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[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]. Prog Urol 2019; 29:1041-1046. [PMID: 31587866 DOI: 10.1016/j.purol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/31/2019] [Accepted: 09/03/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. PATIENTS AND METHODS In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). RESULTS Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H2O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant. CONCLUSIONS Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. LEVEL OF EVIDENCE 4.
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Sling Procedures for Post Prostatectomy Incontinence: What Devices Are Out There? and What Are Their Results? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Meisterhofer K, Herzog S, Strini KA, Sebastianelli L, Bauer R, Dalpiaz O. Male Slings for Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:575-592. [PMID: 30718160 DOI: 10.1016/j.euf.2019.01.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Male slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model. OBJECTIVE To evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence. EVIDENCE ACQUISITION This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords "incontinence," "prostatectomy," and "male sling/system" was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients' quality of life. EVIDENCE SYNTHESIS The literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45-0.56, I2=82%). Subjective cure was achieved in 33-94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51-0.71, I2=88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings. CONCLUSIONS Both fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed. PATIENT SUMMARY Fixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
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Affiliation(s)
| | - Sereina Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karin A Strini
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Research Unit for Neurorehabilitation South Tyrol, Hospital of Vipiteno, Vipiteno, Italy
| | - Ricarda Bauer
- Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria.
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Gill SS, Barstad RD. A Review of the Surgical Management of Perineal Hernias in Dogs. J Am Anim Hosp Assoc 2018; 54:179-187. [DOI: 10.5326/jaaha-ms-6490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.
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Paiva OG, Lima JPC, Bezerra CA. Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence. Int Braz J Urol 2018; 44:536-542. [PMID: 29617074 PMCID: PMC5996792 DOI: 10.1590/s1677-5538.ibju.2017.0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/25/2017] [Indexed: 12/03/2022] Open
Abstract
Objective: To evaluate urodynamic alterations after sub-urethral sling surgery (SSU) in patients with post-prostatectomy urinary incontinence (PPUI). Materials and Methods: We evaluated data of 22 patients submitted to radical prosta- tectomy (RP) or transurethral resection of prostate (TURP) that presented post-surgical urinary incontinence and were treated with SSU implant in a pilot study previously performed in our institution. Methods: Those patients with PPUI were evaluated by urodynamic exam (UD) before and after surgery, and the parameters were compared, including uroflow, cystometry and micturition study. Exclusion criteria included patients without pre-operatory urodynamic study, those with urethral stenosis, those not healed of prostate cancer, pa- tients without clinical conditions to be submitted to urodynamic study and those with severe neurological diseases or that refused to sign the consent form. Results were analyzed statistically by Fisher, Wilcoxon or Mann-Whitney tests. Results: During free uroflow, none parameters showed any statistical significant differ- ences. During cystometry, there were also no statistical differences and the same was observed at pressure versus flow study; the exception was at maximal flow detrusor pressure (PdetQmax), that was lower at post-operatory (p=0.028). In relation to the presence of urinary dysfunctions associated to PPUI, we observed a significant reduc- tion of detrusor overactivity (p=0.035) in relation to pre-operatory period. Conclusion: SSU surgery significantly reduced detrusor overactivity and PdetQMax; however, there were no alterations of other evaluated urodynamic parameters.
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Affiliation(s)
- Odair Gomes Paiva
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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Altan M, Asi T, Bilen CY, Ergen A. Adjustable Perineal Male Sling for the Treatment of Urinary Incontinence: Long-term Results. Urology 2017; 106:216-220. [DOI: 10.1016/j.urology.2017.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/15/2017] [Accepted: 04/20/2017] [Indexed: 11/16/2022]
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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.
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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:
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Adynamic Graciloplasty With a Pedicled Gracilis Muscle Flap Wrapped Around Bulbar Urethra for Treatment of Male Acquired Urinary Incontinence. Urology 2016; 91:208-14. [PMID: 26876461 DOI: 10.1016/j.urology.2015.12.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/15/2015] [Accepted: 12/25/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra for treatment of male acquired urinary incontinence. PATIENTS AND METHODS Twenty-four patients with acquired urinary incontinence (8 after radical prostatectomy, 7 after transurethral resection of the prostate, and 9 after posterior urethroplasty) were included in our study. Eighteen of these patients (75.0%) had mild to moderate urinary incontinence, and 6 (25.0%) had severe urinary incontinence. All patients received adynamic gracilis urethral myoplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra and had a close follow-up. RESULTS The mean postoperative maximum urethral pressure after the gracilis muscle wrapped around bulbar urethra was significantly higher than that of the preoperative measurements (P <.05). After a mean follow-up of 31.5 months (6-64 months), 18 patients were cured, 4 patients improved, and 2 patients were considered failures. The total cure rate was 75.0% (18 of 24). Five out of 6 patients with severe incontinence did not have a great success. CONCLUSION A pedicled gracilis muscle flap wrapped around bulbar urethra can raise the urethral pressure. Adynamic graciloplasty with a pedicled gracilis muscle flap wrapped around bulbar urethra is a safe and effective surgical option in the treatment of male patients with mild to moderate incontinence, but is not suitable for severe incontinence.
