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Zanotti RR, Lustosa F, Matos AC, Korkes F, Toi CH, de Toledo LGM. Male sling adjustability: does it truly matter? Int Urol Nephrol 2024; 56:2147-2156. [PMID: 38315282 DOI: 10.1007/s11255-024-03942-9] [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: 10/26/2023] [Accepted: 12/31/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Patients with post prostatectomy incontinence (PPI) seem to have different needs. Therefore, device post-operative readjustability may be a beneficial feature in PPI management, even though it lacks study support. The purpose of this study is to describe our surgical technique for male sling (MS) implantation, assess outcomes, and the impact of readjustability. METHODS We performed a retrospective analysis of 89 consecutive patients who underwent PPI correction with MS Argus-T™ (Promedon, Córdoba, Argentina) from 2009 to 2021. The median follow-up was 48 months (12-120). Data were collected in a dedicated database. Perioperative variables were assessed. A descriptive statistical analysis was performed. Clinical and urodynamic variables were correlated with the need for readjustments and success. RESULTS In this cohort, objective success was achieved in 80.5% of the patients (65.9% cured and 14.6% improved). A total of 85.4% of the patients met the criteria for subjective success (74.4% cured and 11% improved). For the subgroup of patients who received previous treatment for urethral stricture (US), 79% achieved objective success (63.2% cured, 15.8% improved), and 84.2% achieved subjective success (78.9% cured, 5.3% improved). For the subgroup of patients who received previous radiotherapy (RT) before sling surgery, 68.7% achieved objective success (37.5% cured, 31.2% improved), and 75% achieved subjective success (37.5% cured, 37.5% improved). Procedures for device readjustment were necessary for 27.7% of patients in the total study population. RT and previous US treatment were predictive factors for the need of readjustment, with rates of 66.7% and 61.1% (OR: 8.46; CI: 2.46-29.00; p = 0.001/OR: 6.41; CI: 2.05-20.03; p = 0.001, respectively). CONCLUSIONS MS adjustability improved success rates, especially among irradiated patients and those with previous US. RT was an adverse predictor of total continence status even after readjustments.
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Affiliation(s)
- Rafael R Zanotti
- School of Medical Sciences, Department of Urology, Santa Casa de São Paulo, São Paulo, Brazil.
| | | | - Andre C Matos
- Department of Urology, Federal University of Bahia, Salvador, Brazil
| | - Fernando Korkes
- Faculty of Medicine of ABC, Department of Urology, Santo André, Brazil
| | - Claudio H Toi
- Department of Urology, Ipiranga Hospital, São Paulo, Brazil
| | - Luís G M de Toledo
- School of Medical Sciences, Department of Urology, Santa Casa de São Paulo, São Paulo, Brazil
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Mascolini MV, Carniel EL. In silico assessment of the reliability and performance of artificial sphincter for urinary incontinence. Artif Organs 2024. [PMID: 38895983 DOI: 10.1111/aor.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The standard artificial urinary sphincter (AUS) is an implantable device for the treatment of urinary incontinence by applying a pressure loading around the urethra through an inflatable cuff, often inducing no-physiological stimulation up to tissue degenerative phenomena. A novel in silico approach is proposed to fill the gap of the traditional procedures by providing tools to quantitatively assess AUS reliability and performance based on AUS-urethra interaction. METHODS The approach requires the development of 3D numerical models of AUS and urethra, and experimental investigations to define their mechanical behaviors. Computational analyses are performed to simulate the urethral lumen occlusion by AUS inflation under different pressures, and the lumen opening by applying an intraluminal pressure progressively increased under the AUS action (Abaqus Explicit solver). The AUS reliability is evaluated in terms of tissue stimulation by the mechanical fields potentially responsible for vasoconstriction and tissue damage, while the performance by the intraluminal pressure that causes the lumen opening for a specific occlusive pressure, showing the maximum urethral pressure for which continence is guaranteed. RESULTS The present study implemented the procedure considering the gold standard AMS 800 and a novel patented AUS. Results provided the comparison between two sphincteric devices and the evaluation of the influence of different building materials and geometrical features on the AUS functionality. CONCLUSIONS The approach was developed for the AUS, but it could be adapted also to artificial sphincters for the treatment of other anatomical dysfunctions, widening the analyzable device configurations and reducing experimental and ethical efforts.
