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Artificial urinary sphincter insertion after male sling. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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Chung E. Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques. Ther Adv Urol 2023; 15:17562872231187199. [PMID: 37528956 PMCID: PMC10387683 DOI: 10.1177/17562872231187199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.
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ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis. J Clin Med 2021; 11:jcm11010081. [PMID: 35011821 PMCID: PMC8745557 DOI: 10.3390/jcm11010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0-1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher's exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien-Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a "very much better" PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.
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Schifano N, Capogrosso P, Tutolo M, Dehò F, Montorsi F, Salonia A. How to Prevent and Manage Post-Prostatectomy Incontinence: A Review. World J Mens Health 2020; 39:581-597. [PMID: 33151045 PMCID: PMC8443978 DOI: 10.5534/wjmh.200114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/25/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To provide an overview of the currently available evidence relating to the prevention and management strategies of urinary incontinence (UI) after radical prostatectomy (RP). MATERIALS AND METHODS A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning post-RP UI. The search strategy included these words: urinary continence; urinary continence recovery; urinary incontinence; radical prostatectomy; and prostate cancer. RESULTS Post-RP UI still represents a challenging issue for both urologic patients and clinicians. A complete preoperative assessment of the risk factors associated with post-RP UI aids both in counseling those patients with a higher estimated likelihood of postoperative UI and in identifying those who would probably benefit from preventive strategies in the preoperative and in the intraoperative settings. Over the last decades different surgical strategies based on either the "preservation" or the "reconstruction" of the anatomical elements responsible for urinary continence (UC) led to an overall improvement of postoperative functional outcomes. Finally, several therapeutic strategies should be evaluated for the postoperative UI management. Artificial urinary sphincter implantation represents the gold standard for treatment, notwithstanding its wide adoption is limited due to high costs and significant risk of surgical revision. In this context, male sling positioning seems the most promising strategy, in particular in mild and moderate post-RP UI. CONCLUSIONS To enhance the likelihood of obtaining an optimal UC recovery after RP, it is here strongly suggested to intervene throughout the overall clinical management process thus including the pre-, intra- and postoperative settings.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.
| | - Manuela Tutolo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.,University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Grabbert M, Hüsch T, Kretschmer A, Kirschner-Hermanns R, Anding R, Brehmer B, Naumann CM, Queissert F, Loertzer H, Khoder W, Gratzke C, Hofmann T, Huebner W, Haferkamp A, Bauer RM. Secondary Sling Implantation after Failure of Primary Surgical Treatment for Male Stress Urinary Incontinence: A Retrospective Study. Urol Int 2020; 104:625-630. [PMID: 32541144 DOI: 10.1159/000508585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/10/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). MATERIALS AND METHODS Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. RESULTS Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 (p = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. CONCLUSION We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
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Affiliation(s)
- Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany,
| | - Tanja Hüsch
- Department of Urology, University Medical Center Mainz, Mainz, Germany.,Promedon GmbH, Kolbermoor, Germany
| | - Alexander Kretschmer
- Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany
| | | | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Bernhard Brehmer
- Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany
| | | | - Fabian Queissert
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Hagen Loertzer
- Department of Urology, Westpfalz Hospital Kaiserslautern, Kaiserslautern, Germany
| | - Wael Khoder
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwäbisch Hall, Schwäbisch Hall, Germany
| | - Wilhelm Huebner
- Department of Urology, Korneuburg General Hospital, Korneuburg, Austria
| | - Axel Haferkamp
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | - Ricarda M Bauer
- Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany
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Abstract
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
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Affiliation(s)
- Kole P Akula
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
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Guachetá Bomba PL, Ocampo Flórez GM, Echeverría García F, García-Perdomo HA. Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis. Ther Adv Urol 2019; 11:1756287219875581. [PMID: 31632464 PMCID: PMC6769218 DOI: 10.1177/1756287219875581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP). Methods: This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included. Results: Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies. Conclusions: Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.