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Ostrowski I, Śledź E, Ciechan J, Golabek T, Bukowczan J, Przydacz M, Wiatr T, Stangel-Wojcikiewicz K, Chłosta PL. Current interventional management of male stress urinary incontinence following urological procedures. Cent European J Urol 2015; 68:340-7. [PMID: 26568879 PMCID: PMC4643709 DOI: 10.5173/ceju.2015.616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/09/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Despite improvements in surgical techniques and implementation of minimally invasive procedures, male stress urinary incontinence affects a substantial number of patients after prostatic surgery. In response to increasing demand of optimal treatment modality, new alternatives to artificial urinary sphincter have recently been introduced. This review summarises the therapeutic surgical options with their outcomes in management of postprostatectomy stress incontinence. Material and methods We performed a literature review by searching the PubMed, Web of Science and Embase databases for articles published from January 2000 until April 2015 based on clinical relevance. Results Artificial urinary sphincter is currently considered the “gold standard” treatment of male stress urinary incontinence. Although the new devices in this group have recently been investigated, the AMS 800 remains the only widely used implant. Male slings and adjustable continence devices, achieve the social continence rates up to 60%. Periurethral injections of bulking agents, have limited efficacy of male stress incontinence. Argus sling and ProACT are both associated with substantial explantation rates. Stem cell therapy is a promising option but still requires additional testing. Conclusions The development of new alternatives to artificial urinary sphincter is constantly progressing. Although recently introduced minimally invasive treatment options have not yet surpassed the outcomes of the artificial urinary sphincter they should continue to be evaluated and compared against the gold standard.
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Affiliation(s)
| | - Emil Śledź
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Janusz Ciechan
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Tomasz Golabek
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes Mellitus, Northumbria NHS Foundation Trust, North Shields, United Kingdom
| | - Mikolaj Przydacz
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | | | - Piotr L Chłosta
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
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Romano SV, Huebner W, Rocha FT, Vaz FP, Muller V, Nakamura F. A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study. Int Braz J Urol 2015; 40:781-9. [PMID: 25615246 DOI: 10.1590/s1677-5538.ibju.2014.06.09] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/03/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). MATERIALS AND METHODS From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild-moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. RESULTS AND CONCLUSIONS One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12-21) to 1 (0-10). Retrograde leak point pressure increased from 18 (5-29) to 35 (22-45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.
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Affiliation(s)
| | - Wilhelm Huebner
- Department of Urology, Humanis Clinic, Korneuburg, Lower Austria, Austria
| | | | - Fernando Pires Vaz
- Department of Urology, Hospital dos Servidores, Rio de Janeiro, RJ, Brazil
| | - Valter Muller
- Department of Urology, Hospital dos Servidores, Rio de Janeiro, RJ, Brazil
| | - Fabio Nakamura
- CIEM - Centro de Especialidades Médicas de Florianopolis, Florianopolis, SC, Brazil
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Chughtai B, Sedrakyan A, Isaacs AJ, Mao J, Lee R, Te A, Kaplan S. National study of utilization of male incontinence procedures. Neurourol Urodyn 2014; 35:74-80. [PMID: 25327701 DOI: 10.1002/nau.22683] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/03/2014] [Indexed: 01/06/2023]
Abstract
AIMS We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries. METHODS All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes. RESULTS The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low. CONCLUSIONS All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Art Sedrakyan
- Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Abby J Isaacs
- Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Jialin Mao
- Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Richard Lee
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Alexis Te
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
| | - Steven Kaplan
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York
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Abstract
PURPOSE OF REVIEW The use of synthetic slings for the treatment of male stress urinary incontinence (SUI) has increased over the last decade. Several sling designs and techniques are now available. The purpose of this review is to summarize the past literature with a focus on more recent contributions. RECENT FINDINGS The recent literature focusses on the retrourethral transobturator sling (RTS), which is considered noncompressive. MRI of patients undergoing RTS has shown an increase in membranous urethral length and elevation of the external urethral sphincter, whereas a recent large series demonstrated approximately a half and a quarter of patients are cured or improved, respectively, at 1 year after RTS implantation, with results sustained through to 3 years. Serious complications such as urethral erosion occur rarely. SUMMARY The available evidence suggests that male slings can be an efficacious and well tolerated treatment modality for men with SUI. Nevertheless, important questions remain with regard to the durability of repair, device safety and comparative efficacy. The mechanism of action and factors that predict failure remain to be fully elucidated.
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Singla N, Singla AK. Post-prostatectomy incontinence: Etiology, evaluation, and management. Turk J Urol 2014; 40:1-8. [PMID: 26328137 PMCID: PMC4548645 DOI: 10.5152/tud.2014.222014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Ajay K. Singla
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
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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.
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Affiliation(s)
- Yasutomo Suzuki
- Department of Urologic Surgery, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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Xu YM, Zhang XR, Xie H, Song LJ, Feng C, Fei XF. Pedicled rectus abdominis muscle and fascia flap sling the bulbar urethra for treatment for male-acquired urinary incontinence: report of ten cases. Int Urol Nephrol 2013; 46:571-6. [PMID: 24061765 DOI: 10.1007/s11255-013-0553-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. MATERIALS AND METHODS Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. RESULTS The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. CONCLUSIONS A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.