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Affiliation(s)
- Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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Bajaj M, Frampton C, Losco G, Westenberg A. Adjustable transobturator male system (ATOMS) for stress urinary incontinence: the evidence is mounting. BJU Int 2024; 133 Suppl 3:33-38. [PMID: 37409820 DOI: 10.1111/bju.16118] [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] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate the New Zealand clinical experience with the adjustable transobturator male system (ATOMS), a novel continence device in the management of all degrees of stress urinary incontinence (SUI), focusing on efficacy and safety outcomes. PATIENTS AND METHODS A retrospective review of all ATOMS devices placed between May 2015 and November 2020 was conducted. Severity of SUI was assessed (pad usage) before and after surgery. SUI was defined as mild (1-<3 pads/day), moderate (≥3-5 pads/day) or severe (>5 pads/day). The primary outcome measures considered were the overall success rate (improvement in pad use) and the dry rate (with dry defined as either no or 1 safety pad/day). The number of outpatient adjustments and total filling volumes were also documented in each case. Additionally, we documented incidence and severity of device complications and an analysis of treatment failures. RESULTS A total of 140 patients were reviewed, with the most common indication for ATOMS placement being SUI after radical prostatectomy (82.8%). Of the patients included, 53 (37.9%) had previous radiotherapy, with 26 (18.6%) patients having had a previous continence procedure performed. No intraoperative complications were noted. The median preoperative pad usage was 4 pads/day. After a median follow-up of 11 months, median postoperative pad usage reduced to 1 pad/day. In our cohort, 116 patients (82.9%) reported an improvement in their pad usage and were considered successful with 107 (76.4%) patients reporting themselves to be dry. Complications within the first 90-days after surgery occurred in 20 (14.3%) of patients. CONCLUSION Treatment of SUI with the ATOMS is safe and effective. The option of long-term, minimally invasive adjustment to respond to patient needs is a significant advantage.
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Affiliation(s)
| | - Chris Frampton
- Statistics Department, University of Otago, Dunedin, New Zealand
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Virseda-Chamorro M, Téllez C, Salinas-Casado J, Szczesniewski J, Ruiz-Grana S, Arance I, Angulo JC. Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy. J Clin Med 2023; 12:7505. [PMID: 38137573 PMCID: PMC10744244 DOI: 10.3390/jcm12247505] [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: 10/29/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.
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Affiliation(s)
| | - Carlos Téllez
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain; (C.T.); (J.S.); (S.R.-G.); (I.A.)
- Clinical Department, Faculty of Medical Sciences, Universidad Europea, 28670 Madrid, Spain
| | - Jesus Salinas-Casado
- Urology Department, Hospital Clínico de San Carlos, 28040 Madrid, Spain;
- Department of Surgery, Faculty of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Juliusz Szczesniewski
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain; (C.T.); (J.S.); (S.R.-G.); (I.A.)
| | - Sonia Ruiz-Grana
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain; (C.T.); (J.S.); (S.R.-G.); (I.A.)
| | - Ignacio Arance
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain; (C.T.); (J.S.); (S.R.-G.); (I.A.)
- Clinical Department, Faculty of Medical Sciences, Universidad Europea, 28670 Madrid, Spain
| | - Javier C. Angulo
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain; (C.T.); (J.S.); (S.R.-G.); (I.A.)
- Clinical Department, Faculty of Medical Sciences, Universidad Europea, 28670 Madrid, Spain
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Ameli G, Weibl P, Rutkowski M, Huebner WA. Using a stress reservoir to improve urine leakage after artificial urinary sphincter implantation. Int Urol Nephrol 2023; 55:3089-3094. [PMID: 37634237 DOI: 10.1007/s11255-023-03756-1] [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: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Although the longest efficacy record, some patients report about urinary leakage during higher intra-abdominal pressure after Artificial Urinary Sphincter (AUS) implantation. To improve the continent results, we placed in addition to the occluding cuff and the pressure regulating balloon, in a second procedure a stress-relief reservoir in lower abdomen, for additional passive pressure transmission to the occluding cuff. METHODS In this retrospective monocentric data analysis between 2011 and 2018, 80 patients with persistence incontinence after AUS implantation were included. Stress-relief reservoir was indicated in 12 patients with involuntary leakage of urine, that occurred when intra-abdominal pressure raised. RESULTS In all 12 cases, the stress reservoir was easily implanted and there were no intraoperative complications. In a mean follow-up time of 53 months, the pad per day usage (p/d) improved from 3 (± 1.2) to 1.7 (± 1.5) (p = 0.001). Two patients with multiple previous abdominal surgeries used an equal number of pads after SRR; however, an improvement during physical exertion was reported. Continence situation was evaluated with a questionnaire and was rated as "excellent", "good", or "satisfactory" by 11 (92%) patients. CONCLUSION The persistence of urinary incontinence after AUS is a challenging topic. Implantation of a stress reservoir in carefully selected patients with urinary leakage during higher intra-abdominal pressure is minimally invasive and offers new options to improve the proven long-term record of AUS. Certainly, more investigations are needed to determine the clinical relevance of this approach.
