1
|
Valerio PM, Zordão CC, Gonçalves VE, Hasegawa MSR, Jorge CH, Moisés ECD, de Oliveira Guirro EC. Urinary Incontinence in the Third Trimester of Pregnancy of Type 1 Diabetic Women. Reprod Sci 2024; 31:1558-1564. [PMID: 38438778 DOI: 10.1007/s43032-024-01488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Type 1 diabetes increases the prevalence of urinary incontinence and may be responsible for additional changes to those existing in a regular gestational period. This study aimed to describe the presence and symptoms of urinary incontinence in pregnant women with type 1 diabetes. METHODS In this Cross-sectional case control study, forty pregnant women in third gestational trimester were allocated in two equal groups - control group (CG) and type 1 diabetic group (1DMG). The patients answered the International Consultation on Incontinence Questionnaire Short Form and, to characterize the sample, they answered the Pregnancy Physical Activity Questionnaire, gynecological history and, after delivery, the newborn weight was registered. The groups were compared using the Student's T Test for parametric variables and the U-Mann Whitney Test for non-parametric variables, both at 5% probability. RESULTS The International Consultation on Incontinence Questionnaire Short Form score (p = 0.026) is higher in 1DMG (3.95 ± 4.70) compared to CG (1.05 ± 2.23). No correlations were found between time of diagnosis, HbA1c and newborn weight in relation to ICIQ-SF and other variables in CG and 1DMG with ICIQ-SF (p < 0.05). CONCLUSION Type 1 diabetes mellitus, in the third trimester of gestation, seem to be associated with increase in the ICIQ-SF score.
Collapse
Affiliation(s)
- Paola Marini Valerio
- Postgraduate Program in Rehabilitation and Functional Performance, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| | - Catarina Clapis Zordão
- Postgraduate Program in Rehabilitation and Functional Performance, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil.
| | - Vanessa Ellen Gonçalves
- Physical Therapy Course, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| | - Monique Silva Rezende Hasegawa
- Postgraduate Program in Rehabilitation and Functional Performance, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| | - Cristine Homsi Jorge
- Postgraduate Program in Rehabilitation and Functional Performance, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| | - Elaine Christine Dantas Moisés
- Postgraduate Program in Gynecology and Obstetrics, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| | - Elaine Caldeira de Oliveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, 3900, CEP: 14049-900, Brazil
| |
Collapse
|
2
|
Chen S, Wang S, Liu S, Wang S, Xuan L, Gao Y. Efficacy of electrical pudendal nerve stimulation versus pelvic floor muscle training in treating postradical prostatectomy urinary incontinence: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e062323. [PMID: 36604129 PMCID: PMC9827247 DOI: 10.1136/bmjopen-2022-062323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Urinary incontinence (UI) is one of the main complications of radical prostatectomy. Electrical pudendal nerve stimulation (EPNS) has been used to treat stress UI based on its mechanism of passive pelvic floor muscle contraction reported in the previous research. However, there are no studies comparing the effects of EPNS and active pelvic floor muscle training (PFMT) in the treatment of postradical prostatectomy UI (PPUI). Here, we describe the protocol for a randomised controlled trial to evaluate the efficacy of EPNS in treating PPUI compared with PFMT. METHODS AND ANALYSIS This study is designed as an open-label randomised controlled trial with blinded assessment and analysis. A total of 90 eligible men will be randomly allocated to two groups. The treatment group (n=45) will receive EPNS while the control group will perform PFMT by doing the Kegel exercise. Forty EPNS treatment sessions will occur over a period of 8 weeks. The primary outcome measure will be improvement rate, and the secondary outcome measures, the number of pads used, 24-hour pad test, and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form will be compared between baseline and the study endpoint. The International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life and care compared as the quality of life and satisfaction outcomes between groups. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (approval no. 2021 KL-040-02). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2200055461.
Collapse
Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai Yueyang Hospital, Shanghai, China
| | - Shan Liu
- Clinical Evaluation and Analysis Center, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| |
Collapse
|
3
|
Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1557256. [PMID: 35295170 PMCID: PMC8920663 DOI: 10.1155/2022/1557256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
Pelvic organ prolapse is caused by various causes, which leads to the weakness of the tissue supporting the pelvic floor and then causes the downward displacement of female reproductive organs and adjacent organs. Clinical studies have shown that pop is often associated with stress urinary incontinence. This research project aimed to clarify the clinical effect of laparoscopic sacrocolpopexy (LSC) and tension-free vaginal tape obturator (TVT-O) for stress urinary incontinence (SUI) complicated with pelvic organ prolapse (POP) and the influencing factors of postoperative urinary function (UF) recovery. The clinical data of 125 patients with SUI complicated with POP treated in Wenzhou Central Hospital and Beidahuang Industry Group General Hospital between March 2018 and December 2019 were retrospectively analyzed. Patients were assigned to the following two arms based on different treatment methods: the combination group (n = 65, treated with LSC plus TVT-O) and the control group (n = 60, treated with LSC). The alterations of perioperative clinical and urodynamic indexes were analyzed. The objective and subjective response rates were observed and compared. The degree of POP before and after surgery was evaluated. According to the urinary function recovery time, the patients were divided into the fast and non-fast recovery groups, and then, the factors influencing postoperative UF recovery were analyzed between groups. The combination group showed statistically longer operation time (OT) and postoperative indwelling catheter and higher intraoperative blood loss (IBL) than the control group (all P < 0.05), but the anal exhaust time and postoperative length of stay (LOS) differed insignificantly between the two arms. The combination group outperformed the control group in the objective response rate, as well as the scores of illness, quality of life (QOL), and sexual life (all P < 0.05). Menopause, maximum flow rate (MFR), and preoperative residual urine volume were identified as the influencing factors for normal urination. For patients with SUI complicated with POP, the efficacy of laparoscopic sacrocolpopexy was limited, while combining with TVT-O would obtain more significant short-term and long-term efficacy, which can significantly improve patients' urination and long-term quality of life, with higher safety and clinical promotion value.
