1
|
Chen Y, Song X, Lv T, Huang J, Cai Z, Yan J. A modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for male stress urinary incontinence: a pilot study. Int Urol Nephrol 2024; 56:901-912. [PMID: 37837505 DOI: 10.1007/s11255-023-03822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The aim of this study was to demonstrate the feasibility of a modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence and to preliminarily evaluate the short-term clinical efficacy of this technique. PATIENTS AND METHODS The clinical data of patients treated with the modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique using a Pelvimesh pelvic floor repair patch as a sling were collected. The primary evaluation criteria were surgery-related indicators and daily urinal pad usage before and after treatment, and the secondary evaluation criteria were the corresponding incontinence scores and the results of surgery-related questionnaires. RESULTS After 1-12 months of follow-up, seven patients were clinically cured. Follow-up 1 month after surgery showed that one patient (14.3%) used one pad daily, and six patients (85.7%) did not need pads. The incontinence quality of life questionnaire (I-QOL) scores at 3 days and 1 month postoperatively were 89.4 ± 2.5 and 88.1 ± 6.7, respectively, which were significantly higher than the preoperative scores (31.5 ± 18.9) (P < 0.05). The scores of the International Continence Control Association Incontinence Questionnaire Short Form (ICI-Q-SF) at 3 days and 1 month postoperatively were 3.2 ± 0.9 and 4.2 ± 1.7, respectively, which were significantly lower than the preoperative scores of 19.4 ± 5.0 (P < 0.05). In addition, the results of the surgery-related questionnaires were positive. No serious complications occurred in any of the patients. CONCLUSION The modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence patients is safe, effective, minimally invasive, and has few complications. However, further validation in large sample, randomized, comparative, and longer-term follow-up studies is still needed.
Collapse
Affiliation(s)
- Yingxiu Chen
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, 54 Youdian Road, Hangzhou, 310000, Zhejiang, China
- Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
- Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Xin Song
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Tingting Lv
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Jin Huang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Zhikang Cai
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, 54 Youdian Road, Hangzhou, 310000, Zhejiang, China.
- Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China.
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.
| |
Collapse
|
2
|
Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions. Ther Clin Risk Manag 2023; 19:43-56. [PMID: 36686217 PMCID: PMC9851058 DOI: 10.2147/tcrm.s283305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Urinary incontinence is a common and debilitating problem in patients undergoing radical prostatectomy. Current methods developed to treat urinary incontinence include conservative treatments, such as lifestyle education, pelvic muscle floor training, pharmacotherapy, and surgical treatments, such as bulking agents use, artificial urinary sphincter implants, retrourethral transobturator slings, and adjustable male sling system. Pelvic floor muscle exercise is the most common management to improve the strength of striated muscles of the pelvic floor to try to recover the sphincter weakness. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and a-adrenergic drugs have been proposed as medical treatments for urinary incontinence after radical prostatectomy. Development of new surgical techniques, new surgical tools and materials, such as male slings, has provided an improvement of outcomes after UI surgery. Such improvement is still ongoing, and the uptake of new devices might lead to even better outcomes after UI surgery.
Collapse
Affiliation(s)
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy,Correspondence: Simone Ferretti, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy, Tel +393278733805, Fax +390871357756, Email
| | - Giulio Litterio
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| |
Collapse
|
3
|
Johnson BE, Morey AF. Surgical Management of Male Stress Urinary Incontinence: Artificial Urinary Sphincter Versus Male Slings. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
4
|
Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy. Adv Urol 2022; 2022:8736249. [PMID: 35774194 PMCID: PMC9239822 DOI: 10.1155/2022/8736249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate. Methods We distinguished five categories of treatment: A = bulking agents, B = fixed slings, C = adjustable slings, D = circumferential compressor devices (artificial sphincter), and E = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. Evidence synthesis. 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 g to 747.0 g, and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI −0.12–0.78), 0.63 (95% CI 0.55–0.71), 0.65 (95% CI 0.58–0.72), 0.50 (95% CI 0.34–0.66), and 0.53 (95%CI 0.36–0.70), respectively, in groups A, B, C, D, and E (I2 85.87%; Q 249.82—P > 0.01) (test of group differences P=0.22). Conclusion In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.
Collapse
|
5
|
Sacco E, Gandi C, Bientinesi R, Marino F, Moretto S, Ragonese M, Totaro A, Pierconti F, Racioppi M, Bassi P. Male sling placement for post-prostatectomy incontinence can involve a lengthy learning curve: A multi-outcome assessment via cumulative sum failure analysis. Urologia 2022; 89:521-528. [PMID: 35073794 DOI: 10.1177/03915603211072844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSES Little research exists on potential learning curve for male sling procedures. We aimed to perform a learning curve analysis of a single surgeon's experience of sling placement evaluating multiple outcomes and using the cumulative sum failure methodology. METHODS The study included 65 consecutive patients that underwent implantation of a fixed transobturator sling (TiLOOP Male) for post-radical prostatectomy stress incontinence at our institution from January 2013 to December 2018. Dichotomous outcomes evaluated with cumulative sum failure analysis included 12-months continence defined based on Patient Global Impression of Improvement (PGI-I) questionnaire (primary outcome), 24 h pad test and, 24 h pad use, operative time (⩽/>60 min), and complications (yes/no). Univariate and multivariate logistic regression analyses were performed to evaluate the association of the procedures' chronological sequence number with the outcomes. RESULTS Cumulative sum failure curves revealed a clear and lengthy learning curve effect for most of subjective and quantitative continence outcomes and for operative time. For the primary outcome (at least much improved at PGI-I), 62 procedures were required to overcome the learning curve. Accordingly, multivariate analyses showed that the sequence number was statistically significant for predicting failures based on PGI-I (adjusted OR 0.95; 95% CI: 0.91-0.99; p = 0.02), objective outcomes, and operative time. CONCLUSIONS An evident and lengthy learning curve was observed in our series of male sling placement to achieve the end level of proficiency, independently from case-mix. Individualized structured training on male sling surgery will benefit patients treated in the initial surgeon's experience. Surgical experience should be considered when reporting studies on male slings.