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Affiliation(s)
- Yue-Min Xu
- Department of Urology, Jiaotong University Affiliated Sixth People's Hospital of Shanghai, 600 Yi Shan Road, Shanghai, 200233, China,
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Lee D, Romero C, Alba F, Westney OL, Wang R. Simultaneous penile prosthesis and male sling/artificial urinary sphincter. Asian J Androl 2012. [PMID: 23202702 DOI: 10.1038/aja.2012.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.
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Affiliation(s)
- Dominic Lee
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Hoda MR, Primus G, Fischereder K, Von Heyden B, Mohammed N, Schmid N, Moll V, Hamza A, Karsch JJ, Brössner C, Fornara P, Bauer W. Early results of a European multicentre experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men. BJU Int 2012. [PMID: 23186285 DOI: 10.1111/j.1464-410x.2012.11482.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Raschid Hoda
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Günter Primus
- Department of Urology; Medical University Graz; Austria
| | | | - Burkhard Von Heyden
- Department of Urology; Hospital SLK-Kliniken Heilbronn; Bad Friedrichshall; Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Norbert Schmid
- Department of Urology; Hospital Wels-Grieskirchen; Wels; Austria
| | | | - Amir Hamza
- Department of Urology; St. Georg Hospital; Leipzig
| | | | - Clemens Brössner
- Department of Urology; Hospital Göttlicher Heiland; Vienna; Austria
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Wilhelm Bauer
- Department of Urology; Hospital Göttlicher Heiland; Vienna; Austria
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Abstract
Different kinds of sling systems for the therapy of male urinary incontinence have been developed during the last decade. All systems work by compressing the male urethra. There are adjustable and non-adjustable systems. Implantation is mostly a minimally invasive procedure. On the other hand the well-established AMS 800 hydraulic artificial sphincter has been available since 1972. Recently, another hydraulic artificial sphincter (FlowSecure) has become available providing a boost of occlusive pressure during stress. The aim of this review is to compare effectiveness and indications of the different techniques compared to the artificial sphincter.
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Poon SA, Silberstein JL, Savage C, Maschino AC, Lowrance WT, Sandhu JS. Surgical practice patterns for male urinary incontinence: analysis of case logs from certifying American urologists. J Urol 2012; 188:205-10. [PMID: 22591970 DOI: 10.1016/j.juro.2012.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Several options exist for the surgical correction of male stress urinary incontinence including periurethral bulking agents, artificial urinary sphincters and the recently introduced male urethral slings. We investigated contemporary trends in the use of these treatments. MATERIALS AND METHODS Annualized case log data for incontinence surgeries from certifying and recertifying urologists were obtained from the ABU (American Board of Urology), ranging from 2004 to 2010. Chi-square tests and logistic regression models were used to evaluate the association between surgeon characteristics (type of certification, annual volume, practice type and practice location) and the use of incontinence procedures. RESULTS Among the 2,036 nonpediatric case logs examined the number of incontinence treatments reported for certification has steadily increased over time from 1,936 to 3,366 treatments per year from 2004 to 2010 (p = 0.008). Nearly a fifth of urologists reported placing at least 1 sling. The proportion of endoscopic procedures decreased from 80% of all incontinence procedures in 2004 to 60% in 2010, but they remained the exclusive incontinence procedure performed by 49% of urologists. A urologist's increased use of endoscopic treatments was associated with a decreased likelihood of performing a sling procedure (OR 0.5, p <0.0005). Artificial urinary sphincter use remained stable, accounting for 12% of procedures. CONCLUSIONS Incontinence procedures are on the rise. Urethral slings have been widely adopted and account for the largest increase among treatment modalities. Endoscopic treatments continue to be commonly performed and may represent overuse in the face of improved techniques. Further research is required to validate these trends.
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Affiliation(s)
- Stephen A Poon
- Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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The Inside-Out Transobturator Male Sling for the Surgical Treatment of Stress Urinary Incontinence After Radical Prostatectomy: Midterm Results of a Single-Center Prospective Study. Eur Urol 2012; 61:608-15. [DOI: 10.1016/j.eururo.2011.10.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 10/26/2011] [Indexed: 11/19/2022]
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Welk BK, Herschorn S. The male sling for post-prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes. BJU Int 2011; 109:328-44. [PMID: 22004176 DOI: 10.1111/j.1464-410x.2010.10502.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the outcomes and adverse events associated with novel male sling designs described in the last decade. METHODS A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database. RESULTS Three principal slings are described in the literature. The bone-anchored sling has success rates of 40-88%, with some series having a mean follow-up of 36-48 months. It is associated with a mesh infection rate of 2-12%, which usually requires sling explantation. The retrourethral transobturator sling has a success rate of 76-91% among three large case series with follow-ups of 12-27 months. There is a low reported explantation rate. The adjustable retropubic sling has a success rate of 72-79% with follow-ups of 26-45 months. Erosion (3-13%) and infection (3-11%) can lead to explantation. CONCLUSIONS Most male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid- and long-term data are now available that indicate the male sling is a viable option for PPI. The use of male slings in severe UI, radiated patients, and non-radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.