Collapse
|
4
|
Roumeguère T, Elzevier H, Wagner L, Yiou R, Madurga-Patuel B, Everaert K, Chartier-Kastler E, Hegarty PK. The Virtue quadratic male sling for postradical prostatectomy urinary incontinence: 3-Year outcome measurements and a predictive model of surgical outcome from a European prospective observational study. Neurourol Urodyn 2021; 41:456-467. [PMID: 34888939 DOI: 10.1002/nau.24851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022]
Abstract
AIMS This prospective multicenter observational study evaluated postprostatectomy incontinence treatment outcomes with Virtue male sling at 12 and 36 months. METHODS Objective assessment was based on a 24-h pad weight test with improvement defined by a decrease >50% and cure by less than 1.3 g. Subjective assessment was based on the patient global impression of improvement and International Consultation on Incontinence Questionnaire-urinary incontinence-short form (ICIQ-UI-SF) questionnaires. Subgroups were analyzed by baseline severity of incontinence on a 24-h-pad test, body mass index (BMI), and pads usage. Factors associated with treatment response were assessed using logistic regression at Months 36. Complications were reported. RESULTS We analyzed data from 117 men. Objective and subjective improvement were achieved in 54% and 35% and 51% and 34% at 12 and 36 months, respectively. Twenty-one percent and 19% were considered cured, respectively, at 12 and 36 months. No differences per baseline incontinence severity, BMI and pads usage were found at 36 months. Mean ICIQ-UI-SF score decreased from 15 to 9. Predictive factors were BMI, postvoid residual urine, number of nighttime urination, and ICIQ total score. Seven Clavien-Dindo Grade III (5.1%) including four Virtue sling revisions were reported. The most frequent Grade II complications were overactive bladder symptoms and pain reported in 10.3% and 2.9%, respectively. No complications required explantation. CONCLUSIONS Virtue male sling is safe and effective in males with mild to severe postprostatectomy urinary incontinence over 36 months. Virtue could be considered an interesting option for postradical prostatectomy urinary incontinence with positive results over time even in patients with high BMI. The predictive model should be validated by further studies.
Collapse
Affiliation(s)
- Thierry Roumeguère
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Henk Elzevier
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurent Wagner
- Department of Urology-Andrology, Caremeau University Hospital, Nîmes, France
| | - René Yiou
- Department of Urology, Henri Mondor University Hospital, Créteil, France
| | | | - Karel Everaert
- Department of Urology, University Hospital, Gent, Belgium
| | - Emmanuel Chartier-Kastler
- Department of Urology and Transplantation, Academic Hospital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Paul K Hegarty
- Department of Urology, Mater Private Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Martínez-Cuenca E, Sánchez JV, Bonillo MÁ, Morán E, Broseta E, Arlandis S. Longer is better than shorter: The added value of the seven-day pad test in the post-radical prostatectomy urinary incontinence. Neurourol Urodyn 2021; 40:994-1000. [PMID: 33739536 DOI: 10.1002/nau.24655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the feasibility and reliability of the seven-day pad test (7DPT), the correlation between 7DPT and 24-hour pad test (24HPT), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire, and the different categorization by the severity of each pad test. Pad weighting tests have been recommended in the evaluation of post-radical prostatectomy urinary incontinence severity, being considered the 24HPT gold standard. Some authors consider that the longer the testing, the better assessment. We propose a self-filled pad weight, the 7DPT. METHODS A prospective study of incontinent male patients after radical prostatectomy. We carried out the study in two phases. All patients underwent urodynamic study. The first phase evaluated the feasibility and reliability of 7DPT. The second evaluated the correlation between 7DPT, 24HPT, and ICIQ-SF questionnaire in a larger sample. RESULTS First phase: 32 patients were recruited. Test-retest reliability was excellent, with good agreement between mean 7DPT and 24HPT. The number of pads and mean 7DPT showed a good correlation. Second phase: 72 patients were screened, 51 (71%) met inclusion criteria. Mean 7DPT and 24HPT showed a strong association. Mean 7DPT and 24HPT correlated moderately with ICIQ-SF score. 7DPT and 24HPT agreement with ICIQ-SF groups was slight. As 7DPT captures better days with maximum urinary leakage, up to 12 patients would have been misclassified according to 24HPT (number need to treat for 7DPT was seven). CONCLUSIONS 7DPT is a feasible and reliable tool to evaluate post-radical prostatectomy urinary incontinence, with a strong correlation with the 24HPT and moderate with the ICIQ-SF.
Collapse
Affiliation(s)
| | | | | | - Eduardo Morán
- Urology Department, Hospital Universitari I Politècnic La Fe, València, Spain
| | - Enric Broseta
- Urology Department, Hospital Universitari I Politècnic La Fe, València, Spain
| | - Salvador Arlandis
- Urology Department, Hospital Universitari I Politècnic La Fe, València, Spain
| |
Collapse
|
6
|
Mumm JN, Klehr B, Rodler S, Kretschmer A, Vilsmaier T, Westhofen T, Chaloupka M, Schulz GB, Gozzi C, Rehder P, May F, Homberg R, Stief CG, Grabbert M, Bauer RM. Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors. Urol Int 2021; 105:421-427. [PMID: 33517334 DOI: 10.1159/000512881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. METHODS In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. RESULTS The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. CONCLUSIONS The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.