Collapse
Affiliation(s)
- Emilio Sacco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Gandi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Moretto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Ragonese
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Totaro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierfrancesco Bassi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
6
|
Inouye BM, Premo HA, Weil D, Peterson AC. The male sling for stress urinary incontinence: tips and tricks for success. Int Braz J Urol 2021; 47:1131-1135. [PMID: 33861057 PMCID: PMC8486443 DOI: 10.1590/s1677-5538.ibju.2020.1122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022] Open
Abstract
Urethral slings are a good treatment option for mild male stress urinary incontinence. There are many different sling options, but herein our group describes our techniques with the Advance® and Virtue® slings. More important than technique, we strongly think that patient selection is paramount to sling success. We only offer slings to patients who have low 24 hour pad weights, high Valsalva leak point pressure, and no history of pelvic radiation. Still, like with any surgery, we recommend that the surgeons implant the device that they are most comfortable with along with their chosen techniques.
Collapse
Affiliation(s)
- Brian M Inouye
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Hayley A Premo
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dane Weil
- Division of Urologic Surgery, Charles George VA Medical Center, Asheville, NC, USA
| | - Andrew C Peterson
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
7
|
Deng W, Zhang C, Jiang H, Li Y, Zhu K, Liu X, Chen L, Liu W, Guo J, Zhou X, Fu B, Wang G. Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up. Front Oncol 2021; 11:641887. [PMID: 33937043 PMCID: PMC8082308 DOI: 10.3389/fonc.2021.641887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer. Materials and Methods We analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion. Results No significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p > 0.05). The likelihood of transfusion, ≤Grade II, and >Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387). Conclusions Both T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.
Collapse
Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Jiang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ju Guo
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| |
Collapse
|
8
|
Li Marzi V, Morselli S, Fusco F, Baldesi R, Campi R, Liaci A, Gemma L, Morelli G, Serni S. Advance Xp® Male Sling can be an Effective and Safe Treatment for Post-Prostatectomy Stress Urinary Incontinence Also in Patients with Prior History of External Beam Radiation Therapy: A Multicentric Experience. Surg Innov 2021; 28:723-730. [PMID: 33599558 DOI: 10.1177/1553350621995042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Post-prostatectomy stress urinary incontinence (PPSUI) is one of the major complaints after radical prostatectomy. Transoburator male sling (TMS) placement is indicated in persistent mild to moderate PPSUI. External beam radiation therapy (EBRT) might be a negative prognostic factor for TMS outcomes. Study objective was to analyze EBRT impact on TMS outcome. Methods. We retrospectively investigated patients submitted to TMS for PPSUI, with or without previous EBRT, in two tertiary referral centers since 2010. Objective outcome was measured through ICIQ-SF, 1-hour pad test, and pad per die and subjective improvement through PGI-I. Patients were divided according to EBRT to make in-group and between-group comparisons. Results. Patients were 56, 18 (32.1%) had previous EBRT. Median follow-up was 43.0 months (IQR: 22.3-64.0). TMS was placed at mean 18.8 months (SD 4.6) after EBRT. TMS determined a statistically significant reduction of pads, 1-hour pad test, and ICIQ-SF score (P<.05). Improvement diminished during long-term follow-up. At last follow-up, 12 patients (21.4%) used 1 safety pad, while 15 (26.8%) used 0 pads. Median PGI-I was 2 (IQR 2-3). Recorded complications were 9 (16.1%) and none exceeded Clavien-Dindo grade 2. There were no differences in outcomes, failures, and complications between groups. TMS failures were 6 (10.7%), 2 of whom in the EBRT group. Four of them (7.1%) subsequently placed an artificial urinary sphincter (AUS). Conclusion. Advance XP© placement seems effective and safe in well-selected patients complaining with PPSUI, even after EBRT. Surgical outcomes slightly deteriorate over time. Further studies are needed in these patients to assess TMS efficacy.
Collapse
Affiliation(s)
- Vincenzo Li Marzi
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Simone Morselli
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Ferdinando Fusco
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica. Università della Campania "Luigi Vanvitelli", Italy
| | | | - Riccardo Campi
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Andrea Liaci
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Luca Gemma
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | | | - Sergio Serni
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| |
Collapse
|
9
|
Mumm JN, Klehr B, Rodler S, Kretschmer A, Vilsmaier T, Westhofen T, Chaloupka M, Schulz GB, Gozzi C, Rehder P, May F, Homberg R, Stief CG, Grabbert M, Bauer RM. Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors. Urol Int 2021; 105:421-427. [PMID: 33517334 DOI: 10.1159/000512881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. METHODS In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. RESULTS The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. CONCLUSIONS The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.
Collapse
Affiliation(s)
- Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany,
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Theresa Vilsmaier
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Florian May
- Department of Urology, Klinikum Dachau, Dachau, Germany
| | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
| |
Collapse
|
10
|
Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence - Is It the Best Option? Int Neurourol J 2019; 23:265-276. [PMID: 31905273 PMCID: PMC6944792 DOI: 10.5213/inj.1938210.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/13/2019] [Indexed: 01/13/2023] Open
Abstract
Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.