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Affiliation(s)
- Blayne K Welk
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Shoukry M, Hassouna ME, El-Kerim AA, El-Salmy S. Rectus fascia sling for the treatment of total urethral incontinence in males. AFRICAN JOURNAL OF UROLOGY 2011. [DOI: 10.1007/s12301-011-0009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Claudon P, Spie R, Bats M, Saint F, Petit J. [Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance™]. Prog Urol 2011; 21:625-30. [PMID: 21943659 DOI: 10.1016/j.purol.2011.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 12/08/2010] [Accepted: 01/11/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the functional and urodynamic results of a compressive sub-urethral sling with bone anchoring InVance™. METHODS One hundred and six successive patients were operated with this system between August 2004 and March 2009. Urinary incontinence was classified according to the number of daily protections. All the patients have benefited from a clinical, endoscopic and urodynamic pre and post-operative evaluation. The results were classified in four groups, at three months and at one year, according to whether the patients were dry (A), very improved (B), little improved (C), or with no improvement (D). RESULTS The average age of the patients during the installation of the strip was 67.4 years (46-82). At three months, the rate of dry (A) or very improved patients (B) was of 81.2% (A=75.5%; B=5.7%), and at one year: 75.5% (A=61%; B=14.5%). At three months, the rate of patients little improved (C) or not improved (D) was of 18.8% (C=16%; D=2.8%), and at one year: 24.5% (C=20.3%; D=4.2%). These results deteriorated according to the initial rank of incontinence II, III, and I. Six patients (5.7%) were explanted because of a prosthetic infection which perished at an average of 9 months (3-18). Infection was linked to operative time (p=0.02), and patients age. No osteitis nor urethral erosion were noted. There was a significant rise in the pressures of maximum fence at rest and maximum urethral pressures in reserve (p=0.01). At one year, score ICIQ-UI SF decreased overall by 7.1 points. CONCLUSION The medium-term results of under-urethral supporting with bone anchoring InVance™ are very encouraging. This technique presents an acceptable morbidity and a good tolerance. It can be proposed in first intention for a urinary incontinence whatever the rank is, even if the effectiveness is particularly present in incontinences of rank I and II.
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Affiliation(s)
- P Claudon
- Service d'urologie-transplantation, CHU Sud, Amiens, France.
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Kim IG, Oh SH, Lee JY, Lee JY, Lee JH. Bioactive porous beads as an injectable urethral bulking agent: in vivo animal study for the treatment of urinary incontinence. Tissue Eng Part A 2011; 17:1527-35. [PMID: 21275847 DOI: 10.1089/ten.tea.2010.0600] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In our previous study, growth factor (basic fibroblast growth factor [bFGF] or vascular endothelial growth factor)-immobilized polycaprolactone (PCL)/Pluronic F127 porous beads were fabricated by an isolated particle-melting/melt-molding particulate-leaching method. The growth factors were easily immobilized onto the pore surfaces of the PCL/F127 beads via heparin binding, and were continuously released for up to 28 days. In this study, the growth factor-immobilized porous beads were investigated for their potential use as an injectable urethral bulking agent for the treatment of stress urinary incontinence (SUI). From the in vivo study using Sprague-Dawley rats as an urinary incontinent animal model, it was observed that the growth factor (bFGF or vascular endothelial growth factor)-immobilized porous beads had effective cure behaviors for SUI as follows: the narrowed urethral lumen and the regeneration of smooth muscle around the urethra. In particular, the bFGF-immobilized PCL/F127 porous beads showed desirable smooth muscle regeneration and electrical contractility, which indicates it can be a good candidate as an injectable bioactive bulking agent for the treatment of SUI.
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Affiliation(s)
- In Gul Kim
- Department of Advanced Materials, Hannam University, Daejeon, South Korea
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Styn NR, McGuire EJ, Latini JM. Bone-anchored Sling for Male Stress Urinary Incontinence: Assessment of Complications. Urology 2011; 77:469-73. [DOI: 10.1016/j.urology.2010.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/01/2010] [Accepted: 06/09/2010] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Stress incontinence in men is still a common problem after surgical treatment of prostatic disease. This article reviews the techniques and results of recently described surgical slings available to treat male stress incontinence. RECENT FINDINGS Medium-term follow-up (mean 3-4 years) of patients treated with bone-anchored slings has been recently published, suggesting a success rate (cured or improved) of 70-80%. Short-term follow-up (mean of 6-12 months) of transobturator retrourethral slings demonstrates a success rate of 62-83%. Novel sling designs include mechanisms to manipulate the tension postoperatively and inside-out transobturator trocar passage. Common complications associated with slings are acute urinary retention and perineal pain. Rare complications include urethral erosion and infection. Retropubic approaches are associated with a risk of bladder perforation. SUMMARY Male slings are a valid option for treating male stress incontinence, and do offer several advantages over the artificial urinary sphincter. However, long-term data and multicenter series are needed in order to compare directly with the artificial urinary sphincter.