Collapse
Affiliation(s)
- Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany,
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Theresa Vilsmaier
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Florian May
- Department of Urology, Klinikum Dachau, Dachau, Germany
| | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
| |
Collapse
|
7
|
Angulo JC, Virseda‐Chamorro M, Arance I, Ruiz S, Ojea A, Carballo M, Rodríguez A, Pereira J, Teyrouz A, Rebassa M, Escribano G, Teba F, Celada G, Madurga B, Martins FE, Mendes PA, Cruz F. Long‐term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study. Neurourol Urodyn 2020; 39:1737-1745. [DOI: 10.1002/nau.24410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Javier C. Angulo
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Miguel Virseda‐Chamorro
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Ignacio Arance
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Sonia Ruiz
- Department of Urology, Hospital Universitario de GetafeUniversidad Europea de MadridMadrid Spain
| | - Antonio Ojea
- Department of UrologyHospital Alvaro CunqueiroVigo Spain
| | | | | | - Javier Pereira
- Department of UrologyHospital Arquitecto MarcideFerrol Spain
| | - Antoine Teyrouz
- Department of UrologyHospital Son LlatzerPalma de Mallorca Spain
| | - Miguel Rebassa
- Department of UrologyHospital Son LlatzerPalma de Mallorca Spain
| | - Gregorio Escribano
- Department of UrologyHospital Universitario Gregorio MarañónMadrid Spain
| | - Fernando Teba
- Department of UrologyHospital Universitario de la PrincesaMadrid Spain
| | - Guillermo Celada
- Department of UrologyHospital Universitario de la PrincesaMadrid Spain
| | - Blanca Madurga
- Department of UrologyHospital Universitario Puerta del MarCádiz Spain
| | | | - Pedro A. Mendes
- Department of UrologyCentro Hospitalar São JoãoOporto Portugal
| | - Francisco Cruz
- Department of UrologyCentro Hospitalar São JoãoOporto Portugal
| |
Collapse
|
8
|
Hüsch T, Kretschmer A, Obaje A, Kirschner-Hermanns R, Anding R, Pottek T, Rose A, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Abdunnur R, Queissert F, Naumann CM, Schweiger J, Wotzka C, Nyarangi-Dix J, Hofmann T, Ulm K, Hübner W, Bauer RM, Haferkamp A. Fixed or adjustable sling in the treatment of male stress urinary incontinence: results from a large cohort study. Transl Androl Urol 2020; 9:1099-1107. [PMID: 32676393 PMCID: PMC7354336 DOI: 10.21037/tau-19-852] [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] [Indexed: 11/30/2022] Open
Abstract
Background Fixed and adjustable male slings for the treatment of male urinary stress incontinence became increasingly popular during the last decade. Although fixed slings are recommended for the treatment of mild to moderate stress urinary incontinence, there is still a lack of evidence regarding the precise indication for an adjustable male sling. Furthermore, there is still no evidence that one type of male sling is superior to another. However, both, adjustable and fixed slings, are commonly utilized in daily clinical practice. This current investigation aims to evaluate the differences between fixed and adjustable male slings regarding indications, complication rates and functional outcome in the treatment of male stress urinary incontinence in current clinical practice. Methods A total of 294 patients with a fixed and 176 patients with an adjustable male sling were evaluated in a multicenter single arm cohort trial. Data collection was performed retrospectively according the medical record. Functional outcome was prospectively analyzed by standardized, validated questionnaires. Descriptive statistics was performed to present patient characteristics, complication rates and functional outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups and to correlate preoperative characteristics with the outcome. A P value <0.05 was considered statistically significant. Results Patients with higher degree of urinary incontinence (P<0.001) and risk factors such as history of pelvic irradiation (P<0.001) or prior surgery for urethral stricture (P=0.032) were more likely to receive an adjustable MS. Complication rates were comparable except for infection (P=0.009, 0 vs. 2.3%) and pain (P=0.001, 1.7% vs. 11.3%) which occurred more frequently in adjustable slings. Functional outcome according validated questionnaires demonstrated no differences between fixed and adjustable male slings. Conclusions Adjustable male slings are more frequently utilized in patients with higher degree of incontinence and risk factors compared to fixed slings. No differences could be identified between functional outcome which may imply an advantage for adjustability. However, pain and infection rates were significantly higher in adjustable MS and should be considered in the decision process for sling type.
Collapse
Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,Promedon GmbH, Clinical Research, Kolbermoor, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.,Vancouver Prostate Center, University of British Columbia, Vancouver, Canada
| | - Alice Obaje
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
| | | | - Ralf Anding
- Neuro-Urology/Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Tobias Pottek
- Reconstructive Urology, Vivantes Hospital, Berlin, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | | | - Alexander Friedl
- Department of Urology, Merciful Sisters Hospital, Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Rudi Abdunnur
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
| | - Fabian Queissert
- Department of Urology, University Hospital Muenster, Muenster, Deutschland
| | - Carsten M Naumann
- Department of Urology and Pediatric Urology, Marienhaus Hospital Neuwied, Neuwied, Germany
| | - Josef Schweiger
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
| | - Carola Wotzka
- Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Kurt Ulm
- Institute of medical Statistic and Epidemiology, Technical University Munich, Munich, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | |
Collapse
|
9
|
Angulo JC, Arance I, Ojea A, Carballo M, Rodríguez A, Pereira J, Rebassa M, Teyrouz A, Escribano G, Teba F, Madurga B, Martins FE, Cruz F. Patient satisfaction with adjustable transobturator male system in the Iberian multicenter study. World J Urol 2019; 37:2189-2197. [DOI: 10.1007/s00345-019-02639-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
|
10
|
Guo GY, Kang YG. Effectiveness of neuromuscular electrical stimulation therapy in patients with urinary incontinence after stroke: A randomized sham controlled trial. Medicine (Baltimore) 2018; 97:e13702. [PMID: 30593142 PMCID: PMC6314727 DOI: 10.1097/md.0000000000013702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of neuromuscular electrical stimulation (NMES) therapy in patients with urinary incontinence after stroke (UIAS). METHODS A total of 82 patients with UIAS were randomly assigned to 2 groups that received NMES therapy (NMES group) or sham NMES (sham group) for 10 weeks. The primary efficacy endpoints were measured by urodynamic values, and Overactive Bladder Symptom Score (OABSS). The secondary efficacy endpoints were assessed by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, Barthel Index (BI) scale, and adverse events. All outcomes were evaluated at baseline and at the end of 10 weeks treatment. RESULTS After 10-week treatment, the patients received NMES therapy showed better efficacy in primary endpoints of urodynamic values (P <.01) and OABSS (P <.01), and secondary endpoints of ICIQ-SF (P <.01) and BI (P <.01), compared with patients who underwent sham NMES. No adverse events were recorded in both groups. CONCLUSIONS In summary, we demonstrated that 10 weeks of NMES therapy was efficacious in patients with UIAS.