Collapse
|
11
|
Sling Surgery for Male Urinary Incontinence Including Post Prostatectomy Incontinence: A Challenge to the Urologist. Int Neurourol J 2019; 23:185-194. [PMID: 31607097 PMCID: PMC6790820 DOI: 10.5213/inj.1938108.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022] Open
Abstract
The management of postprostatectomy urinary incontinence (PPI) is still challenging for urologists. In recent decades, various kinds of male sling system have been developed and introduced; however, they have not yet shown as good a result as that of artificial urinary sphincter (AUS). However, a male sling is still in an important position because patients have a high demand for sling implantation, and it can allow the avoidance of the use of mechanical devices like AUS. Recently, the male sling has been widely used in mild-to-moderate PPI patients; however, there are no studies that compare individual devices. Thus, it is hard to directly compare the success rate of operation, and it is impossible to judge which sling system is more excellent. It is expected that many sling options will be available in addition to AUS in the near future with the technological development of various male slings and the accumulation of long-term surgical outcomes. In that in patients with PPI, sling implantation is an option that must be explained rather than an option that need not be explained to them, this review would share the latest outcomes and complications.
Collapse
|
12
|
Grabbert M, Mumm JN, Klehr B, Kretschmer A, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Bauer RM. Extended follow-up of the AdVance XP male sling in the treatment of male urinary stress incontinence after 48 months: Results of a prospective and multicenter study. Neurourol Urodyn 2019; 38:1973-1978. [PMID: 31297894 DOI: 10.1002/nau.24101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the AdVance XP male sling in a midterm follow-up for the treatment of male urinary incontinence in a selected patient cohort. MATERIALS AND METHODS In all, 115 patients with postprostatectomy incontinence were prospectively enrolled. A previous endoscopic evaluation of a sufficient coaptive zone in the repositioning test was mandatory. Patients with urine leakage in supine position or previous incontinence surgery were excluded. Postoperatively a standardized 24-hour pad test and pad usage were evaluated. To compare pre- and postoperative continence status nonparametric t test was used. A P-value of <.05 was seen as statistically significant. RESULTS Median preoperative urine loss in the 24-hour pad test was 272 g (min. 42-max. 1600) and was significantly improved at any point in follow-up. Success was defined as 0 pads per day and a maximum of 5 g in the 24-hour pad test. After a follow-up of 48 months, 71.7% of the patients were cured, whereas 15.0% of patients had an improved continence situation and 13.3% were classified as failed. Mean urine loss decreased significantly to 24.4 g (P ≤ .001). No severe intra- or postoperative complications are to be reported. Median follow-up was 4.2 years. CONCLUSIONS A stable effectiveness in a selected patient cohort can also be demonstrated in an extended follow-up. The complication rates are low and no late postoperative complications occurred, indicating the safety of the procedure.
Collapse
Affiliation(s)
- Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Peter Gebhartl
- Department of Urology, Salzkammergut Klinikum Voecklabruck, Voecklabruck, Austria
| | | | - Roland Homberg
- Department of Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | - Florian May
- Department of Urology, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | | | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
| |
Collapse
|
13
|
MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Sacco E, Gandi C, Vaccarella L, Recupero S, Racioppi M, Pinto F, Totaro A, Foschi N, Palermo G, Pierconti F, Bassi P. Titanized Transobturator Sling Placement for Male Stress Urinary Incontinence Using an Inside-out Single-incision Technique: Minimum 12-Months Follow-up Study. Urology 2018; 115:144-150. [DOI: 10.1016/j.urology.2018.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 11/16/2022]
|
15
|
The assessment and management of post-prostatectomy stress urinary incontinence. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
16
|
Linder BJ, Rangel LJ, Elliott DS. Evaluating Success Rates After Artificial Urinary Sphincter Placement: A Comparison of Clinical Definitions. Urology 2018; 113:220-224. [DOI: 10.1016/j.urology.2017.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/10/2017] [Accepted: 10/28/2017] [Indexed: 11/16/2022]
|
17
|
Abstract
The AdVance sling (American Medical Systems, Minnetonka, MN, United States of America) is a synthetic transobturator sling, which is a safe and effective minimally invasive treatment for mild to moderate stress urinary incontinence (SUI) in male patients. This article provides a step-by-step description of our technique for placement of the AdVance male sling, including details and nuances gained from surgical experience, advice for avoidance of complications and discussion on management of complications and sling failures. Patient selection is very important, including exclusion and preoperative treatment of urethral stenosis and bladder dysfunction. Previous pelvic radiation is a poor prognostic factor. In brief, the steps of sling placement are: (I) mobilization of the corpus spongiosum (CS); (II) marking and mobilization of the central tendon; (III) passage of the helical trocar needles exiting at the apex of the angle between the CS and inferior pubic ramus; (IV) fixation of the broad part of the sling body to the CS at the previous mark; (V) cystoscopy during sling tensioning; (VI) placement of a Foley urethral catheter; (VII) Subcutaneous tunnelling of the sling arms back toward the midline; (VIII) wound closure. The most common early postoperative complication is urinary retention but long-term retention is extremely rare. Management of sling failures include placement of an artificial urinary sphincter, repeat AdVance sling, urethral bulking agent or ProACT device.
Collapse
|
18
|
Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Transl Androl Urol 2017; 6:S112-S121. [PMID: 28791230 PMCID: PMC5522789 DOI: 10.21037/tau.2017.04.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.