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Affiliation(s)
| | - Ginna Marcela Ocampo Flórez
- UROGIV Research Group, Universidad del Valle, Cali, Colombia, and Department of Urology, Universidad CES, Medellín, Colombia
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Urethral Bulking and Salvage Techniques for Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tutolo M, Cornu JN, Bauer RM, Ahyai S, Bozzini G, Heesakkers J, Drake MJ, Tikkinen KAO, Launonen E, Larré S, Thiruchelvam N, Lee R, Li P, Favro M, Zaffuto E, Bachmann A, Martinez-Salamanca JI, Pichon T, De Nunzio C, Ammirati E, Haab F, Van Der Aa F. Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn 2018; 38:710-718. [PMID: 30575997 DOI: 10.1002/nau.23901] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 11/08/2022]
Abstract
AIMS To assess efficacy and safety as well as predictive factors of dry rate and freedom from surgical revision in patients underwent AUS placement. The artificial urinary sphincter (AUS) is still considered the standard for the treatment of moderate to severe post-prostatectomy stress urinary incontinence (SUI). However, data reporting efficacy and safety from large series are lacking. METHODS A multicenter, retrospective study was conducted in 16 centers in Europe and USA. Only primary cases of AUS implantation in non-neurogenic SUI after prostate surgery, with a follow-up of at least 1 year were included. Efficacy data (continence rate, based on pad usage) and safety data (revision rate in case of infection and erosion, as well as atrophy or mechanical failure) were collected. Multivariable analyses were performed in order to investigate possible predictors of the aforementioned outcomes. RESULTS Eight hundred ninety-two men had primary AUS implantation. At 32 months mean follow-up overall dry rate and surgical revision were 58% and 30.7%, respectively. Logistic regression analysis showed that patients without previous incontinence surgery had a higher probability to be dry after AUS implantation (OR: 0.51, P = 0.03). Moreover institutional case-load was positively associated with dry rate (OR: 1.18; P = 0.005) and freedom from revision (OR: 1.51; P = 0.00). CONCLUSIONS The results of this study showed that AUS is an effective option for the treatment of SUI after prostate surgery. Moreover previous incontinence surgery and low institutional case-load are negatively associated to efficacy and safety outcomes.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Sascha Ahyai
- Department of Urology, University-Medical-Center Hamburg, Hamburg, Germany.,Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | | | - John Heesakkers
- Department of Urology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
| | - Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
| | - Kari A O Tikkinen
- Department of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ene Launonen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, United Kingdom
| | - Richard Lee
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Philip Li
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Michele Favro
- Department of Urology, Ospedale Maggiore Della Carità Di Novara, Novara, Italy
| | - Emanuele Zaffuto
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas Pichon
- Department of Urology, Angers University Hospital, Angers, France
| | - Cosimo De Nunzio
- Department of Urology, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Enrico Ammirati
- Department of Urology, Azienda Ospedaliera Universitaria, Città Della Salute E Della Scienza, Ospedale Molinette, Turin, Italy
| | | | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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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]
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Averbeck MA, Woodhouse C, Comiter C, Bruschini H, Hanus T, Herschorn S, Goldman HB. Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence. Neurourol Urodyn 2018; 38:398-406. [PMID: 30350875 DOI: 10.1002/nau.23845] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/10/2018] [Indexed: 11/07/2022]
Abstract
AIMS To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. METHODS The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. RESULTS Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. CONCLUSIONS Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.
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Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | | | - Homero Bruschini
- Department of Urology, University of Sao Paulo, Rua Barata Ribeiro, Brazil
| | - Thomas Hanus
- 1st Faculty of Medicine, Charles University, Prague Prague, CZ
| | - Sender Herschorn
- Sunnybrook and Womens Health Sciences Centre, Toronto, ON, Canada
| | - Howard B Goldman
- The Cleveland Clinic Foundation, Glickman Urological Institute, Cleveland, Ohio
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Management of Postradical Prostatectomy Urinary Incontinence: A Review. Urology 2018; 113:13-19. [DOI: 10.1016/j.urology.2017.09.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
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13
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Malval B, Rebibo JD, Baron M, Nouhaud FX, Pfister C, Cornu JN, Grise P. Long-term outcomes of I-Stop TOMS™ male sling implantation for post-prostatectomy incontinence management. Prog Urol 2017; 27:1084-1090. [DOI: 10.1016/j.purol.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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15
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Fairbanks J, Duffy M, Hamid R, Ockrim J, Greenwell TJ. Male post-prostatectomy incontinence MDT. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817712182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The management of post-prostatectomy incontinence remains controversial with ongoing confusion as to who benefits from male sling or artificial urinary sphincter. We present a post-prostatectomy incontinence MDT format to illustrate key factors in decision-making and determination of best management in post-prostatectomy incontinence.
