of associated anomalies. In those with recurrent strictures/pathology, a concomitant correction was contemplated.\\u003c/p\\u003e \\u003cp\\u003eAdverse events were graded according to Clavien-Dindo system, results of follow up visits were analyzed including pad test and the number of postoperative pads used (if any). Follow up schedule included visit every 3 months for 1 year and then half annual thereafter.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eGroup 1: 14 patients have completed 12 months follow up. Mean age of the patients is 67 year (56\\u0026ndash;80 years). Mean BMI was 25.98 (range: 22-32.4)\\u003c/p\\u003e \\u003cp\\u003eAll had radical cysto-prostatectomy and ileal neobladder, 2 were nerve-sparing. One patient had local recurrence for which he has received platinum-based chemotherapy with significant reduction in size.\\u003c/p\\u003e \\u003cp\\u003eThe interval between cystectomy and sling was 7 months (Range: 0.6\\u0026ndash;10 years). At time of surgery, none had evidence of local recurrence on MRI. All patients had severe incontinence with 8 of them using an average of 5 pads per day while 6 were putting on a condom catheter as a protective means. One- hour pad test was carried out before surgery. Mean pad weight gain was 109.5 gm. (80\\u0026ndash;200)\\u003c/p\\u003e \\u003cp\\u003ePost-operative, 2 patients had superficial wound dehiscence in the early post- operative period (2 weeks) that was treated by simple sutures under local anesthesia. Clavien Dindo grade 1)\\u003c/p\\u003e \\u003cp\\u003ePVR was estimated after the Foley catheter was taken out and was found to be in the range of 10\\u0026ndash;140 ml (mean: 85 ml). 1 year after surgery, pad test was negative in 6 patients (50%) and positive in 6. Mean increase of pad weight was 17.8 gm. (range 1\\u0026ndash;80 gm.). Mean PVR was 15.3 ml (range: 1\\u0026ndash;82). Average pad use was 2 pads /day (1\\u0026ndash;3)\\u003c/p\\u003e \\u003cp\\u003eOnly slight scrotal pain (2 patients) and a sensation of numbness in the scrotum (1 patient) were noted. \\u003cb\\u003eTable\\u0026nbsp;1\\u003c/b\\u003e shows patients\\u0026rsquo; data.\\u003c/p\\u003e \\u003cp\\u003eGroup 2: 4 patients were included in the study so far. The mean age of patients at the time of sling surgery was 29.3 years (range: 18\\u0026ndash;43). The mean BMI was 26. All had post- traumatic injury of the urethra with post-traumatic incontinence following pelvic fracture. All had anastomotic urethroplasty (AU); 1of whom had re-do procedure.\\u003c/p\\u003e \\u003cp\\u003eThe median time from the initial trauma to the urethroplasty was 5 months (1\\u0026ndash;13). The median incontinence duration was 24months (24\\u0026ndash;120). All suffered from severe urinary incontinence (5 or more pads per day). Median pad number per day was 6 pads. 1 hour pad test showed an average increase of 70.6 gm. at baseline.\\u003c/p\\u003e \\u003cp\\u003eMedian follow up duration was 55 months (36\\u0026ndash;80). 1 out of 4 was dry, 2 had significant improvement with an average increase in 1-hour pad test of 6.2 gm. 1 patient did not show any improvement.\\u003c/p\\u003e \\u003cp\\u003e \\u003cb\\u003eTable\\u0026nbsp;2\\u003c/b\\u003e demonstrates demographic and perioperative data of the patients.\\u003c/p\\u003e \\u003cp\\u003eOne patient had perineal wound infection and it was managed by frequent dressing in the ward (Clavien- Dindo grade I). However, this patient developed urethrocutaneous fistula two months later and required surgical correction\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe incidence of day-time continence ranged from 87\\u0026ndash;100%\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn13\\\" id=\\\"#FNLinkFn13\\\"\\u003e\\u003c/a\\u003e\\u003csup\\u003e,\\u003c/sup\\u003e\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn14\\\" id=\\\"#FNLinkFn14\\\"\\u003e\\u003c/a\\u003e \\u003ca class=\\\"FNLink\\\" href=\\\"#Fn15\\\" id=\\\"#FNLinkFn15\\\"\\u003e\\u003c/a\\u003e\\u003csup\\u003eand\\u003c/sup\\u003e\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn16\\\" id=\\\"#FNLinkFn16\\\"\\u003e\\u003c/a\\u003e\\u003csup\\u003e,\\u003c/sup\\u003e after RCOD. The treatment options included pelvic floor muscle training\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn17\\\" id=\\\"#FNLinkFn17\\\"\\u003e\\u003c/a\\u003e, Duloxetine\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn18\\\" id=\\\"#FNLinkFn18\\\"\\u003e\\u003c/a\\u003e, perineal sling\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn19\\\" id=\\\"#FNLinkFn19\\\"\\u003e\\u003c/a\\u003e, artificial urinary sphincter (AUS)\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn20\\\" id=\\\"#FNLinkFn20\\\"\\u003e\\u003c/a\\u003e, pubovaginal sling \\u003ca class=\\\"FNLink\\\" href=\\\"#Fn21\\\" id=\\\"#FNLinkFn21\\\"\\u003e\\u003c/a\\u003e or adjustable continence therapy\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn22\\\" id=\\\"#FNLinkFn22\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003eGrim ET al\\u003csup\\u003e17\\u003c/sup\\u003enoted that pelvic floor muscle training was an independent predictor of increased HRQOL (p\\u0026thinsp;=\\u0026thinsp;0.009, OR\\u0026thinsp;=\\u0026thinsp;10.459) in 178 patients at 61 months. Median daytime pad use was 1 and median daily urine loss based on pad testing was 4.0 g, with a daytime continence rate of 48.5%.