Collapse
Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia.,AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane QLD, Australia
| |
Collapse
|
19
|
Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review. Eur Urol 2017; 71:936-944. [DOI: 10.1016/j.eururo.2016.09.031] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/16/2016] [Indexed: 11/18/2022]
|
20
|
Chen YC, Lin PH, Jou YY, Lin VCH. Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review. PLoS One 2017; 12:e0130867. [PMID: 28467435 PMCID: PMC5415174 DOI: 10.1371/journal.pone.0130867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background This meta-analysis was designed to assess the efficacy of the male sling and artificial urinary sphincter on treating post-prostatectomy incontinence by evaluating daily pad use, cure rate, frequency of improvement in incontinence, and quality of life. Methods Medline, Cochrane, Google Scholar, and ClinicalTrials.gov were searched (until March 31, 2014) for studies that investigated the effectiveness of artificial urinary sphincter or sling surgical treatments for prostate cancer. The primary outcome was daily pad use before and after surgery and secondary outcomes were quality of life before and after surgery, and frequency of cures (no need to use of a pad for at least 1 day) and improvements (decreased pad usage) in incontinence after surgery. Results We found that that both the sling and artificial urinary sphincter significantly decreased the number of pads used per day by about 3 (P-values <0.001) and increased the quality of life compared with before intervention (P-values < 0.001). In addition, the cure rate and was around 60%. Intervention resulted in improvement in incontinence by about 25% (P < 0.001). Conclusion Our findings indicate that both sling and artificial urinary sphincter interventions are effective in reducing incontinence and improving the patient’s quality of life.
Collapse
Affiliation(s)
- Yu-Chi Chen
- Department of Urology, E-Da Hospital, Kaohsiung City, Taiwan
| | - Pin-Hsuan Lin
- Department of Health and Beauty, Shu-Zen College of Medicine and Management, Kaohsiung City, Taiwan
| | - Yann-Yuh Jou
- Taiwan Food and Drug Administration, Taipei City, Taiwan
| | - Victor Chia-Hsiang Lin
- Department of Urology, E-Da Hospital, Kaohsiung City, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Taiwanese Urological Association, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
21
|
Mason J, Erickson B. The Male Transobturator Sling for Stress Incontinence After the Treatment of Prostate Cancer. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Papachristos A, Mann S, Talbot K, Moon D. AdVance male urethral sling: medium-term results in an Australian cohort. ANZ J Surg 2017; 88:E178-E182. [PMID: 28239989 DOI: 10.1111/ans.13890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures. METHODS A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores. RESULTS At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02). CONCLUSIONS The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.
Collapse
Affiliation(s)
| | - Sarah Mann
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Kay Talbot
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Daniel Moon
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Australian Urology Associates, Melbourne, Victoria, Australia.,Department of Urology, Cabrini Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
23
|
Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate. Int Neurourol J 2016; 20:335-341. [PMID: 28043113 PMCID: PMC5209579 DOI: 10.5213/inj.1632648.324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/18/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods A total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05). Results Follow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041). Conclusions The findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.
Collapse
|
24
|
Cunningham KG, Westney OL. Post Prostatectomy Bladder Dysfunction: Where Are We Now? CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
25
|
Salomon L, Droupy S, Yiou R, Soulié M. [Functional results and treatment of functional dysfunctions after radical prostatectomy]. Prog Urol 2016; 25:1028-66. [PMID: 26519966 DOI: 10.1016/j.purol.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
Collapse
Affiliation(s)
- L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - S Droupy
- Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Yiou
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
| |
Collapse
|
26
|
Galiano M, Guillot-Tantay C, Sivaraman A, Slaoui H, Barret E, Rozet F, Sanchez-Salas R, Cathelineau X. Superficial Implantation of the I-Stop TOMS Transobturator Sling in the Treatment of Postprostatectomy Urinary Incontinence: Description of a Novel Technique and 1-Year Outcomes. Urology 2016; 90:195-8. [DOI: 10.1016/j.urology.2015.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
|
27
|
Kretschmer A, Grabbert M, Sommer A, Stief CG, Bauer RM. Mid-term outcomes after AdVanceXP male sling implantation. BJU Int 2016; 118:458-63. [PMID: 26918426 DOI: 10.1111/bju.13459] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow-up of almost 3 years. PATIENTS AND METHODS A total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow-up of 12months and after an individual maximum follow-up. Efficacy was evaluated by daily pad usage, 24-h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed-rank test was used. A P value <0.05 was taken to indicate statistical significance. RESULTS The mean ± sd follow-up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow-up. At follow-up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24-h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected. CONCLUSIONS The present study had the longest follow-up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow-up of almost 3 years. The results indicate that late-onset complications are rare after AdVanceXP implantation.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.,The Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Sommer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
28
|
Bauer RM, Oelke M, Hübner W, Grabbert M, Kirschner-Hermanns R, Anding R. [Urinary incontinence in men]. Urologe A 2016; 54:887-99; quiz 900. [PMID: 26081822 DOI: 10.1007/s00120-015-3826-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.
Collapse
Affiliation(s)
- R M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland,
| | | | | | | | | | | |
Collapse
|
29
|
Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and Management of Postprostatectomy Incontinence: A Systematic Review of Current Literature. Eur Urol Focus 2016; 2:245-259. [PMID: 28723370 DOI: 10.1016/j.euf.2016.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/22/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still uncertainty about its diagnostic and therapeutic management. OBJECTIVE To evaluate current evidence regarding the diagnosis and therapy of postprostatectomy incontinence (PPI). EVIDENCE ACQUISITION A systematic review of the literature was performed in October 2015 using the Medline database. EVIDENCE SYNTHESIS Diagnosis and conservative treatment of PPI are currently mostly based on expert opinions. Pelvic floor muscle training is the noninvasive treatment of choice of PPI. For invasive management of moderate to severe PPI, the artificial urinary sphincter is still the treatment of choice, but an increasing number of adjustable and nonadjustable, noncompressive as well as compressive devices are used more frequently. However, no randomized controlled trial has yet investigated the outcome of one specific surgical treatment or compared the outcome of different surgical treatment options. CONCLUSIONS The level of evidence addressing the surgical management of PPI is still unsatisfactory. Further research is urgently needed. PATIENT SUMMARY Incontinence after the removal of the prostate (postprostatectomy incontinence) is the most common cause of male stress urinary incontinence. First-line therapy is physiotherapy and lifestyle changes. If no satisfactory improvement is obtained, various surgical treatment options are available. The most commonly used is the artificial urinary sphincter, but other treatment options like male slings are also available.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany.