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Affiliation(s)
- Ghazal Ameli
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria.
| | - Peter Weibl
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
| | - Michael Rutkowski
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
| | - Wilhelm Alexander Huebner
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
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Harland N, Walz S, Eberli D, Schmid FA, Aicher WK, Stenzl A, Amend B. Stress Urinary Incontinence: An Unsolved Clinical Challenge. Biomedicines 2023; 11:2486. [PMID: 37760927 PMCID: PMC10525672 DOI: 10.3390/biomedicines11092486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Stress urinary incontinence is still a frequent problem for women and men, which leads to pronounced impairment of the quality of life and withdrawal from the social environment. Modern diagnostics and therapy improved the situation for individuals affected. But there are still limits, including the correct diagnosis of incontinence and its pathophysiology, as well as the therapeutic algorithms. In most cases, patients are treated with a first-line regimen of drugs, possibly in combination with specific exercises and electrophysiological stimulation. When conservative options are exhausted, minimally invasive surgical therapies are indicated. However, standard surgeries, especially the application of implants, do not pursue any causal therapy. Non-absorbable meshes and ligaments have fallen into disrepute due to complications. In numerous countries, classic techniques such as colposuspension have been revived to avoid implants. Except for tapes in the treatment of stress urinary incontinence in women, the literature on randomized controlled studies is insufficient. This review provides an update on pharmacological and surgical treatment options for stress urinary incontinence; it highlights limitations and formulates wishes for the future from a clinical perspective.
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Affiliation(s)
- Niklas Harland
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Simon Walz
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.E.); (F.A.S.)
| | - Florian A. Schmid
- Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland; (D.E.); (F.A.S.)
| | - Wilhelm K. Aicher
- Centre for Medical Research, University of Tuebingen Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Arnulf Stenzl
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
| | - Bastian Amend
- Department of Urology, University of Tuebingen Hospital, 72076 Tuebingen, Germany; (N.H.); (S.W.); (A.S.)
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Smith WJ, VanDyke ME, Venishetty N, Langford BT, Franzen BP, Morey AF. Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success. Res Rep Urol 2023; 15:217-232. [PMID: 37366389 PMCID: PMC10290851 DOI: 10.2147/rru.s395359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. Methods A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Results Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Conclusion Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.
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Affiliation(s)
- Wesley J Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikit Venishetty
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian T Langford
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce P Franzen
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cotte J, Dechartres A, Mozer P, Poinard F, Chartier-Kastler E, Beaugerie A. Long-term device survival after a first implantation of AMS800™ for stress urinary incontinence: Comparison between men and women. Neurourol Urodyn 2023; 42:80-89. [PMID: 36183390 DOI: 10.1002/nau.25047] [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: 04/27/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The artificial urinary sphincter is the reference treatment for stress urinary incontinence in men, but it remains rarely used in women. This study aimed to compare long-term device survival between women and men, after the first implantation of an AMS800™ artificial urinary sphincter (Boston Scientific) for the treatment of a non-neurogenic stress urinary incontinence. MATERIALS AND METHODS This retrospective cohort study included all patients with nonneurogenic stress urinary incontinence who underwent surgery in a large-volume university hospital between 2000 and 2013. The primary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Men and women were matched 3:1 according to age and year of implantation. Differences were analyzed using a Cox model accounting for matching and applying time intervals because hazards were not proportional over time. Sensitivity analyzes were performed, excluding firstly a population with a history of radiotherapy and secondly a population with more than one previous surgery for urinary incontinence. RESULTS A total of 107 women were matched to 316 men. Median follow-up was 6.0 years (Q1-Q3 1.8-9.4): 7.0 years (Q1-Q3 3.1-10.3) for women and 5.1 years (Q1-Q3 1.3-9.1) for men. During the follow-up, 56 patients had an explantation of the device: 44 men (13.9%) and 12 women (11.2%), and 113 had a revision: 85 men (26.9%) and 28 women (26.1%). Men have a significantly higher risk of explantation or revision than women between 6 months and 8 years after implantation (hazard ratio 2.12 [1.29-3.48]). Before 6 months and after 8 years, there were no significant differences. Both sensitivity analyses found consistent results. CONCLUSIONS This study suggests that device survival seems better in women after the first 6 months.