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Spie R, Claudon P, Raynal G, Saint F, Petit J. [Radiotherapy influence, about results of the InVance(®) male sling in men with stress urinary incontinence]. Prog Urol 2011; 21:549-53. [PMID: 21872158 DOI: 10.1016/j.purol.2010.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 11/07/2010] [Accepted: 11/21/2010] [Indexed: 11/17/2022]
Abstract
AIMS To study impact of previous radiotherapy on urodynamic parameters, continence and complication rate, after prosthetic implantation with InVance® device. PATIENTS AND METHODS We included 106 patients between August 2004 and March 2009. We stratified urinary incontinence according to pads daily used, in grade I (one to two pads), II (three to four), or III (more than four or condom catheter use). We compared one group of 24 patients with previous radiotherapy (R) to 82 control patients (T) without one. Follow-up was made at three and six postoperative months and then annually. Results were classified into: no leaks, improved or failure. RESULTS Mean follow-up was 14.8 months (median=12.8) in group R and 12.4 months (median=8.8) in group T. At three postoperative months, continence was achieved in 62.5% patients from group R and in 77% patients in group T (P: ns). At 12 months, results on continence were respectively 52.6% in group R and 63.2% in group T (P: ns). Six patients were explanted because of an infection (5.7%), among which two in group R (8.3%) and four in group T (4.8%). Infection was significantly linked to operative time (P: 0.02). CONCLUSION Previous radiotherapy has no impact on urodynamic parameters and continence, on short- and mid-term analysis, after implantation of a bone-anchored suburethral sling with InVance® device, preferentially patients with mild to moderate incontinenec urinary.
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Affiliation(s)
- R Spie
- Service d'Urologie et Transplantation, Hôpital Sud, CHU, Avenue R.-Laennec-Salouel, 80054 Amiens Cedex 1, France. romain
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Elliott CS, Comiter CV. Slings for Stress Urinary Incontinence in Men: An Update. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The diagnosis and management of male stress urinary incontinence (SUI) is complex. Various etiologies exist, with radical prostatectomy being the most common cause in men seeking treatment. SUI in this setting is often temporary and resolves within the first postoperative year. Therefore, it is important to understand the natural history of male SUI before initiating treatment. Generally, the initial management of SUI that persists after 12 months consists of conservative measures, such as pelvic floor muscle exercises. Several treatments are available for men whose continence does not improve after pelvic floor muscle exercises. In order of increasing complexity they are urethral bulking agents, male slings, and the artificial urinary sphincter (AUS). With over 30 years of published data suggesting excellent long-term outcomes, the AUS is considered the gold standard treatment of male SUI. Male slings have recently demonstrated efficacy for selected patients and are likely to be used more often in the future as experience with these devices grows.
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Oh SH, Kim IG, Lee JY, Lee JY, Lee JH. Bioactive porous beads as an injectable urethral bulking agent: their in vitro evaluation on smooth muscle cell differentiation. Tissue Eng Part A 2010; 17:655-64. [PMID: 20919951 DOI: 10.1089/ten.tea.2010.0430] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Growth factor (basic fibroblast growth factor or vascular endothelial growth factor)-immobilized polycaprolactone (PCL)/Pluronic F127 porous beads were prepared as an injectable bulking agent for effective treatment of urinary incontinence. The growth factor-immobilized porous beads may stimulate smooth muscle cell (SMC) differentiation of muscle-derived stem cells or defect tissues around urethra to improve the sphincter function (bioactive therapy) as well as to provide a bulking effect (passive therapy). The porous PCL/F127 beads were fabricated by an isolated particle-melting/melt-molding particulate-leaching method. The growth factors were easily immobilized onto the surfaces of the PCL/F127 porous beads via heparin binding and were continuously released for up to 28 days. Both growth factor-immobilized porous beads had a positive effect for the SMC differentiation of muscle-derived stem cells, as were demonstrated by the analyses of quantitative polymerase chain reactions, Western blot using SMC-specific markers, and immunohistochemical staining. In particular, the basic fibroblast growth factor-immobilized porous beads showed desirable SMC differentiation behavior that can be applied as an injectable bulking agent for the treatment of urinary incontinence.