| | - Wilhelm Hübner
- Landesklinikum Weinviertel Korneuburg, Klinik für Urologie, Kornneuburg, Austria
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricarda M Bauer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany
| |
Collapse
|
30
|
Comiter CV, Dobberfuhl AD. The artificial urinary sphincter and male sling for postprostatectomy incontinence: Which patient should get which procedure? Investig Clin Urol 2016; 57:3-13. [PMID: 26966721 PMCID: PMC4778750 DOI: 10.4111/icu.2016.57.1.3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/16/2015] [Indexed: 11/18/2022] Open
Abstract
Surgery is the most efficacious treatment for postprostatectomy incontinence. The ideal surgical approach depends on a variety of patient factors including history of prior incontinence surgery or radiation treatment, bladder contractility, severity of leakage, and patient expectations. Most patients choose to avoid a mechanical device, opting for the male sling over the artificial urinary sphincter. The modern male sling has continued to evolve with respect to device design and surgical technique. Various types of slings address sphincteric incompetence via different mechanisms of action. The recommended surgery, however, must be individualized to the patient based on degree of incontinence, detrusor contractility, and urethral compliance. A thorough urodynamic evaluation is indicated for the majority of patients, and the recommendation for an artificial urinary sphincter, a transobturator sling, or a quadratic sling will depend on urodynamic findings and the patient's particular preference. As advancements in this field evolve, and our understanding of the pathophysiology of incontinence and mechanisms of various devices improves, we expect to see continued evolution in device design.
Collapse
Affiliation(s)
- Craig V Comiter
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
31
|
Le Portz B, Haillot O, Brouziyne M, Saussine C. Surgimesh M-SLING®transobturator and prepubic four-arm urethral sling for post-prostatectomy stress urinary incontinence: clinical prospective assessment at 24 months. BJU Int 2015; 117:966-75. [DOI: 10.1111/bju.13368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Male Readjustable Sling (MRS) System for Postprostatectomy Incontinence: Experiences of 2 Centers. Urology 2015; 88:195-200. [PMID: 26505836 DOI: 10.1016/j.urology.2015.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the outcomes of Male Readjustable Sling (MRS) in patients with postprostatectomy incontinence at 2 unrelated centers and to determine preoperative factors relevant to the outcome. MATERIALS AND METHODS From January 2007 to January 2014, a total of 64 men with urinary incontinence following radical prostatectomy were treated with MRS at 2 centers. Patients were evaluated based on medical history, daily pad usage, urodynamics, and cystoscopy. The clinical outcome was evaluated according to daily pad usage and questionnaires. Success was defined according to reductions in the number of pads used per day after surgery, and factors related to surgical outcome were investigated. RESULTS The median age of the patients was 70 years (range: 53-84), and the mean follow-up duration was 46.0 ± 19.47 months (range: 12-89). During follow-up, readjustment of the sling was required 1.9 times on average. Daily pad usage decreased significantly from 3.42 ± 2.00 to 0.84 ± 1.20 (P <.001), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score improved (18.65 ± 2.61 to 10.55 ± 6.21, P <.001) without deterioration of voiding symptoms at the last follow-up. MRS was successful in 46 of 64 patients (71.9%). Of the 18 patients who experienced surgical failure, 12 patients required secondary artificial urethral sphincter implantation. The number of daily used pads (odds ratio 1.414) and a history of pelvic irradiation (odds ratio 8.400) were potential risk factors for surgical failure. CONCLUSION According to our midterm follow-up data, MRS is an effective and a safe treatment option for radiation-naïve patients with a mild degree of postprostatectomy incontinence.
Collapse
|
33
|
[Diagnosis and surgical treatment of postprostatectomy stress incontinence: recommendation of the working group Urologische Funktionsdiagnostik und Urologie der Frau]. Urologe A 2015; 53:847-53. [PMID: 24903836 DOI: 10.1007/s00120-014-3531-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Today, for the surgical treatment of postprostatectomy incontinence, several treatment options are available, e.g., adjustable and functional sling systems, artificial sphincter, bulking agents, and balloons. However, no recommendations in terms of specific diagnostic tools and differentiated treatment options for everyday life are available. Our aim is to provide some clinically relevant recommendations for the necessary diagnostic workup and different treatment options of postprostatetectomy incontinence to support clinical decisions in everyday life. Treatment selection should be based on contraindications. However, there is a broad overlap of the various surgical options.
Collapse
|
34
|
Comiter C. Surgery for postprostatectomy incontinence: which procedure for which patient? Nat Rev Urol 2015; 12:91-9. [PMID: 25558839 DOI: 10.1038/nrurol.2014.346] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Surgery remains the most effective treatment for postprostatectomy incontinence. Over the past two decades, this surgery has evolved with respect to both operative technique and sling design, and various devices are now available that have different mechanisms of action, such as the artificial urinary sphincter, retroluminal sling or quadratic sling. The choice of device, however, should be individualized according to the circumstances of each patient. The optimal surgical treatment depends on a variety of patient-related factors, including the degree of urine leakage as assessed by incontinence pad weight test results, bladder contractility, urethral compliance, history of radiation exposure or prior incontinence surgery, and patient preference--given the choice, most patients opt for a sling procedure over an artificial sphincter to avoid implantation of a mechanical device. Athorough urodynamic evaluation is, therefore, necessary for the majority of patients. An artificial urinary sphincter, retroluminal sling or quadratic sling might be the most appropriate choice for a particular patient, depending on their specific urodynamic findings. Progress in this field continues, and several new devices are in development.