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Affiliation(s)
- Juliette Cotte
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux Paris, Sorbonne Université, Paris, France
| | - Agnès Dechartres
- Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Pierre Mozer
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux Paris, Sorbonne Université, Paris, France
| | - Florence Poinard
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux Paris, Sorbonne Université, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux Paris, Sorbonne Université, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux Paris, Sorbonne Université, Paris, France
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Altaweel W, Almesned R, Seyam R. A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence. Ann Saudi Med 2023; 43:57-61. [PMID: 36739496 PMCID: PMC9899335 DOI: 10.5144/0256-4947.2023.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes. OBJECTIVE Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach. DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS AND METHODS We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively. MAIN OUTCOME MEASURES Rates of dry, infection, erosion, malfunction, atrophy, revision. SAMPLE SIZE 44 males who underwent 68 procedures. RESULTS Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (P=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, P=.042). At the last follow-up, dryness was comparable among groups. CONCLUSION The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal. LIMITATIONS Small sample size, single-center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Waleed Altaweel
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Razan Almesned
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf Seyam
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Chiu LW, Chen WC, Hsieh PF, Chen YH, Huang CP. Efficacy and Complications of the Re-Adjustable Male Sling System for Stress Urinary Incontinence after Radical Prostatectomy. J Clin Med 2022; 11:jcm11226764. [PMID: 36431241 PMCID: PMC9698314 DOI: 10.3390/jcm11226764] [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: 10/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the outcomes of re-adjustable male slings in pa-tients with postoperative stress urinary incontinence (SUI) following radical prostatectomy (RP). We retrospectively analyzed 18 patients with SUI following RP for prostate cancer, who were treated with re-adjustable male slings from January 2016 to December 2021. The clinical outcomes were evaluated based on daily pad usage and urodynamic studies, both preoperatively and post-operatively. The degree of SUI was categorized as either mild, moderate, or severe. Success was defined as no more pad use or significantly decreased pad use. Complications were classified ac-cording to the Clavien-Dindo system. The mean age of patients was 70.4 ± 5.9 years, and 61.1% of cases were diagnosed as locally advanced prostate cancer. Mild, moderate, and severe SUI were reported as 33.3%, 50.0%, and 16.7%, respectively. The average daily pad use after RP was 3.3 pads and there was a significant reduction in the number of daily pads used after the re-adjustable male sling procedure (3.3 vs. 1.3; p = 0.002). Overall, the operation was considered successful in 11 pa-tients (61.1%), 1 case showed improvement (5.6%), and it was considered unsuccessful in 6 patients (33.3%). Impressively, in the severe incontinence subgroup (three patients), one (33.3%) had im-provement and one (33.3%) had success. Transient perineal discomfort after the operation was the most common complaint. However, two patients had severe complications with bowel injury during sling implantation (Clavien-Dindo grade III). The re-adjustable male sling system was an efficient surgical treatment option for post-RP SUI, even in a locally advanced disease dominant population. One should pay attention to the complication of bowel perforation during surgery.