\\u003c/p\\u003e \\u003cp\\u003eSchlenker et al \\u003csup\\u003e18\\u003c/sup\\u003e studied 20 patients; 15 after radical prostatectomy and 5 after radical cystectomy and orthotopic ileal neobladder. Each had persistent SUI despite PFMT and received 40 mg duloxetine twice daily for a mean of 9.4week. The use of pads decreased significantly (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) from 8.0 (\\u0026plusmn;\\u0026thinsp;6.5) to 4.2 (\\u0026plusmn;\\u0026thinsp;5.9). Seven patients were completely dry or used one pad/ day.\\u003c/p\\u003e \\u003cp\\u003eRajpurkar et al \\u003csup\\u003e19\\u003c/sup\\u003e studied 35 men with post-radical prostatectomy incontinence with In Vance bone anchored sling. Using Polypropylene, fascia lata and Stratasis with the most durable results noted after Polypropylene. At a mean follow-up of 24 months, 34 patients were either dry (37%) or utilizing 1\\u0026ndash;2 pads per day (37%). Based on questionnaire, 72% patients felt that their incontinence was \\u0026lsquo;\\u0026lsquo;small to no problem\\u0026rsquo;\\u0026rsquo;, 59% patients were moderately or completely satisfied.\\u003c/p\\u003e \\u003cp\\u003eWe utilized Polypropylene, being commonly used in different male slings. Our technique is customizable as we noted that the size of the bulbospongiosus muscles varies from one patient to another\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn23\\\" id=\\\"#FNLinkFn23\\\"\\u003e\\u003c/a\\u003e. So, the sling is better \\u0026ldquo;tailored\\u0026rdquo; to the proper size of the muscle of each patient. Direct fixation of the sling using 5/8 circle robust needle of Ethilon 1 suture; with good bite into the inferior pubic ramus cortex, using a strong needle holder is more time- and money-saving than the bone screws and the special drill.\\u003c/p\\u003e \\u003cp\\u003eAUS was tried with modest success in the treatment of incontinence following radical cystectomy. Vainrib et al \\u003ca class=\\\"FNLink\\\" href=\\\"#Fn24\\\" id=\\\"#FNLinkFn24\\\"\\u003e\\u003c/a\\u003e studies 36 men with radical cystectomy and orthotopic diversion in whom AUS was fixed on average 28 months after surgery. Data were available for 29 patients only. Significant improvement was reported in 17 at 40 months follow up. The authors concluded that AUS provided good continence with an \\u0026ldquo;acceptable\\u0026rdquo; complication rate. However, the authors stated that 38 revision procedures were necessary in 21 patients, including 12 explantations. Only 2 out of 10 patients in our series had bothersome pain, 1 had superficial wound dehiscence that required secondary sutures under local anesthesia.\\u003c/p\\u003e \\u003cp\\u003eThe results of pubovaginal rectus fascia sling was not promising when tried in 4 women after RCOD\\u003csup\\u003e21\\u003c/sup\\u003e and the authors recommended against its further use while Pro Act was tried in a one case- report \\u003csup\\u003e22\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eTreatment of PTI is a challenge. The urethra is traumatized, usually its membrano-prostatic segment with damage to the internal sphincter and may be rhabdosphincter\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn25\\\" id=\\\"#FNLinkFn25\\\"\\u003e\\u003c/a\\u003e. 2-stage urethroplasty was associated with 12% permanent stress incontinence in a series of 33 men following prostatectomy\\u003csup\\u003e25\\u003c/sup\\u003e One- stage anastomotic urethroplasty was associated with a variable incidence of incontinence. One case of stress incontinence after 1 stage urethroplasty in 61 men in one report \\u003ca class=\\\"FNLink\\\" href=\\\"#Fn26\\\" id=\\\"#FNLinkFn26\\\"\\u003e\\u003c/a\\u003e. However, continence was found to be maintained primarily by the proximal bladder neck mechanism with a significant contribution of the rhabdosphincter\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn27\\\" id=\\\"#FNLinkFn27\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe task to restore continence in those patients is painstaking and is met with limited success. Typically, when urethral bulking agents were utilized, the results were neither satisfactory nor durable. Moreover, some of the bulking agents were associated with significant complications, including urethral erosion and loss of the material \\u003ca class=\\\"FNLink\\\" href=\\\"#Fn28\\\" id=\\\"#FNLinkFn28\\\"\\u003e\\u003c/a\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe AUS is the modality with the longest reported follow up and was considered the gold standard in the treatment of post-prostatectomy incontinence (PPI). However, it is associated with a high rate of mechanical malfunction; 23% in some series. Moreover, men with PPI showed a tendency to avoid the use of a mechanical device recently and elected the use of suburethral slings\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn29\\\" id=\\\"#FNLinkFn29\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003eMale sling is gaining ground in the treatment of male incontinence. Many modifications were introduced rendering the procedure safe, effective, durable and adjustable\\u003ca class=\\\"FNLink\\\" href=\\\"#Fn30\\\" id=\\\"#FNLinkFn30\\\"\\u003e\\u003c/a\\u003e.