Collapse
Affiliation(s)
- Craig Comiter
- School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| |
Collapse
|
35
|
Evaluation of salvage male transobturator sling placement following recurrent stress urinary incontinence after failed transobturator sling. Urology 2015; 85:478-82. [PMID: 25559726 DOI: 10.1016/j.urology.2014.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the outcome of patients treated with a salvage AdVance male sling after a failed primary transobturator sling placement. METHODS Retrospective review of patients treated at our center with a primary and subsequent salvage AdVance sling. Success was defined as a dry safety pad or no pads (cured), or >50% improvement in pads used per day and patient satisfaction (improved). Early primary sling failures (<6 months) were compared with late (≥6 months) failures with regard to continence outcomes. RESULTS We identified 18 patients who underwent a salvage AdVance sling placement at our institution. Overall success was 72% at 6 months postoperatively and 56% at a mean follow-up of 17.5 months, including 50% and 39% of patients who were dry at those same time periods. Patients failing late after their primary sling (n = 8) enjoyed improved outcomes with salvage sling placement compared with patients who failed early (n = 10) after the primary sling. At 6 months, more patients in the late primary failure group were cured (75% vs. 30%; P = .031). These improved cure rates remained significant through final follow-up with cure rates of 63% and 20%, respectively (P = .041). CONCLUSION Salvage AdVance male sling is a viable treatment option after a failed primary sling procedure, especially in patients who demonstrated a prolonged efficacy period before primary sling failure.
Collapse
|
36
|
The extent of changes in the membranous urethra angle is associated with the outcome of retrourethral transobturator sling procedure. Int Urol Nephrol 2014; 47:249-55. [DOI: 10.1007/s11255-014-0888-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
|
37
|
Surgery for Male Urinary Incontinence: Where are we now and what is in the Pipeline? Urologia 2014; 82:139-50. [DOI: 10.5301/uro.5000103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 02/06/2023]
Abstract
Male stress urinary incontinence, which has radical prostatectomy as the main aetiology, affects about 39% of the adult male population and is one of the complications of radical prostatectomy with the greatest impact on the quality of life of patients. There are a wide range of treatments for stress urinary incontinence available to the urologist, ranging from conservative treatments to surgical treatments, from minimally invasive procedures to the implant of artificial sphincter prosthesis. The aim of this work is to define the state-of-the-art of surgical treatments for male stress urinary incontinence, analyzing the most recent studies in the literature and evaluating the available scientific evidence.
Collapse
|
38
|
Yiou R, Butow Z, Baron T, Salomon L, Audureau E. Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with one-year follow-up. World J Urol 2014; 33:1331-6. [PMID: 25416348 DOI: 10.1007/s00345-014-1447-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the effects of the ProACT™ device as a second-line treatment for persistent incontinence after male sling insertion. METHODS Twenty consecutive patients were treated with the ProACT™ device due to persistent urinary incontinence following male sling insertion (9 AdVance™, 9 TOMS™, 2 InVance™). All balloons were implanted using a combination of fluoroscopic imaging and fibroscopic retrovision. Urinary symptoms were assessed prior to male sling insertion (T0) and before (T1) and 1 year after the ProACT™ insertion (T2) using questionnaires (ICIQ, USP, and ULCA-PCI-urinary bother) and by determining the number of pads used daily. RESULTS The mean age of the study population at T1 was 68.6 ± 9 years. The mean volume of adjustment at T2 was 4.5 ± 2.7 mL. The previous sling did not cause any technical difficulties during ProACT™ insertion. Late wound infections occurred in the two patients who had been previously treated with the InVance sling and required removal of all implanted materials (Clavien-Dindo classification IIIb). Improvement in mean urinary scores was noted in the remaining patients (n = 18) through T0, T1, and T2, respectively: The ICIQ scores were 16.8 ± 2.6, 13.1 ± 3.4, and 5.7 ± 5.7 (P < 0.0001); USP stress urinary incontinence scores were 8 ± 1.8, 5.6 ± 2.2, and 2.4 ± 2.8, (P < 0.0001); USP overactive bladder symptom scores were 6.8 ± 4.3, 7.6 ± 4.3, and 4.1 ± 3.5 (P = 0.008), UCLA-PCI urinary bother scores were 7.1 ± 11.3, 28.6 ± 12.9, and 69.6 ± 31.6 (P < 0.0001), and number of pads used were 2.9 ± 1, 2 ± 1, and 0.3 ± 0.9 (P < 0.0001). USP obstructive symptoms were 0.4 ± 1, 1 ± 1.6, and 1.3 ± 1.4 (P = 0.19). CONCLUSIONS The Pro-ACT™ device may provide additional benefits for improving continence in case of persistent incontinence following male sling insertion.
Collapse
|
39
|
Hamann MF, Naumann CM, Knüpfer S, Jünemann KP, Bauer R. [Urogynecology II: urinary incontinence in men and women: surgical treatment of urinary incontinence and prolapse]. Urologe A 2014; 53:1671-80; quiz 1681-2. [PMID: 25316184 DOI: 10.1007/s00120-014-3607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Numerous surgical procedures are available for the treatment of stress urinary incontinence in women and men. On a par with classical therapy options (e.g. colposuspension and artificial sphincter prosthesis) suburethral tape procedures have become established as the minimally invasive standard of care. Regarding comorbidities and recurrent urinary incontinence, therapeutic procedures should be modified on an individual basis. It is crucial to involve patients in therapeutic decision-making and counseling should be given with respect to all conservative and operative alternatives.