Collapse
Affiliation(s)
- Gai-yan Guo
- Department of Neurology, Yanan University Affiliated Hospital, Yanan
| | - Yong-gang Kang
- Department of Neurology, The First People's Hospital of Xianyang City, Xianyang, China
| |
Collapse
|
11
|
Esquinas C, Arance I, Pamplona J, Moraga A, Dorado JF, Angulo JC. Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Actas Urol Esp 2018; 42:473-482. [PMID: 29642999 DOI: 10.1016/j.acuro.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.
Collapse
Affiliation(s)
- C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - J Pamplona
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - A Moraga
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | | | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España.
| |
Collapse
|
12
|
The AdVance and AdVanceXP male sling in urinary incontinence: is there a difference? World J Urol 2018; 36:1657-1662. [PMID: 29728764 DOI: 10.1007/s00345-018-2316-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/27/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To compare the efficacy and perioperative complications of the AdVanceXP with the original AdVance male sling. METHODS We retrospectively enrolled 109 patients with an AdVance and 185 patients with an AdVanceXP male sling. The baseline characteristics and complication rates were analyzed retrospectively. Functional outcome and quality of life were evaluated prospectively by standardized, validated questionnaires. The Chi2-test for categorical and Mann-Whitney U test for continuous variables were performed to identify heterogeneity between the groups. RESULTS Regarding operation time, there was no significant difference between the slings (p = 0.146). The complication rates were comparable in both groups except for postoperative urinary retention. This occurred significantly more often in patients with the AdVanceXP (p = 0.042). During follow-up, no differences could be identified regarding ICIQ-SF, PGI or I-QoL or number of pad usage. CONCLUSIONS The AdVance and AdVanceXP are safe and effective treatment options for male stress urinary incontinence. However, the innovations of the AdVanceXP sling did not demonstrate a superiority over the original AdVance sling regarding functional outcome.
Collapse
|
13
|
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]
|
14
|
Sourial MW, Richard PO, Morisset J, Jundi M, Tu LM. Retrograde leak point pressure measurement improves outcomes of the Virtue male sling for postprostatectomy incontinence. Can Urol Assoc J 2017; 11:E271-E276. [PMID: 28761587 DOI: 10.5489/cuaj.4381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare the efficacy of two different sling tensioning approaches, and to report our experience, including safety and impact on quality of life (QoL) of the Virtue® male sling for the treatment of postprostatectomy incontinence (PPI). METHODS From our prospectively maintained database, we retrospectively identified all men treated with the Virtue male sling for PPI between March 2009 and February 2014 by two urologists in two institutions. Baseline demographic data and the sling tensioning method were abstracted from the database. Likewise, the Patient Global Impression of Improvement (PGI-I) scale, severity of incontinence, and clinical outcomes were also abstracted. RESULTS 48 patients were treated with the Virtue quadratic male sling. Sling tensioning was done using cystoscopy in the first 18 patients (Group 1), while per-operative retrograde leak point pressure (RLPP) measurement was done in the last 30 patients (Group 2). The median (interquartile range [IQR]) followup from the day of surgery was 22 (15-41) months. At the last followup visit, 7 (39%) patients in Group 1 were cured or improved of their PPI, compared to 21 (70%) patients in Group 2 (p=0.03). The final median (IQR) RLPP in these patients was 41 (37-48) cm H2O. Transient pain was the most common adverse event, occurring in 23 (48%) of patients. Twenty-one (70%) patients in Group 2 were "much better" or "very much better" with their device, compared to 7 (39%) in Group 1 (p=0.0008). CONCLUSIONS The Virtue male sling is a valuable treatment option for PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates.
Collapse
Affiliation(s)
- Michael W Sourial
- Division of Urology, Department of Surgery, Faculté de Médecine et Science de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Canada
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Faculté de Médecine et Science de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Canada.,Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC; Canada
| | - Julie Morisset
- Division of Urology, Department of Surgery, CSSS Trois-Rivière, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivière, QC; Canada
| | - Mazen Jundi
- Division of Urology, Department of Surgery, CSSS Trois-Rivière, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivière, QC; Canada
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Faculté de Médecine et Science de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Canada
| |
Collapse
|
15
|
Outcome Measures of Adjustable Transobturator Male System with Pre-attached Scrotal Port for Male Stress Urinary Incontinence After Radical Prostatectomy: A Prospective Study. Adv Ther 2017; 34:1173-1183. [PMID: 28405960 DOI: 10.1007/s12325-017-0528-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The objective of this study was to report outcome measures with third-generation pre-attached scrotal port adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI) after radical prostatectomy. METHODS A prospective open study was conducted on consecutive patients. Evaluation included cough test, urethroscopy, filling and voiding cystometry, 24-h pad count and pad test, patient-reported outcomes (ICIQ-SF, IIQ-7, PGI, GRA, and VAS), complications according to the Clavien-Dindo system, operative results, number of adjustments, and filling of the system. RESULTS Thirty-four patients with median pad test 510 (170-1225) ml were operated on. Preoperative SUI was mild (5.9%), moderate (17.6%), and severe (76.5%). At median 18.5 (12-26) months follow-up distribution of SUI was none (85.3%), mild (8.8%), and moderate (5.9%). Median intraoperative filling was 14 (8-17) ml, number of adjustments 1 (0-5), and total filling 17.5 (11-33.5) ml. At 3 months, median ICIQ-SF (p = 0.0001) and IIQ-7 (p < 0.0001) decreased. At 12 months, 24-h pad count and pad test decreased (both p < 0.0001), residual volume slightly increased (p = 0.018), PGI-I was 1 (1-3), GRA 6 (3-6), and 97% were satisfied with treatment. Continence (p = 0.016) and satisfaction (p = 0.09) were worse in irradiated patients. Median operative time was 67 (35-120) min, hospital stay 1 (1-3) days, and VAS for pain on postoperative day 1 was 0 (0-2). Complications presented in 14.7% (8.8% grade I and 5.9% grade III). CONCLUSION Treatment of severe male SUI after radical prostatectomy with pre-attached scrotal port ATOMS is safe and very effective in the short term. A positive cough test before implant and intraoperative overfilling of the system may optimize patient selection and results.