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Affiliation(s)
- Se Heang Oh
- Department of Advanced Materials, Hannam University, Yuseong Gu, Daejeon, South Korea
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Hübner WA, Gallistl H, Rutkowski M, Huber ER. Adjustable bulbourethral male sling: experience after 101 cases of moderate-to-severe male stress urinary incontinence. BJU Int 2010; 107:777-782. [PMID: 20964801 DOI: 10.1111/j.1464-410x.2010.09619.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Helmut Gallistl
- Department of Urology and Andrology, Clinic Korneuburg, Austria
| | | | - Erik R Huber
- Department of Urology and Andrology, Clinic Korneuburg, Austria
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Wadie BS. Retropubic bulbourethral sling for post-prostatectomy male incontinence: 2-year followup. J Urol 2010; 184:2446-51. [PMID: 20952002 DOI: 10.1016/j.juro.2010.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Post-prostatectomy incontinence is usually due to sphincter damage as a complication of prostatectomy but may result from other causes. The intermediate term outcome of the retropubic bulbourethral sling is presented. MATERIALS AND METHODS Included in study were 40 men with post-prostatectomy incontinence who used 5 or greater pads daily for protection. All patients had undergone prostatectomy, including transurethral resection in 17, holmium laser enucleation in 3, and open retropubic and radical prostatectomy in 12 and 8, respectively. Preoperatively voiding cystourethrogram and urodynamics were done in all men as applicable. A bulbourethral sling was prepared from polypropylene mesh. Suspension was achieved using size zero nylon sutures to fix the mesh in front of the rectus sheath. Patients were followed at 1 week, 3 and 6 months, and semiannually thereafter. RESULTS Median incontinence duration was 3 years (range 0.5 to 14). Concomitant surgery was done in 11 men (27.5%), 34 (85%) were dry at 24-month followup and 10 (25%) underwent retightening at 3 to 6 months. Urodynamics showed no significant change in filling or voiding parameters. The increase in maximum urethral closure pressure and functional urethral length was not statistically significant. CONCLUSIONS The described retropubic bulbourethral sling is a viable option for severe male incontinence with a satisfactory cure rate at intermediate followup. It is adjustable and cost-effective.
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Affiliation(s)
- Bassem S Wadie
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Börgermann C, Kaufmann A, Sperling H, Stöhrer M, Rübben H. The treatment of stress incontinence in men: part 2 of a series of articles on incontinence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:484-91. [PMID: 20661415 DOI: 10.3238/arztebl.2010.0484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 02/23/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stress incontinence in men is a rare, usually iatrogenic condition. Its prevalence can be expected to rise in the future because of the increasingly common performance of radical prostatectomy. Most men who have undergone prostatectomy experience a transient disturbance of urinary continence. Such disturbances are only rarely due to structural damage to the sphincter apparatus and therefore have a good prognosis for spontaneous recovery. METHOD Selective literature review. RESULTS Pelvic floor training and/or pharmacotherapy can be used for more rapid restoration of subjectively satisfactory urinary continence. If the sphincter is intact, continence can also be regained in the early postoperative period through the submucosal injection of bulking agents. Incontinent patients whose urinary sphincter is dysfunctional because of denervation or direct injury to striated muscle can now be treated with a variety of surgical techniques. The implantation of an artificial sphincter is the gold standard of therapy. Properly selected and informed patients can also be treated with minimally invasive procedures, such as the creation of a male suburethral sling, although the experience with such procedures to date has not been extensive. CONCLUSION Post-prostatectomy incontinence has a good prognosis and should thus be treated conservatively at first. If it nonetheless persists, surgical treatment is indicated for patients who choose it after being fully informed about their options.
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Affiliation(s)
- Christof Börgermann
- Klinik für Urologie, Kinderurologie und Uroonkologie, Krankenhaus Düren gGmbH, Roonstr. 30 52351 Düren, Germany.
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Abstract
OBJECTIVES The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. MATERIALS AND METHODS MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. RESULTS With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. CONCLUSIONS Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.
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Affiliation(s)
- Fabrizio Gallo
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - M. Schenone
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - C. Giberti
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
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Betz D, Bach P, Gozzi C, Goepel M. [Non-adjustable sling for treatment of male stress urinary incontinence]. Urologe A 2010; 49:504-10. [PMID: 20232035 DOI: 10.1007/s00120-010-2249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Even though the artificial sphincter is still the treatment of choice in the surgical therapy of male stress urinary incontinence, recent developments have introduced numerous minimally invasive treatment options with acceptable clinical results. The male slings have been included into the EAU guidelines for treatment of male stress urinary incontinence. A distinct choice of patients and treatment options will lead to the highest chance of success. Besides the adjustable compressive slings, the non-adjustable and non-compressive AdVance Sling offers a possible option for a functional approach to treatmentratio. A critical assessment of all these methods remains essential and prospective randomized trials are still missing.
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Affiliation(s)
- D Betz
- Urologisches Zentrum Ratingen, Mülheimer Strasse 37, 40878, Ratingen, Deutschland.