Collapse
Affiliation(s)
- M F Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 7, 24105, Kiel, Deutschland,
| | | | | | | | | |
Collapse
|
40
|
Soljanik I, Bauer RM, Stief CG, Gozzi C, Becker AJ. Pelvic floor muscle function is an independent predictor of outcome after retrourethral transobturator male sling procedure. World J Urol 2014; 33:1143-9. [PMID: 25312682 DOI: 10.1007/s00345-014-1418-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the impact of the retrourethral transobturator sling (RTS) on pelvic floor muscle function (PFMF) and whether preoperative PFMF is associated with RTS outcome. METHODS Between May 2008 and December 2010, 59 consecutive men with postprostatectomy stress urinary incontinence (PSUI) underwent PFMF assessment before RTS and 6 months thereafter in a prospective cohort study. The assessments included demographic and clinical characteristics, and quality of life (QoL) questionnaires. PFMF was evaluated by digital rectal examination on the modified 6-point Oxford scale and by surface electromyography. The primary outcome measurement was success after RTS defined as PSUI cure with use of no or one dry "security" pad. For secondary outcome, PFMF, 1-h pad test, and impact of PSUI on QoL were evaluated. Uni- and multivariate analyses were performed. RESULTS After 6-month follow-up, the cure, improvement (>50 % pad reduction) and failure rates were 50 % (29/58 patients), 24 % (14/58 patients) and 26 % (15/58 patients), respectively. Significant improvement of QoL, clinical and PFMF parameters occurred after RTS. On multivariate analysis, weak PFMF (OR 86.29) and greater muscle fatigue (OR 3.31) were significant independent predictors of RTS failure. The final model demonstrated good calibration (p = 0.882) and excellent discriminative ability (0.942, 95 % CI 0.883-1.0) to predict success after RTS. CONCLUSIONS PFMF improved significantly after RTS procedure. Higher muscle fatigue and weak PFMF were independent predictors of RTS failure. Digital rectal evaluation of PFMF is a simple and reliable clinical tool, which can be used by urologists in daily routine to predict the RTS outcome.
Collapse
Affiliation(s)
- Irina Soljanik
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany,
| | | | | | | | | |
Collapse
|
41
|
Jura YH, Comiter CV. Urodynamics for postprostatectomy incontinence: when are they helpful and how do we use them? Urol Clin North Am 2014; 41:419-27, viii. [PMID: 25063598 DOI: 10.1016/j.ucl.2014.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Urodynamics is indicated for the evaluation of postprostatectomy incontinence unless an artificial urinary sphincter placement is the preferred option, as in cases of severe incontinence, prior radiation, or previous male sling or artificial urinary sphincter placement--when male sling is unlikely to achieve efficacy. Urodynamics should be performed only when there is a question it can answer that would affect treatment choice or outcome. Urodynamic findings of detrusor underactivity, overactivity, and reduced compliance are important considerations in deciding how best to treat postprostatectomy incontinence.
Collapse
Affiliation(s)
- Ying H Jura
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Craig V Comiter
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| |
Collapse
|
42
|
How to Best Predict Success of the Transobturator Male Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
43
|
Bauer RM, Kretschmer A, Stief CG, Füllhase C. AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence. World J Urol 2014; 33:145-50. [PMID: 24706183 DOI: 10.1007/s00345-014-1297-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). METHODS Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. RESULTS Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. CONCLUSIONS Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.
Collapse
Affiliation(s)
- Ricarda M Bauer
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany,
| | | | | | | |
Collapse
|
44
|
[Modern operative treatment possibilities in male stress urinary incontinence]. Urologe A 2014; 53:339-40, 342, 344-5. [PMID: 24522693 DOI: 10.1007/s00120-013-3351-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postprostatectomy incontinence (PPI) is one of the most feared complications of radical prostatectomy with major impact on quality of life and social well-being. In recent years due to improved surgical techniques a reduction of the postoperative incontinence rate was achieved. However, due to the increasing number of radical prostatectomies performed for prostate cancer, a substantial and increasing number of patients are suffering from postoperative stress urinary incontinence. If conservative treatment fails, surgical therapy is recommended. For decades, the artificial urinary sphincter was the reference standard for moderate to severe postoperative male stress urinary incontinence. However, patients' demand on minimally invasive treatment options is high. Age or advanced prostate cancer should not be an exclusion criterion for surgical treatment of persistent PPI.
Collapse
|
45
|
Soljanik I, Bauer RM, Becker AJ, Stief CG, Gozzi C, Solyanik O, Brocker KA, Kirchhoff SM. Is a wider angle of the membranous urethra associated with incontinence after radical prostatectomy? World J Urol 2014; 32:1375-83. [PMID: 24452450 DOI: 10.1007/s00345-014-1241-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/10/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate whether differences in the anatomy and dynamics of the pelvic floor (PF) in patients after radical prostatectomy (RP) depicted on magnetic resonance imaging (MRI) are associated with continence status. METHODS In the prospective designed study, 24 patients with post-prostatectomy stress urinary incontinence were enrolled. Additionally, 10 continent patients after RP were matched for age, body mass index and perioperative parameters. All patients underwent continence assessment and MRI (TrueFISP sequence; TR 4.57 ms; TE 2.29 ms; slice thickness 7 mm; FOV 270 mm) 12 months after RP. Images were analyzed for membranous urethra length (MUL), angle of the membranous urethra (AMU), severity of periurethral/urethral fibrosis, lifting of the levator ani muscle, lowering of the posterior bladder wall (BPW), bladder neck (BN) and external urinary sphincter (EUS), and symphyseal rotation of these structures during the Valsalva maneuver and voiding. RESULTS Compared to continent controls, incontinent patients showed a significant wider AMU during voiding (p = 0.002) and more pronounced lowering of the BN and EUS (p < 0.001). No differences between the groups were found in symphyseal rotation of the analyzed structures, MUL and severity of periurethral/urethral fibrosis. CONCLUSIONS The angle of the membranous urethra as a result of anchoring of the BN and EUS in the PF appears to be an important functional factor with an essential impact on continence after RP. Functional MRI seems to be a helpful imaging tool for morphologic and dynamic evaluation of the PF.