Collapse
|
16
|
Papachristos A, Mann S, Talbot K, Moon D. AdVance male urethral sling: medium-term results in an Australian cohort. ANZ J Surg 2017; 88:E178-E182. [PMID: 28239989 DOI: 10.1111/ans.13890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures. METHODS A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores. RESULTS At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02). CONCLUSIONS The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.
Collapse
Affiliation(s)
| | - Sarah Mann
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Kay Talbot
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Daniel Moon
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Australian Urology Associates, Melbourne, Victoria, Australia.,Department of Urology, Cabrini Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Ribeiro AM, Peria FM, Mateus-Vasconcelos ECL, Ferreira CHJ, Muglia VF, Oliveira HFD. Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ao19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract Introduction: Despite the technical and scientific progress that improved therapeutic resources available in Oncology, adverse effects of treatment can be prominent, impacting the quality of life (QoL). Objective: This research aims to determine the prevalence of post-radiotherapy pelvic symptoms in prostate cancer (PC) and its impact on QoL. Methods: We assessed three groups of patients at different stages during radiotherapy (RT): Pre-RT, evaluated before of RT; Post-RT#1, evaluated between six months and one year post-RT; Post-RT#2, evaluated between two and a half and four years post-RT. The presence of urinary incontinence (UI), its characteristics and impact on daily living activities (DLA) were evaluated by ICIQ-SF questionnaire. WHOQOL-BREF questionnaire was used to assess QoL. Student t test was used, considering significant p < 0.05. Results: Thirty-three men were assessed (pre-RT, n = 12; Post-RT#1, n = 10; Post-RT#2, n = 11). The prevalence of lower urinary tract symptoms (LUTS) was highest in Post-RT#1 group. Post-RT#2 group had the highest prevalence of post-RT UI. In QoL, Pre-RT and Post-RT#2 groups experiencing the greatest impact on physical, environmental and overall QoL. Conclusion: Acute effect of RT is characterized by a high prevalence of LUTS. Post-RT#2 group experienced the most adverse effects on DLA due to a higher prevalence of post-RT UI.
Collapse
|
18
|
Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate. Int Neurourol J 2016; 20:335-341. [PMID: 28043113 PMCID: PMC5209579 DOI: 10.5213/inj.1632648.324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/18/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods A total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05). Results Follow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041). Conclusions The findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.
Collapse
|
19
|
Bauer RM, Grabbert MT, Klehr B, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Kretschmer A. 36-month data for the AdVance XP ® male sling: results of a prospective multicentre study. BJU Int 2016; 119:626-630. [PMID: 27862836 DOI: 10.1111/bju.13704] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence (SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape. PATIENTS AND METHODS In all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of <1 cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, quality-of-life scores [International Quality of Life score (IQOL) and International Consultation on Incontinence Questionnaire short form (ICIQ-UI SF)], visual analogue scale (VAS) for pain, five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and Patient Global Impression of Improvement (PGI-I) score, were performed. All patients with a 0-5 g pad test were defined as cured and improved with a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. RESULTS The mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g (P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g (P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred. CONCLUSION The AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months.
Collapse
Affiliation(s)
| | | | - Benedikt Klehr
- Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | | | | | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Peter Rehder
- Department of Urology, University of Innsbruck, Innsbruck, Austria
| | | | | |
Collapse
|
20
|
Salomon L, Droupy S, Yiou R, Soulié M. [Functional results and treatment of functional dysfunctions after radical prostatectomy]. Prog Urol 2016; 25:1028-66. [PMID: 26519966 DOI: 10.1016/j.purol.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
Collapse
Affiliation(s)
- L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - S Droupy
- Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Yiou
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
| |
Collapse
|
21
|
Kretschmer A, Grabbert M, Sommer A, Stief CG, Bauer RM. Mid-term outcomes after AdVanceXP male sling implantation. BJU Int 2016; 118:458-63. [PMID: 26918426 DOI: 10.1111/bju.13459] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow-up of almost 3 years. PATIENTS AND METHODS A total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow-up of 12months and after an individual maximum follow-up. Efficacy was evaluated by daily pad usage, 24-h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed-rank test was used. A P value <0.05 was taken to indicate statistical significance. RESULTS The mean ± sd follow-up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow-up. At follow-up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24-h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected. CONCLUSIONS The present study had the longest follow-up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow-up of almost 3 years. The results indicate that late-onset complications are rare after AdVanceXP implantation.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.,The Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Sommer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
22
|
Bauer RM, Gozzi C, Klehr B, Kretschmer A, Grabbert M, Rehder P, May F, Stief CG, Gebhartl P, Homberg R. AdVanceXP male sling: 2-year results of a multicentre study. World J Urol 2015; 34:1025-30. [PMID: 26582060 DOI: 10.1007/s00345-015-1731-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE For the treatment of persistent post-prostatectomy incontinence (PPI), several surgical treatment options including male slings are available. In 2010, the second generation of the retrourethral male sling Advance, AdVanceXP, was introduced. Aim of the study was to examine in a prospective multicentre study the outcome of AdVanceXP in the treatment of PPI. METHODS Ninety-four patients were treated with AdVanceXP. Patients with nocturnal incontinence, previous incontinence surgery, with coaptive zone <1 cm and irradiated patients were excluded. Measurements included: daily pad usage, 24-h pad weight test, post-operative pain in the visual analogue scale, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, IEEF5 and Patient Global Impression of Improvement. Adverse events were recorded. All patients with no pads and 0-5 g in the 24-h pad test were defined as cured and those with a reduction in urine loss >50 % as improved. RESULTS Preoperatively, the median 24-h pad weight test was 274 g and daily pad usage was 3. At 1-year follow-up, 66.3 % of patients could be classified as cured and 25.3 % as improved. After 2 years, 73.1 % could be classified as cured and 19.6 % as improved. Urine loss decreased (p < 0.001), and quality of life improved significantly (p < 0.001). Mean PGI was 1.5 after 1 year and 1.4 after 2 years. Majority of complications were minor. No intraoperative complications and five serious post-operative events occurred (grade IIIB complications). No explantation was necessary. CONCLUSIONS AdVanceXP, when correctly indicated, shows good effectiveness and low complication rates after up to 2 years.