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Affiliation(s)
- Jessica Fairbanks
- Department of Urology, University College London Hospital, UK
- West Midlands Core Surgical Training Rotation, UK
| | - Megan Duffy
- Department of Urology, University College London Hospital, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, UK
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16
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Abstract
Although currently still the gold standard treatment for post-prostatectomy urinary incontinence, the artificial urinary sphincter (AUS) (AMS800) is an invasive procedure with associated risks factors. In this paper, we aim to outline what the scientific literature and what we personally believe are the factors that are useful and/or necessary to mitigate these risks, including both patient factors and surgeon factors. We also review special populations, including transcorporal (TC) AUS approach, AUS with inflatable penile prosthesis, AUS after male urethral sling, AUS erosion management, and AUS after orthotopic urinary diversion.
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Affiliation(s)
- William O Brant
- Division of Urology, Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah, USA.,Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Francisco E Martins
- Department of Urology, University of Lisbon, School of Medicine, Hospital Santa Maria, Lisbon, Portugal
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Friedl A, Schneeweiss J, Stangl K, Mühlstädt S, Zachoval R, Hruby S, Gründler T, Kivaranovic D, Fornara P, Lusuardi L, Brössner C. The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate. Urology 2017; 109:184-189. [PMID: 28712889 DOI: 10.1016/j.urology.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 06/30/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of the Adjustable Transobturator Male System (ATOMS) in men with stress urinary incontinence after transurethral resection of the prostate (TURP). MATERIALS AND METHODS From a large international prospectively administrated ATOMS register, we identified 49 patients with an ATOMS device as a result of persistent stress urinary incontinence after TURP. For evaluation, the men were divided into standard transurethral resection of the prostate (sTURP) and palliative transurethral resection of the prostate (pTURP) in radiated patients. Baseline and follow-up measurements included continence parameters, urodynamics, quality-of-life surveys (Patient Global Impression-Improvement and International Consultation on Incontinence Questionnaire-Short Form), and pain ratings. The dry rate (0-1 security pad/<10 mL urine loss), the success rate (overall improvement), removals, complications, and treatment failures were recorded. A P value of <.05 was considered statistically significant. RESULTS After a median of 34 and 22 months' follow-up and 2-3 adjustments, the sTURP and pTURP cohorts had 58% and 50% dry rates and 90% and 87% success rates. Hence, no improvement was seen in 10% and 13%. The removal rate was higher in pTURP (50% vs 10%, P = .0171) and infection was the most common side effect (50%) observed. Neither intraoperative nor Clavien-Dindo 4 and 5 adverse events were recorded. In sTURP and pTURP, the median daily pad count and the pad test improved significantly (all P <.001), and quality-of-life parameters shifted to a high satisfaction level (P <.001 and P = .001). Urodynamics remained unchanged and postoperative pain was not an issue. CONCLUSION The ATOMS device shows promising treatment outcomes in patients after TURP and a similar efficacy as in postprostatectomy incontinence. There is no difference in continence outcome between sTURP and pTURP; however, a higher removal rate was found after pTURP, which may be important for patient counseling.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria.