\\u003c/p\\u003e \\u003cp\\u003eIts effectiveness in the treatment of post- traumatic urinary incontinence in males is not well-studied in literature. Our modification devised for post cystectomy and post traumatic incontinence was tried in this sub-set of patients with promising result. Our sample size and follow up duration are modest. Enrollment of more patients and following them for years longer is underway.\\u003c/p\\u003e \\u003cp\\u003eOur study shows that a customizable bone-fixed sling is safe and effective in the treatment of post-radical cystectomy and post-traumatic incontinence. More patients have been enrolled and we plan a longer follow up report.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eClinical registration number: was not obtained, as the study represents a compilation of data from multiple clinical routine work\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData of this study is available upon request\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eContribution of the authors:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWadie B S: Design, performance of surgery and drafting the manuscript\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSalim, A A: Enrollment of patients and follow up\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFakhr, I: Enrollment of patients and follow up\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of interest:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone of the authors has relevant financial or non-financial interests to disclose.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical considerations:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWritten informed consent was obtained from each patient.\\u003c/p\\u003e\\n\\u003cp\\u003eApproval of the research protocol: IRB approved the study as part of the clinical work for patients subject matter of the study. Approval # 138\\u003c/p\\u003e\\n\\u003cp\\u003eRegistration # in public trials registry: NA\\u003c/p\\u003e\\n\\u003cp\\u003eAnimal studies NA\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eZhong J, Switchenko J, Jegadeesh NK, et al: Comparison of Outcomes in Patients with Muscle-invasive Bladder Cancer Treated with Radical Cystectomy Versus Bladder Preservation. \\u003cem\\u003eAm J Clin Oncol\\u003c/em\\u003e.; 2019, 42(1):36.\\u003c/li\\u003e\\n\\u003cli\\u003eFedeli U, De Paoli A, Corti MC, et al: Perioperative Mortality and Long-Term Survival after Radical Cystectomy: A Population-Based Study in a Southern European Country on 4,389 Patients. \\u003cem\\u003eUrol Int\\u003c/em\\u003e.; 2020,1-8.\\u003c/li\\u003e\\n\\u003cli\\u003eel-Mekresh M, Akl A, Mosbah A, et al: Prediction of survival after radical cystectomy for invasive bladder carcinoma: risk group stratification, nomograms or artificial neural networks?. J Urol.; 2009, 182(2):466.\\u003c/li\\u003e\\n\\u003cli\\u003eDaneshmand S.: Orthotopic urinary diversion. Curr Opin Urol.; 2015, 25(6):545.\\u003c/li\\u003e\\n\\u003cli\\u003eSteers WD.: Voiding dysfunction in the orthotopic neobladder. \\u003cem\\u003eWorld J Urol\\u003c/em\\u003e.; 2000, 18(5):330.\\u003c/li\\u003e\\n\\u003cli\\u003eAhmadi H, Skinner EC, Simma-Chiang V, et al: Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol.; 2013, 189 (5):1782.\\u003c/li\\u003e\\n\\u003cli\\u003eDemetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L.: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. JACS. 2002, 195(1):1- 10.\\u003c/li\\u003e\\n\\u003cli\\u003eMouraviev VB, Coburn M, Santucci RA: The treatment of posterior urethral disruption associated with pelvic fractures: comparative experience of early realignment versus delayed urethroplasty. J. Urol. 2005, 173(3):873-6.\\u003c/li\\u003e\\n\\u003cli\\u003ePratap A, Agrawal CS, Tiwari A, Bhattarai BK, Pandit RK, Anchal N: Complex posterior urethral disruptions: management by combined abdominal transpubic perineal urethroplasty. J. Urol. 2006, 175: 1751- 4.\\u003c/li\\u003e\\n\\u003cli\\u003eJordan GH, Schlossberg SM: Surgery of the penis and urethra. In Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA eds.: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders, 1054\\u0026ndash;84, 2007.\\u003c/li\\u003e\\n\\u003cli\\u003eShindel A: Bulbourethral sling in male incontinence. IJU. 2007, 23(1):32- 33. \\u003c/li\\u003e\\n\\u003cli\\u003eWadie BS.: A novel technique of bulbourethral sling for post-prostatectomy incontinence. Scand J Urol Nephrol\\u003cem\\u003e.\\u003c/em\\u003e; 2007, 41(5):398.\\u003c/li\\u003e\\n\\u003cli\\u003eElmajian DA, Stein JP, Esrig D et al: The Kock ileal neobladder: updated experience in 295 male patients. J Urol.; 1996, 156(3):920.