Collapse
Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Marchioninistr. 15, Campus Grosshadern, 81377, Munich, Germany.
| | | | - Benedikt Klehr
- Department of Urology, Ludwig-Maximilians-University, Marchioninistr. 15, Campus Grosshadern, 81377, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Marchioninistr. 15, Campus Grosshadern, 81377, Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University, Marchioninistr. 15, Campus Grosshadern, 81377, Munich, Germany
| | - Peter Rehder
- Department of Urology, Medical University, Innsbruck, Austria
| | - Florian May
- Helios Amper Klinik Dachau, Department of Urology, Ludwig-Maximilians-University Teaching Hospital, Dachau, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Marchioninistr. 15, Campus Grosshadern, 81377, Munich, Germany
| | - Peter Gebhartl
- Department of Urology, LKH Voecklabruck, Voecklabruck, Austria
| | | |
Collapse
|
23
|
Evaluation of a supervised multi-modal physical exercise program for prostate cancer survivors in the rehabilitation phase: Rationale and study protocol of the ProCaLife study. Contemp Clin Trials 2015; 45:311-319. [DOI: 10.1016/j.cct.2015.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 11/20/2022]
|
24
|
Kueronya V, Miernik A, Stupar S, Kojovic V, Hatzichristodoulou G, Egydio PH, Tosev G, Falcone M, De Luca F, Mulalic D, Djordjevic M, Schoenthaler M, Fahr C, Kuehhas FE. International multicentre psychometric evaluation of patient-reported outcome data for the treatment of Peyronie's disease. BJU Int 2015; 115:822-8. [DOI: 10.1111/bju.12968] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Verena Kueronya
- Department of Obstetrics and Gynecology; Medical University of Vienna; Vienna Austria
| | - Arkadius Miernik
- Departments of Urology; Medical University of Freiburg; Freiburg Germany
| | - Slavisa Stupar
- Department of Urology; Medical University of Vienna; Vienna Austria
| | | | | | - Paulo H. Egydio
- Centre for Peyronie's Disease Reconstruction; Sao Paulo Brazil
| | - Georgi Tosev
- Departments of Urology; Medical University of Heidelberg; Heidelberg Germany
| | - Marco Falcone
- Department of Urology; Medical University of Turin; Turin Italy
| | | | - Demir Mulalic
- Department of Urology; Medical University of Vienna; Vienna Austria
| | | | | | - Christian Fahr
- Departments of Urology; Medical University of Freiburg; Freiburg Germany
| | | |
Collapse
|
25
|
Nyström E, Sjöström M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn 2014; 34:747-51. [PMID: 25154378 DOI: 10.1002/nau.22657] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/24/2014] [Indexed: 11/09/2022]
Abstract
AIMS To determine whether changes in questionnaire scores on symptoms and condition-specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI). METHODS We retrospectively analyzed questionnaires collected during a randomized controlled trial in women with SUI, that received pelvic floor muscle training (PFMT) in two different formats. We included 218 women that answered validated self-assessment questionnaires at baseline and at a 4-month follow-up. We registered changes on two questionnaires, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol). We compared these score changes to responses from the Patient Global Impression of Improvement (PGI-I) questionnaire. Differences were analyzed with the Spearman rho and one-way-ANOVA. The minimum important difference (MID) was the mean change in score for women that experienced a small improvement. RESULTS The PGI-I correlated significantly to both the ICIQ-UI SF (r = 0.547, P < 0.0001) and ICIQ-LUTSqol (r = 0.520, P < 0.0001). Thus, larger reductions in symptoms or quality of life scores were associated with greater impressions of improvement. The changes in ICIQ-UI SF and ICIQ-LUTSqol scores were significant across all PGI-I groups from "no change" to "very much improved" (P < 0.05). The MIDs were 2.52 (SD 2.56) for ICIQ-UI SF and 3.71 (SD 4.95) for ICIQ-LUTSqol. CONCLUSIONS The change in ICIQ-UI SF and ICIQ-LUTSqol scores after PFMT reflected clinically relevant improvements in women with SUI. The MIDs established for this population may facilitate future research, treatment evaluations, and comparisons between studies.
Collapse
Affiliation(s)
- E Nyström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M Sjöström
- Department of Public Health and Clinical Medicine, Unit of Clinical Research Center - Östersund, Umeå University, Umeå, Sweden
| | - H Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - E Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
26
|
Bauer RM, Kretschmer A, Stief CG, Füllhase C. AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence. World J Urol 2014; 33:145-50. [PMID: 24706183 DOI: 10.1007/s00345-014-1297-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). METHODS Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. RESULTS Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. CONCLUSIONS Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.