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Affiliation(s)
- Liang-Wei Chiu
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Correspondence:
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Saavedra AA, Fuentes A, Giménez B, Calvo CI, Bernal J, Valderrama R, Bernier P, Arenas J, Bustamante A. ATOMS®: A step-by-step surgical video in a difficult preoperative decision-making context upon a case of post-prostatectomy urinary incontinence. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ajay D, Kahokehr AA, Lentz AC, Peterson AC. Valsalva leak point pressure (VLPP) greater than 70 cm H 2O is an indicator for sling success: a success prediction model for the male transobturator sling. Int Urol Nephrol 2022; 54:1499-1503. [PMID: 35505169 DOI: 10.1007/s11255-022-03222-4] [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: 01/24/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Urodynamic studies are often performed in the evaluation of post-prostatectomy urinary incontinence (PPUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPUI. Others have reported their results with a specific Valsalva leak point pressure (VLPP) that predicts a good outcome with the male TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high-volume, single center. We hypothesized that a higher pre-operative VLPP better predicts successful outcomes. METHODS We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 h. Cox and linear regression models were performed. RESULTS 290 patients were included. All patients underwent a radical prostatectomy for prostate cancer and presented with PPUI. Mean age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 1-15). A linear regression model shows an inverse prediction curve for sling failure versus VLPP (p = 0.02). The hazard ratio for failure with a VLPP of ≤ 70 cm H2O compared with a VLPP of > 70 cm H2O, adjusted for pelvic radiation and 24-h pad weight was 0.5 (95% CI 0.2-0.98). CONCLUSION Patient selection is imperative in the success of the male TOS for patients with PPUI. In our cohort of patients with PPUI, those with a pre-procedural VLPP of > 70 cm H2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤ 70 cm H2O. In our practice, we use these data to support the use of VLPP cut off of 70 cm H2O as an indicator for success to help in the evaluation and counseling of patients.
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Affiliation(s)
- Divya Ajay
- Department of Urology, University of Rochester Medical Center, 601 Elmwood Drive, Rochester, NY, 14602, USA.
| | - Arman A Kahokehr
- Department of Urology, The University of Adelaide, Adelaide, SA, Australia
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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13
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Márquez-Sánchez GA, Padilla-Fernández BY, Perán-Teruel M, Navalón-Verdejo P, Valverde-Martínez S, Márquez-Sánchez MT, Flores-Fraile J, Lorenzo-Gómez MF. Remeex ® System Effectiveness in Male Patients with Stress Urinary Incontinence. J Clin Med 2021; 10:jcm10102121. [PMID: 34068891 PMCID: PMC8156339 DOI: 10.3390/jcm10102121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.
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Affiliation(s)
| | | | - Miguel Perán-Teruel
- Department of Urology, University Hospital Arnau de Villanova, 46015 Valencia, Spain;
| | - Pedro Navalón-Verdejo
- Department of Urology, University Hospital Casa de Salud, Catholic University of Valencia, 46021 Valencia, Spain;
| | - Sebastián Valverde-Martínez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology, University Hospital of Ávila, 05004 Ávila, Spain
| | - Magaly-Teresa Márquez-Sánchez
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
| | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Correspondence:
| | - María-Fernanda Lorenzo-Gómez
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain; (G.-A.M.-S.); (S.V.-M.); (M.-F.L.-G.)
- Renal Urological Multidisciplinary Research Group (GRUMUR), Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Department of Urology University Hospital of Salamanca, 37007 Salamanca, Spain
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14
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Ferreira A, Duarte Cruz C. The urethra in continence and sensation: Neural aspects of urethral function. Neurourol Urodyn 2021; 40:744-752. [PMID: 33604909 DOI: 10.1002/nau.24632] [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: 10/22/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 11/08/2022]
Abstract
AIMS Traditionally, the urethra has been considered a mere conduit to guide urine from the bladder to the external side of the body. Building evidence indicates that the urethra may directly influence bladder function via mechanisms restricted to the lower urinary tract (LUT). METHODS Here, we discuss the tissue arrangement of the urethra and addressed the contribution of new paraneuronal cells to LUT function. We also briefly reviewed two frequent LUT pathologies associated with urethral dysfunction. RESULTS Continence depends on an intact and functional urethral sphincter, composed of smooth, and striated muscle fibers and regulated by somatic and autonomic fibers. Recent studies suggest the existence of an urethro-vesical reflex that also contributes to normal LUT function. Indeed, the urethral lumen is lined by a specialized epithelium, the urothelium, in the proximal urethra. In this region, recent evidence demonstrates the presence of specific paraneuronal cells, expressing the neurotransmitters acetylcholine and serotonin. These cells are in close proximity of nerve fibers coursing in the lamina propria and are able to release neurotransmitters and rapidly induce detrusor contractions, supporting the existence of an urethro-vesical crosstalk. CONCLUSION The mechanism underlying the fast communication between the urethra and thebladder are beginning to be understood and should involve the interaction between specificepithelial cells and fibres innervating the urethral wall. It is likely that this reflex should bealtered in pathological conditions, becoming an attractive therapeutic target.