\\u003c/li\\u003e\\n\\u003cli\\u003eCancrini A, De Carli P, Pompeo V et al: Lower urinary tract reconstruction following cystectomy: experience and results in 96 patients using the orthotopic ileal bladder substitution of Studer et al. Eur Urol.; 1996, 29(2):204.\\u003c/li\\u003e\\n\\u003cli\\u003eHautmann RE, de Petriconi R, Gottfried HW et al: The ileal neobladder: complications and functional results in 363 patients after 11 years of follow up. J Urol.; 1999, 161(2):422.\\u003c/li\\u003e\\n\\u003cli\\u003eSteven K, Poulsen AL: The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol.; 2000, 164(2):288.\\u003c/li\\u003e\\n\\u003cli\\u003eGrimm T, Grimm J, Buchner A et al: Health-related quality of life after radical cystectomy and ileal orthotopic neobladder: effect of detailed continence outcomes. World J Urol.; 2019, 37(11):2385.\\u003c/li\\u003e\\n\\u003cli\\u003eSchlenker B, Gratzke C, Reich O et al: Preliminary results on the off-label use of duloxetine for the treatment of stress incontinence after radical prostatectomy or cystectomy. Eur Urol.; 2006, 49(6):1075.\\u003c/li\\u003e\\n\\u003cli\\u003eRajpurkar AD, Onur R, Singla A: Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol.; 2005, 47(2):237.\\u003c/li\\u003e\\n\\u003cli\\u003eSimma-Chiang V, Ginsberg DA, Teruya KK et al: Outcomes of artificial urinary sphincter placement in men after radical cystectomy and orthotopic urinary diversions for the treatment of stress urinary incontinence: the University of Southern California experience. Urology; 2012, 79(6):1397.\\u003c/li\\u003e\\n\\u003cli\\u003eQuek ML, Ginsberg DA, Wilson S et al: Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women. J Urol.; 2004, 172(1):219.\\u003c/li\\u003e\\n\\u003cli\\u003eRiccetto C, Palma P, Herrmann V et al: Adjustable continence therapy for the treatment of urinary incontinence after radical cystectomy and orthotopic neobladder in women. Int Urogynecol J Pelvic Floor Dysfunct.; 2007, 18 (9):1101.\\u003c/li\\u003e\\n\\u003cli\\u003ePeikert K, Platzek I, Bess\\u0026egrave;de T et al: The male bulbospongiosus muscle and its relation to the external anal sphincter. J Urol.; 2015, 193(4):1433.\\u003c/li\\u003e\\n\\u003cli\\u003eVainrib M, Simma-Chiang V, Boyd SD, Ginsberg DA: Potential risk factors and outcomes of artificial urinary sphincter placement after radical cystectomy and orthotopic neobladder urinary diversion. Neurourol Urodyn. 2013; 32(7):1010-3. \\u003c/li\\u003e\\n\\u003cli\\u003eColapinto,V McCallum, RW: Urinary Continence After Repair of Membranous Urethral Stricture in Prostatectomized Patients. J. Urol. 1976,115 (4) 392- 396.\\u003c/li\\u003e\\n\\u003cli\\u003eJohnson, E.K and Latini, J. M: The Impact of Urethroplasty on Voiding Symptoms and Sexual Function. Urology. 2011, 78: 198 - 201.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u003csup\\u003e34 \\u003c/sup\\u003eWhitson, J. M, McAninch,J. W., Tanagho, E A, Metro, M. J. and Rahman, N U: Mechanism of Continence After Repair of Posterior Urethral Disruption: Evidence of Rhabdosphincter Activity. J Urol. 2008, 179,1035- 1039.\\u003c/li\\u003e\\n\\u003cli\\u003eHurtado EA, McCrery RJ, Appell RA: Complications of ethylene vinyl alcohol copolymer as an intraurethral bulking agent in men with stress urinary incontinence. Urology. 2008, 71(4):662- 665.\\u003c/li\\u003e\\n\\u003cli\\u003eKumar A, Litt ER, Ballert KN, Nitti VW: Artificial urinary sphincter versus male sling for post-prostatectomy incontinence--what do patients choose? J Urol. 2009, 181(3):1231- 5.\\u003c/li\\u003e\\n\\u003cli\\u003eWadie BS: Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. J. Urol. 2010, 184(6):2446- 2451.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTable 1: Group 1: RCOD patients\\u0026rsquo; data\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"111%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e#\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCo morbid\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDate of cystectomy\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHistopathology\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMRI\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePre Pad test\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003edate of sling\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePost pad test\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePVR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eComplications\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDM,Hypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3/1/2014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt2a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e89\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e22/6/2019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWound dehiscence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e30/3/2014\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt3b\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4/2/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e3\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHepatic, IDDM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e27/12/2010\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt3a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19/2/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWound dehiscence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e4\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e21/6/2017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt2b\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e160\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e29/7/2019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e5\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n 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dir=\\\"LTR\\\"\\u003e7\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15/4/2017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt4a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7/6/2020\\u003c/p\\u003e\\n 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valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHypertension, IDDM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10/6/2015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt2a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14/10/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n 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width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15/11/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e12\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e01/8/2018\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt3a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e110\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e21/12/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e13\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2/5/2019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt3a\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e08/12/2019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.1914893617021276%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp dir=\\\"RTL\\\"\\u003e\\u003cspan dir=\\\"LTR\\\"\\u003e14\\u003c/span\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.76595744680851%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIDDM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.702127659574469%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14/9/2020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eTCC, pt3b\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"4.25531914893617%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFree\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e140\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.638297872340425%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e02/4/2021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"7.446808510638298%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"5.319148936170213%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"22.340425531914892%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNil\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eTable (2): Group 2: PTI. Patients\\u0026rsquo; demographics, perioperative data and results of follow up\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"681\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.2305433186490453%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.020558002936857%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.95741556534508%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eType of trauma\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.09691629955947%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eDuration of incontinence in years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.80323054331865%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNumber of preoperative pads\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.977973568281937%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePostoperative catheter duration\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.831130690161528%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNeed \\u0026nbsp; \\u0026nbsp; for postoperative CIC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.509544787077827%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNeed for retightening\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.572687224669604%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eLast follow up (months)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.2305433186490453%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.020558002936857%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.95741556534508%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePFUDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.09691629955947%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.80323054331865%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.977973568281937%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.831130690161528%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.509544787077827%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.572687224669604%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.2305433186490453%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.020558002936857%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e36\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.95741556534508%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePFUDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.09691629955947%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.80323054331865%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.977973568281937%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.831130690161528%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.509544787077827%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.572687224669604%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.2305433186490453%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.020558002936857%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.95741556534508%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePFUDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.09691629955947%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.80323054331865%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.977973568281937%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.831130690161528%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.509544787077827%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.572687224669604%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"3.2305433186490453%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.020558002936857%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19 \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.95741556534508%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003ePFUDI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.09691629955947%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.80323054331865%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.977973568281937%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.831130690161528%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.509544787077827%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.572687224669604%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Perineal, sling, post-cystectomy, post-traumatic, incontinence\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3934336/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3934336/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e \\u003cp\\u003ePost radical cystectomy/post-traumatic incontinence is challenging. Albeit not life-threatening; it has significantly negative impact on patients\\u0026rsquo; quality of life. We studied the application of customized perineal sling in treatment of these two conditions.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eMen after RCOD with significant daytime incontinence had MRI, basic laboratory testing and 1-hour pad test. Patients with post traumatic incontinence had anastomotic urethroplasty at least once. All had a median 5 pad/day. Tailored to the size of the patient\\u0026rsquo;s bulb, Polypropylene mesh is fixed by 4 No 1. Ethilon sutures, to the inferior pubic ramus.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eGroup 1 included 12 patients; mean age: 67 years. (56\\u0026ndash;80 years). No evidence of local recurrence prior to sling. Mean BMI: 25.62 (range: 22-32.4) Mean pad weight was 112.5 gm. (80\\u0026ndash;200). 12 months after surgery, pad test was negative in 6 patients (50%) and positive in 6, with mean increase of 17.8 gm. (range 1\\u0026ndash;80 gm.). Average pad use was 2 pads /day (1\\u0026ndash;3). Mean PVR was 15.3 ml (range: 1\\u0026ndash;82). Group 2: 4 patients. Mean age: 29.3 years. All had anastmotic urethroplasty for post- traumatic stricture. Median incontinence duration was 24 months (24\\u0026ndash;120). Median follow up was 50 months (32\\u0026ndash;70). At the time of last follow up, 3 out of 4 (75%) were either completely dry or showed significant improvement with only one pad /day.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eAt 1 year this customized perineal sling is a safe, easy to learn and effective mode of treatment of severe male incontinence.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Perineal sling for the treatment of severe male incontinence, a cohort study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-02-09 17:10:03\",\"doi\":\"10.21203/rs.3.rs-3934336/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"db7104f8-979e-45ed-aa4a-0d1854f39e50\",\"owner\":[],\"postedDate\":\"February 9th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-02-09T17:10:05+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-02-09 17:10:03\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3934336\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3934336\",\"identity\":\"rs-3934336\",\"version\":[\"v1\"]},\"buildId\":\"J0_U0BvcaRcwD8yVFaRlm\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}