Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success

Nabeel A. Shakir, Joceline S. Fuchs, Maxim J. McKibben, Boyd R. Viers, Travis J. Pagliara, Jeremy M. Scott, Allen Morey

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Aims: To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms. Methods: We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated. Results: Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001). Conclusions: MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI.

Original languageEnglish (US)
Pages (from-to)2632-2637
Number of pages6
JournalNeurourology and Urodynamics
Issue number8
StatePublished - Nov 1 2018


  • male stress urinary incontinence
  • male transobturator sling
  • predictive nomogram

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology


Dive into the research topics of 'Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success'. Together they form a unique fingerprint.

Cite this