Collapse
Affiliation(s)
- Ricarda M Bauer
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany,
| | | | | | | |
Collapse
|
27
|
Nitti VW, Mourtzinos A, Brucker BM. Correlation of patient perception of pad use with objective degree of incontinence measured by pad test in men with post-prostatectomy incontinence: the SUFU Pad Test Study. J Urol 2014; 192:836-42. [PMID: 24650425 DOI: 10.1016/j.juro.2014.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Many investigators have used the number of pads to determine the severity of post-prostatectomy incontinence and yet the accuracy of this tool remains unproven. We determined whether the patient perception of pad use and urine loss reflects actual urine loss. We also identified a quality of life measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS We prospectively enrolled 235 men from a total of 18 sites 6 months or more after radical prostatectomy who had incontinence requiring protection. Patients completed a questionnaire on the perception of pad number, size and wetness, a quality of life question, several standardized incontinence questionnaires and a 24-hour pad test that assessed pad number, size and weight. SPSS® was used for statistical analysis. RESULTS Perception of the number of pads used closely agreed with the number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p <0.001). Patients with wet and soaked pads had statistically and clinically significantly different pad weights that were uniquely different from each other and from those of patients who were almost dry and slightly wet. Response to the quality of life question separated the men into 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS Patients accurately described the number, size and degree of wetness of pads collected during a 24-hour pad test. These values correlated well with actual urine loss. The single question, "To what extent does urine loss affect your quality of life?" separated men into distinct categories.
Collapse
Affiliation(s)
- Victor W Nitti
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts.
| | - Arthur Mourtzinos
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
| | - Benjamin M Brucker
- New York University Langone Medical Center, New York, New York, and Tufts Medical School (AM), Boston, Massachusetts
| | | |
Collapse
|
28
|
Cornu JN, Batista Da Costa J, Henry N, Peyrat L, Beley S, Haab F. Comparative study of AdVance and AdVanceXP male slings in a tertiary reference center. Eur Urol 2013; 65:502-4. [PMID: 24210912 DOI: 10.1016/j.eururo.2013.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France.
| | - José Batista Da Costa
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France
| | - Nicolas Henry
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France
| | - Laurence Peyrat
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France
| | - Sébastien Beley
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France
| | - Francois Haab
- Department of Urology, Tenon Hospital, Hopitaux Universitaires Paris-EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, Paris, France
| |
Collapse
|
29
|
Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy. Int J Urol 2013; 20:986-92. [PMID: 23432098 DOI: 10.1111/iju.12099] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/06/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Urinary incontinence is a predictable sequela of radical retropubic prostatectomy, and is most severe in the early postoperative phase. The present study aimed to evaluate the effect of a physiotherapist-guided pelvic floor muscle training program, commenced preoperatively, on the severity and duration of urinary continence after radical retropubic prostatectomy. METHODS A retrospective analysis of men undergoing radical retropubic prostatectomy by one high-volume surgeon (n = 284) was carried out. The intervention group received physiotherapist-guided pelvic floor muscle training from 4 weeks preoperatively (n = 152), whereas the control group was provided with verbal instruction on pelvic floor muscle exercise by the surgeon alone (n = 132). Postoperatively, all patients received physiotherapist-guided pelvic floor muscle training. The primary outcome measure was 24-h pad weight at 6 weeks and 3 months postoperatively. Secondary outcome measures were the percentage of patients experiencing severe urinary incontinence, and patient-reported time to one and zero pad usage daily. RESULTS At 6 weeks postoperatively, the 24-h pad weight was significantly lower (9 g vs 17 g, P < 0.001) for the intervention group, which also showed less severe urinary incontinence (24-h pad weight >50 g; 8/152 patients vs 33/132 patients, P < 0.01). There was no significant difference between groups in the 24-h pad weight at 3 months (P = 0.18). Patient-reported time to one and zero pad usage was significantly less for the intervention group (P < 0.05). Multivariate Cox regression showed that preoperative physiotherapist-guided pelvic floor muscle training reduced time to continence (1 pad usage daily) by 28% (P < 0.05). CONCLUSIONS A physiotherapist-guided pelvic floor muscle training program, commenced 4 weeks preoperatively, significantly reduces the duration and severity of early urinary incontinence after radical retropubic prostatectomy.
Collapse
Affiliation(s)
- Manish I Patel
- Urological Cancer Outcomes Center, Discipline of Surgery, The University of Sydney
| | | | | | | |
Collapse
|
30
|
Hudak SJ, Morey AF, Adibi M, Bagrodia A. Favorable patient reported outcomes after penile plication for wide array of peyronie disease abnormalities. J Urol 2012; 189:1019-24. [PMID: 23017514 DOI: 10.1016/j.juro.2012.09.085] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE We present patient reported outcomes from our 5-year experience using penile plication to correct a wide variety of Peyronie disease malformations. MATERIALS AND METHODS We reviewed the records of all men who underwent penile plication for Peyronie disease, as performed by one of us (AFM). All patients were treated with tunical plication without penile degloving via a 2 cm longitudinal penile incision regardless of curvature severity or erectile function. A concomitant inflatable penile prosthesis was placed in men with refractory erectile dysfunction. A questionnaire was administered to assess the patient perception of postoperative penile curvature, length, rigidity and adequacy for intercourse. RESULTS Of 154 treated patients 78 (51%) and 65 (42%) had simple (less than 60 degrees) and complex (biplanar curvature, or curvature 60 degrees or greater) malformation, respectively, while 11 (7%) underwent plication plus inflatable penile prosthesis placement. A total of 132 patients responded to the questionnaire a mean 14 months after surgery. Overall, 96% of patients reported curvature improvement after penile plication, 93% reported erection adequate for sexual intercourse and 95% considered that the overall condition improved after surgery. Despite a significant difference in the number of plication sutures (mean 10 vs 7) and curvature angle correction (mean 57 vs 30 degrees, each p <0.005), self-reported outcomes of complex cases were equivalent to those of simple cases. While 84% of patients had no measureable decrease in stretched penile length, 103 of 154 (78%) reported a perceived penile length reduction after surgery. CONCLUSIONS Penile plication without degloving is effective for correcting a wide variety of Peyronie disease malformations. It can be safely combined with inflatable penile prosthesis placement.