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Herschorn S, Bruschini H, Comiter C, Grise P, Hanus T, Kirschner-Hermanns R, Abrams P. Surgical treatment of stress incontinence in men. Neurourol Urodyn 2010; 29:179-90. [DOI: 10.1002/nau.20844] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dean GE, Kunkle DA. Outpatient Perineal Sling in Adolescent Boys With Neurogenic Incontinence. J Urol 2009; 182:1792-6. [DOI: 10.1016/j.juro.2009.04.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Gregory E. Dean
- Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David A. Kunkle
- Department of Pediatric Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
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Gorbatiy V, Westney OL, Romero C, Wang R. Outcomes of simultaneous placement of an inflatable penile prosthesis and a male urethral sling through a single perineal incision. J Sex Med 2009; 7:832-8. [PMID: 19796057 DOI: 10.1111/j.1743-6109.2009.01506.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Synchronous implantation of an inflatable penile prosthesis (IPP) and a bulbourethral sling single via a single perineal is a unique approach in managing erectile dysfunction and stress urinary incontinence. AIM This article describes our surgical approach and reviews the operative time, length of hospital stay (LOS), estimated blood loss (EBL), and cost of synchronous dual prosthetic implantation compared with the implants performed individually. Additionally, we review the short-term outcomes in patients with dual sling and penile prosthesis synchronous implants. METHODS Fifty-eight patients with IPP, 53 slings, and eight simultaneous dual implantations between January 2000 and July 2008 were retrospectively reviewed. Operative times, EBL, length of stay, cost, and complications were compared in three groups (group 1, IPP; group 2, slings; group 3, dual implants). Additionally, we reviewed pre- and postoperative Sexual Health Inventory for Men (SHIM) scores and pad use in group 3. MAIN OUTCOME MEASURES Review of operative times, EBL, LOS, cost, and complications. RESULTS Dual implantation had similar operative times compared with the total time for the individual procedures (98 +/- 24 minutes for IPP; 86 +/- 24 minutes for sling; 177 +/- 17 minutes for dual implant, P > 0.05). EBL was reduced (57 +/- 30 mL for IPP; 48 +/- 59 mL for sling; 49 +/- 5 mL for group 3). LOS was also reduced (1.2 +/- 0.45 days for IPP, 0.7 +/- 0.48 days for sling; and 1.1 +/- 0.50 days for dual implant). Dual implantation was associated with approximately $9,000 in savings. With a mean follow-up of 13.6 months, group 3 reported SHIM increase from 1.3 +/- 0.5 to 23.5 +/- 0.6 and a decrease in pad use from three pads per day (range 2-6) down to a mean of one pad per day (range 0-2). One sling erosion and one sling infection occurred in group 2. One patient in group 3 had acute urinary retention resolved with 5 days of catheter drainage. CONCLUSION Dual penile prosthesis and bulbourethral sling implantation through a single perineal incision is safe, efficient, and cost-effective.
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Affiliation(s)
- Vladislav Gorbatiy
- Division of Urology, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Romano SV, Metrebian SE, Vaz F, Muller V, D'Ancona CAL, de Souza EAC, Nakamura F. [Long-term results of a phase III multicentre trial of the adjustable male sling for treating urinary incontinence after prostatectomy: minimum 3 years]. Actas Urol Esp 2009; 33:309-14. [PMID: 19537070 DOI: 10.1016/s0210-4806(09)74146-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To communicate long-term results of the multicentre phase III trial post-prostatectomy urinary incontinence (PPI) treated with an adjustable male sling. PATIENTS AND METHODS 48 PPI patients were included in this trial from April 2003 to September 2004. 39 post radical prostatectomy and 9 post adenomectomy. 19 wore 5 pads per day (3-8) each weight 83 gr (17-198). 29 wore condom catheter or penile clamp The Argus was implanted through perineal approach. Using needles, the sling was transferred to the abdominal wall where it was adjusted by washers. The adjustment was done with retrograde urethral pressure from 45 to 55 cm water. Clinical data were updated till September 2007. The mean follow-up was 45 months (36-54) and median age was 67 years (52-77). The evaluation was: the ICIQ-SF score and qualification as Dry: no pads, Improved: 1 pad and Failed: 2 or more pads in 24 hr, including those with slings removed. RESULTS 47 were evaluated, resulting: 31 (66%) Dry, 6 (12.8%) Improved and 10 (21%) Failed. The ICIQ-SF score changed from 19.5 to 6. Of the 31 dry pts, 5 required one adjustment. 10 pts failed, 9 after sling removal, 6 due to erosion and 3 for infection. One patient failed with the sling in place, 6 erosions were registered: 4 in the urethra, 1 into the bladder and 1 through the abdominal wall. Perineal pain persisted in 2. One patient was excluded, died in September 2006. CONCLUSIONS Argus has demonstrated its efficacy in long- term follow-up. The social continence rate was about 80%. The important complication was erosion or infection.
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Cetinel B, Demirkesen O, Kural AR, Onal B, Alan C. Polypropylene mesh tape for male sphincteric incontinence. ACTA ACUST UNITED AC 2009; 38:396-400. [PMID: 15764251 DOI: 10.1080/00365590410031779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Management of male sphincteric incontinence is still challenging. We present our experience with a new male sling technique using polypropylene mesh tape (PMT). MATERIAL AND METHODS A total of 12 patients (age range 17-75 years; median age 61 years) underwent the procedure. Sphincteric incontinence was due to radical prostatectomy in three patients, transurethral prostatectomy in four, open prostatectomy in two and neurologic etiologies in three. All patients had urodynamic stress incontinence with a mean Valsalva leak point pressure of 48.8 cmH2O (range 40-68 cmH2O). Through a midline incision the PMT sling was passed through the perineal membrane on each side and the limbs of the tape were withdrawn to a suprapubic incision with the help of trocars. The tension of the tape was adjusted during a retrograde sphincterometry until a retrograde leak point pressure of 30-50 cmH2O was achieved. RESULTS The average operative time was 65 min (45-110 min). Follow-up was 12.1-46.4 months (median 31.6 months). Urinary incontinence was cured or improved in nine patients (75%) and there was no improvement in three (25%). Intermittent catheterization was initiated in three patients with impaired detrusor contractions due to neurologic etiology. One patient had intraoperative bladder perforation and one had perineal numbness lasting for 2 months. None of the patients had urethral erosion, wound infection or any other major complications. CONCLUSIONS This procedure seems to be an effective and safe treatment for patients with sphincteric incontinence. Regarding the etiology of urinary incontinence, this technique seems to be more effective in transurethral prostatectomy-related sphincteric incontinence than in sphincteric incontinence of other etiologies. Further experience with more patients and a longer follow-up period is mandatory to determine the long-term effectiveness of the technique.