Collapse
Affiliation(s)
- Irina Soljanik
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Kowalik CG, DeLong JM, Mourtzinos AP. The advance transobturator male sling for post-prostatectomy incontinence: Subjective and objective outcomes with 3 years follow up. Neurourol Urodyn 2013; 34:251-4. [DOI: 10.1002/nau.22539] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Casey G. Kowalik
- Lahey Hospital & Medical Center; Institute of Urology; Burlington Massachusetts
| | - Jessica M. DeLong
- Lahey Hospital & Medical Center; Institute of Urology; Burlington Massachusetts
| | | |
Collapse
|
47
|
|
48
|
Suzuki Y, Saito Y, Kondo Y. Bone-anchored sling created with the InVance™ system for the treatment of incontinence after radical prostatectomy: initial experience in Japan. J NIPPON MED SCH 2013; 79:143-6. [PMID: 22687358 DOI: 10.1272/jnms.79.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This report describes creation of a bone-anchored sling with the InVance™ system (American Medical Systems, Minnetonka, MN, USA) for the treatment of 2 patients with incontinence after radical prostatectomy. The InVance™ system uses a silicon-coated polyester sling positioned under the bulbar urethra via a perineal incision. The sling is attached to both ischiopubic rami by 3 titanium screws. Operative times were 157 minutes (patient 1) and 240 minutes (patient 2). Blood loss was 70 mL (patient 1) and 10 mL (patient 2). The patients used 7 and 5 absorbent pads/day, respectively, before surgery and 1 and 0 pads/day after surgery (this datum does not appear in the main text, although the absence of incontinence is mentioned). The only major adverse event encountered was mesh infection necessitating mesh removal in patient 2. This operation appears comparatively simple and useful.
Collapse
Affiliation(s)
- Yasutomo Suzuki
- Department of Urologic Surgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
| | | | | |
Collapse
|
49
|
Yiou R, Loche CM, Lingombet O, Abbou C, Salomon L, de la Taille A, Audureau E. Evaluation of urinary symptoms in patients with post-prostatectomy urinary incontinence treated with the male sling TOMS. Neurourol Urodyn 2013; 34:12-7. [DOI: 10.1002/nau.22503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/13/2013] [Indexed: 11/10/2022]
Affiliation(s)
- René Yiou
- Assistance Publique des Hôpitaux de Paris; Urology Department and CRCDC, Henri Mondor Teaching Hospital; Créteil France
| | - Catherine-Marie Loche
- Assistance Publique des Hôpitaux de Paris; Hospital Albert Chenevier; Service de Médecine Physique et de Réadaptation; Créteil France
| | - Odile Lingombet
- Assistance Publique des Hôpitaux de Paris; Urology Department and CRCDC, Henri Mondor Teaching Hospital; Créteil France
| | - Claude Abbou
- Assistance Publique des Hôpitaux de Paris; Urology Department and CRCDC, Henri Mondor Teaching Hospital; Créteil France
| | - Laurent Salomon
- Assistance Publique des Hôpitaux de Paris; Urology Department and CRCDC, Henri Mondor Teaching Hospital; Créteil France
| | - Alexandre de la Taille
- Assistance Publique des Hôpitaux de Paris; Urology Department and CRCDC, Henri Mondor Teaching Hospital; Créteil France
| | - Etienne Audureau
- Assistance Publique des Hôpitaux de Paris; Department of Public Health; Henri Mondor Teaching Hospital; Créteil France
| |
Collapse
|
50
|
Drai J, Caremel R, Riou J, Grise P. The two-year outcome of the I-Stop TOMS™ transobturator sling in the treatment of male stress urinary incontinence in a single centre and prediction of outcome. Prog Urol 2013; 23:1494-9. [PMID: 24286551 DOI: 10.1016/j.purol.2013.08.308] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to present the results of the 2 year outcome of I-Stop TOMS™ transobturator sling for post-prostatectomy (UIPP) minor to moderate male urinary incontinence treatment. MATERIALS AND METHODS A prospective, single center study, including 26 patients with minor to moderate IUPP and operated on using a suburethral sling (MS) TOMS™ (four arms) was performed. UIPP assessment was made preoperatively and 1 year postoperatively, using validated questionnaires (SF36 and ICIQ), number of pads daily, and the 24 hours Pad-test (LPT). Telephone follow-up evaluation was performed in 21 patients over a 2 years period following surgery. RESULTS Radical prostatectomy was performed 48.4 months earlier and average patient age was 67.3 years. Preoperatively, the mean number of pads used daily was 2.3 with an average weight loss of 207.1grams at LPT. At 1 year, ICIQ and SF36 scores significantly improved. Weight loss in the LPT as well as the number of pads significantly decreased (P<0.05). At 1 year, 13 patients were cured, 12 were improved, one reached improvement criteria, and 96.2% using a pad daily maximum. With more than a 2 year follow-up, 10/21 patients were dry, nine improved and two failed, and 90.5% using 0 to 1 pad per day. CONCLUSIONS The transobturator TOMS™ male sling is a simple and well-tolerated procedure permitting a significant improvement of UIPP, with 50% of patients achieving complete continence at 1 year postoperatively, these good results continued beyond 2 years. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- J Drai
- Urology Department, Rouen University Hospital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | | | | | | |
Collapse
|