Collapse
Affiliation(s)
- Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
| | | | | | | |
Collapse
|
31
|
|
32
|
Late pelvic function following rectal cancer resection – a case-control study. Eur Surg 2011. [DOI: 10.1007/s10353-011-0036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
33
|
Han JS, Brucker BM, Demirtas A, Fong E, Nitti VW. Treatment of post-prostatectomy incontinence with male slings in patients with impaired detrusor contractility on urodynamics and/or who perform Valsalva voiding. J Urol 2011; 186:1370-5. [PMID: 21855941 DOI: 10.1016/j.juro.2011.05.089] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for urodynamics can be safely treated with slings. MATERIALS AND METHODS A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status. Exclusion criteria were lack of preoperative urodynamics and/or postoperative post-void residual. A total of 92 patients were analyzed. The variables were compared using the Student t test and the chi-square test. RESULTS No statistically significant difference was shown in postoperative post-void residual (mean 4 months postoperatively) or urinary retention when comparing by bladder contractility or Valsalva voiding. In the subset of patients with available postoperative uroflow data, there were no differences in postoperative maximum flow rate or voided volume. CONCLUSIONS Men with post-prostatectomy urinary incontinence with urodynamic findings suggesting impaired contractility or Valsalva voiding can be safely treated with sling surgery if they have normal preoperative emptying.
Collapse
Affiliation(s)
- Justin S Han
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
| | | | | | | | | |
Collapse
|
34
|
Editorial Comment. Urology 2011; 77:479; author reply 480. [DOI: 10.1016/j.urology.2010.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022]
|
35
|
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]
|
36
|
Kahlon B, Baverstock RJ, Carlson KV. Quality of life and patient satisfaction after artificial urinary sphincter. Can Urol Assoc J 2011; 5:268-72. [PMID: 21251472 DOI: 10.5489/cuaj.09137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We assessed satisfaction and quality of life (QOL) in men with artificial urinary sphincter (AUS) placement. METHODS We identified 39 men who had AUS placement. A retrospective chart review was conducted. Validated questionnaires, including the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Post-Operative Patient Global Impression of Improvement (PGI-I), Incontinence Impact Questionnaire-Short Form (IIQ-SF), and Urogenital Distress Index (UDI-SF), were used to measure patient-reported outcome. Global satisfaction was also assessed. RESULTS At chart review, 34 of 39 questionnaires were assessed for QOL, satisfaction and surgical outcome. Follow-up ranged from 7 to 60 months (median = 24 months). Surgical revisions were required in 6 (17.6%) patients due to infection (1), erosion (1), combined infection and erosion (1), device failure (1) and second cuff placement (2). Quality of life was assessed using the IIQ-SF and UDI-SF, with mean scores of 15.4 and 24.8, respectively; these scores indicated a low negative impact on QOL. The ICIQ-SF mean score was 8.2, well below the worst possible score. The number of men using more than 1 pad per day dropped from 27 preoperatively to 10 postoperatively. Most patients (31/34) described their urinary condition as better, 2 had no change and 1 was worse. Most patients (31/34, 91.2%) would be willing to undergo the procedure again, 2 were undecided, and 1 would not. Similarly, 28 patients (82.4%) would recommend the procedure to a friend, 3 respondents would "with reservation," 1 respondent was undecided, and 2 would not recommend the AUS placement. CONCLUSION Treatment of urinary incontinence with the AUS has a positive effect on QOL with high patient satisfaction and reasonably low complication rates.
Collapse
|
37
|
Cornu JN, Haab F. Re: Can AdVance™ Transobturator Sling Suspension Cure Male Urinary Postoperative Stress Incontinence? J Urol 2010; 184:1229-30; author reply 1230-1. [DOI: 10.1016/j.juro.2010.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, Groupe Hospitalo-Universitaire EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Francois Haab
- Department of Urology, Tenon Hospital, Groupe Hospitalo-Universitaire EST, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris VI, 4 rue de la Chine, 75970 Paris Cedex 20, France
| |
Collapse
|
38
|
Ballert KN, Nitti VW. Association Between Detrusor Overactivity and Postoperative Outcomes in Patients Undergoing Male Bone Anchored Perineal Sling. J Urol 2010; 183:641-5. [DOI: 10.1016/j.juro.2009.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Indexed: 11/25/2022]
|
39
|
Patel A, Chapple C. What's hot from the ICS Annual Meeting 2007. Neurourol Urodyn 2007; 26:956-65. [DOI: 10.1002/nau.20531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
Fischer MC, Huckabay C, Nitti VW. The Male Perineal Sling: Assessment and Prediction of Outcome. J Urol 2007; 177:1414-8. [PMID: 17382743 DOI: 10.1016/j.juro.2006.11.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE The male perineal sling has become an option for treating male stress incontinence. We evaluated its overall efficacy and determined preoperative parameters that could predict success. MATERIALS AND METHODS A total of 62 men with stress incontinence were prospectively evaluated and underwent a male perineal sling. Preoperatively 24-hour pad weight, urodynamics and a number of validated incontinence questionnaires were completed. At a minimum of 3 months of followup 24-hour pad weight and questionnaires were repeated. Success was assessed using the 1 question Patient Global Impression of Improvement. The Patient Global Impression of Improvement was compared to a number of other subjective and objective measures of outcome. Finally, preoperative parameters were evaluated to determine predictors of outcome. RESULTS As determined by the Patient Global Impression of Improvement, the success rate was 58%. The only preoperative factor predictive of success was 24-hour pad weight. An individual had a 71% chance of successful surgery if preoperative pad weight was less than 423 gm. There was a statistically significant difference between successes and failures in terms of postoperative pad weight and certain questionnaires, including the UCLA/RAND Prostate Cancer Index urinary function score, International Consultation on Incontinence short form, Incontinence Impact Questionnaire, Urogenital Distress Index and International Prostate Symptom Score. The overall complication rate was 21% and the reoperation rate was 14.5%. CONCLUSIONS The male perineal sling can be an effective surgical treatment for stress incontinence in the appropriate patient. The procedure is most successful in patients with lesser objective degrees of incontinence. The Patient Global Impression of Improvement is an effective tool for assessing outcome for this population.
Collapse
Affiliation(s)
- Melissa C Fischer
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
| | | | | |
Collapse
|