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Affiliation(s)
- Bulent Cetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
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Abstract
OBJECTIVE The treatment of post-prostatectomy incontinence (PPI) can be challenging. Although many injectable materials have been used to treat this problem, the results are at best unsatisfactory. Fixation of an artificial urinary sphincter has been the gold standard of care for patients with PPI for many years. In the last decade there has been a revival of male sling techniques, involving either a fixed or dynamic compressive effect. Herein, a technique for the correction of PPI is described which involves minimal incursion of exogenous material and has excellent cost-effectiveness. MATERIAL AND METHODS A total of 23 patients underwent a bulbourethral sling procedure using mesh suspended from the anterior abdominal wall for the management of PPI. The technique is performed under spinal anesthesia and utilizes knitted polypropylene mesh, which is fastened by three pairs of sutures. A modified Stamey needle is used for transferring nylon sutures to the suprapubic wound. The sutures are tied in front of the rectus sheath, utilizing intraoperative urodynamic guidance. A 12 F suprapubic tube is utilized as a pressure channel for monitoring vesical pressure and sling tension. RESULTS Twenty patients were completely dry at the last follow-up, one was greatly improved and in two the treatment was considered a failure. The median follow-up period was 9 months (range 6-24 months). No urethral erosion has been reported thus far. Morbidity in the form of perineal pain and limited ambulation in the first few days after surgery were reported. Five patients had scrotal and penile numbness which continued for an average of 3 months. CONCLUSIONS The mesh sling technique described herein is efficient and cost-effective. It yielded promising results in this study, which involved a short-term follow-up period and a limited number of patients. More cases are being enrolled and a study involving a longer follow-up period is underway.
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Affiliation(s)
- Bassem S Wadie
- Department of Urology, Urology and Nephrology Center, Mansoura, Egypt.
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Traitement de l’incontinence urinaire post-opératoire de l’homme par bandelette sous urétrale: A propos de 16 cas. AFRICAN JOURNAL OF UROLOGY 2009. [DOI: 10.1007/s12301-009-0014-7] [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] Open
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Comparison of Outcomes for Adjustable Bulbourethral Male Sling and Artificial Urinary Sphincter After Previous Artificial Urinary Sphincter Erosion. Urology 2009; 73:1363-7. [DOI: 10.1016/j.urology.2008.10.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 09/15/2008] [Accepted: 10/27/2008] [Indexed: 11/19/2022]
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Mahdy A, Elmissiry M, Ghoniem G. Recurrent Stress Urinary Incontinence After Dislodged Screws in Patient With Bone-Anchored Suburethral Sling. Urology 2008; 72:1185.e11-3. [DOI: 10.1016/j.urology.2008.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 12/26/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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de Leval J, Waltregny D. The Inside-Out Trans-Obturator Sling: A Novel Surgical Technique for the Treatment of Male Urinary Incontinence. Eur Urol 2008; 54:1051-65. [DOI: 10.1016/j.eururo.2007.11.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/07/2007] [Indexed: 11/16/2022]
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Bauer RM, Bastian PJ, Gozzi C, Stief CG. Postprostatectomy incontinence: all about diagnosis and management. Eur Urol 2008; 55:322-33. [PMID: 18963418 DOI: 10.1016/j.eururo.2008.10.029] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
Abstract
CONTEXT The ever-increasing number of radical prostatectomies entails an increasing number of patients suffering from postprostatectomy stress incontinence despite improved surgical techniques. We provide an overview of the current diagnosis and treatment of postprostatectomy stress incontinence. OBJECTIVE To review previous and recent literature on this subject and to assess the current standards of diagnosis and management of postprostatectomy incontinence. EVIDENCE ACQUISITION The PubMed database was searched, and all articles published since 2000 were evaluated. EVIDENCE SYNTHESIS This review presents the current recommended diagnostic tools and available noninvasive and invasive treatment options. CONCLUSIONS The European Association of Urology (EAU) recommends a two-stage assessment for diagnosis of postprostatectomy incontinence. Noninvasive therapy, pelvic floor-muscle training and biofeedback, is recommended in early postoperative and mild incontinence. Pharmacological treatment with duloxetine is especially effective in combination with physiotherapy, where it synergistically improves the continence rate. For surgical treatment, the insertion of an artificial urinary sphincter, AS-800, is still the gold standard. In recent years, several minimal invasive treatment options have been introduced with different rates of success, but they have not yet surpassed the results of the artificial sphincter.
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Affiliation(s)
- Ricarda M Bauer
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany.
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