| | | | - Kathrin Stangl
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University, Halle (Saale), Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Stephan Hruby
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Therese Gründler
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Danijel Kivaranovic
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin Luther University, Halle (Saale), Germany
| | - Lukas Lusuardi
- Department of Urology, Landeskrankenhaus Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Clemens Brössner
- Department of Urology, Barmherzige Schwestern Krankenhaus, Vienna, Austria
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MacDonald S, Colaco M, Terlecki R. Waves of Change: National Trends in Surgical Management of Male Stress Incontinence. Urology 2017; 108:175-179. [PMID: 28709851 DOI: 10.1016/j.urology.2017.04.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/25/2017] [Accepted: 04/30/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the trend in surgical management of male stress urinary incontinence (SUI) in the context of the rate of radical prostatectomy (RP) as reported by a national database. Traditionally, the artificial urinary sphincter (AUS) has been the gold standard, but the male sling represents a newer and popular alternative. Refinements in prostate surgery may reduce the incidence and degree of subsequent SUI. MATERIALS AND METHODS A retrospective cross-sectional analysis was performed using the National Inpatient Survey database, which captures discharge data from inpatient and overnight admissions. Cases were identified by their International Classification of Diseases, Ninth Revision procedure codes. We queried the codes 58.93 (implantation of AUS), 59.4 (suprapubic sling operation), 59.5 (retropubic urethral suspension), and 59.6 (paraurethral suspension). We also queried 60.5 (RP) for comparison. Data were collected from January 2000 to December 2012 and weighted to a national average using National Inpatient Survey guidelines. RESULTS A total of 32,416 anti-incontinence operations (20,790 AUS and 11,625 sling procedures) were performed over the study period. There was a significant downward trend in the total number of incontinence procedures (F(1,11) = 6.15, P = .03). However, when stratifying the data by procedure type, only AUS placement demonstrated a significant decline (F(1,11) = 21.70, P <.01), whereas sling procedures significantly increased (F(1,11) = 12.95, P <.01). There was no significant change in the annual incidence of RP. CONCLUSION Inpatient surgery for male SUI is decreasing overall. Placement of the AUS declined significantly, whereas sling placement became more common. Future study will determine the etiology of these trends.
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Affiliation(s)
- Susan MacDonald
- Department of Urology, Penn State Hershey Medical Center, Hershey, PA.
| | - Marc Colaco
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ryan Terlecki
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
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The Artificial Urinary Sphincter: Evolution and Implementation of New Techniques in the Man with Stress Incontinence After Treatment for Prostate Cancer. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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]
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Friedl A, Mühlstädt S, Zachoval R, Giammò A, Kivaranovic D, Rom M, Fornara P, Brössner C. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int 2016; 119:785-792. [PMID: 27868328 DOI: 10.1111/bju.13684] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. PATIENTS AND METHODS In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (<10 mL/day and 0-1 pad/day), device durability, treatment failure, and device complications were recorded. Nonparametric tests were used for statistical analyses. RESULTS After a median (interquartile range [IQR]) follow-up of 31 (10-54) months and a median (IQR) of 3 (2-4) adjustments, the overall success rate was 90% (258 men) and the dry rate was 64% (184). Daily pad test and pad use decreased from a median of 400 mL/day and 4 pads/day to a median of 18 mL/day and 1 pad/day (both P < 0.001), concomitantly QoL ratings significantly improved and changed to a high level of satisfaction (PGI-I 4 to 2, ICIQ-SF 17 to 5; both P < 0.001). The UI results at 12 months were comparable to those at final follow-up. Chronic pain and intraoperative complications did not occur. Most of the postoperative complications were Clavien-Dindo grade I-III (no grade IV or V). At present, 231 (80%) of all the ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P < 0.001) were prognostic factors for beneficial treatment outcome. CONCLUSION The ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Danijel Kivaranovic
- Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Maximilian Rom
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Clemens Brössner
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
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Ziegelmann MJ, Linder BJ, Rivera ME, Viers BR, Elliott DS. The impact of prior urethral sling on artificial urinary sphincter outcomes. Can Urol Assoc J 2016; 10:405-409. [PMID: 28096915 PMCID: PMC5167597 DOI: 10.5489/cuaj.3922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS). METHODS We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Cox-regression analysis. RESULTS There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy. CONCLUSIONS AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.
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Affiliation(s)
| | - Brian J. Linder
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | | | - Boyd R. Viers
- Department of Urology, Mayo Clinic, Rochester, MN, United States
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Friedl A, Mühlstädt S, Rom M, Kivaranovic D, Mohammed N, Fornara P, Brössner C. Risk Factors for Treatment Failure With the Adjustable Transobturator Male System Incontinence Device: Who Will Succeed, Who Will Fail? Results of a Multicenter Study. Urology 2016; 90:189-94. [DOI: 10.1016/j.urology.2015.12.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
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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.
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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
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This Month in Adult Urology. J Urol 2015. [DOI: 10.1016/j.juro.2015.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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