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Affiliation(s)
- Ana Ferreira
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.,Translational Neuro-Urology, Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
| | - Célia Duarte Cruz
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, Porto, Portugal.,Translational Neuro-Urology, Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal
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15
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Casteleijn NF, Cornel EB. Argus-T adjustable male sling: A follow-up study on urinary incontinence and patient's satisfaction. Neurourol Urodyn 2021; 40:802-809. [PMID: 33527521 DOI: 10.1002/nau.24619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/09/2022]
Abstract
AIMS The use of Argus-T adjustable sling may be a promising alternative option for the treatment of urinary incontinence after radical prostatectomy, however long-term data is lacking. The aim of this study is to evaluate the long-term results of the Argus-T sling on incontinence rates, patient's quality of life and tape-related complications. METHODS Patients were eligible if persistent stress incontinence was present ≥12 months after radical prostatectomy. Measurements included 24 h frequency volume micturition list, 24 h pad test, 24 h pad count and quality of life questionnaires. Argus-T adjustable sling was placed with a single perineal route incision approach. RESULTS Seventy-eight patients were included, 69 ± 6 years, pre-intervention 24 h urinary loss 212 (75-385) g. Directly after surgery, 63.6% of the patients was completely dry, 79.2% of the patients reported greater than 90% improvement of their urinary loss and 92.2% > 50% improvement. Median follow-up time was 3.2 (2.5-6.1) years. After 5 years of follow-up, 53.3% of the patients were completely dry, 71.5% reported an improvement greater than 90% and 79.6% reported an improvement of greater than 50%. Patients with preoperative urinary loss less than 250 g reported significantly higher improvement of their urinary loss compared to patients with urinary loss ≥250 g (p = .02). Patients satisfaction was still increased after 5 years follow-up (70 ± 21 vs.16 ± 9, p < .001) and patients quality of life remained high (85 ± 20 vs. 88 ± 13, p = .1). Complications were mainly observed directly after surgery. Two patients (2.6%) needed reimplantation of the sling. CONCLUSION These data indicate that Argus-T sling is an effective treatment option in obtaining substantial long-term incontinence relief in patients with invalidating moderate stress urinary incontinence after radical prostatectomy.
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Affiliation(s)
- Niek F Casteleijn
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands.,Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik B Cornel
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands
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16
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Ostrowski I, Śledź E, Wilamowski J, Józefczak M, Dyś W, Ciechan J, Drewa T, Chłosta PL. Patients' quality of life after implantation of ZSI 375 artificial urinary sphincter due to stress urinary incontinence. Cent European J Urol 2020; 73:178-186. [PMID: 32782838 PMCID: PMC7407780 DOI: 10.5173/ceju.2020.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The study aimed to evaluate the outcomes of artificial urinary sphincter ZSI 375 implantation for stress urinary incontinence, focusing on quality of life assessment (QoL). Material and methods The study had a prospective and non-randomized design. It was conducted in two urological centres in Poland. Between July 2013 and June 2019, artificial urinary sphincter ZSI 375 was implanted in 86 consecutive men with stress urinary incontinence. The follow up was completed in December 2019. The assessment of functional results was based on number of pads used and declared to have been used by patients. The quality of life was assessed on the basis of the ICIQ-SF questionnaire (International Consultation on Incontinence Questionnaire-Short Form), SF-36 questionnaire (Short Form 36 Health Survey Questionnaire) and the severity of pain by means of the NRS (numerical rating scale of pain intensity). Results The operations were performed in 86 patients aged 28 to 80 (median 69). With the median (SD; range) follow-up of 21 (20.2; 1–68) months, daily pad usage decreased significantly from ≥4 to 1.1 (±0.97 pads) per day. Seven (8.1%) patients achieved total continence, 60 (69.8%) social continence, 14 (16.3%) improvement and 5 (5.8%) failures (≥4 pads per day). 15 patients (17.5%) experienced complications after surgery. The study showed a significant improvement of QoL evaluated by ICIQ-UI SF and SF-36. Conclusions Therapy with the use of ZSI 375 device is successfully applied in surgical management of moderate to severe male stress urinary incontinence. The life quality of patients assessed using questionnaires is at a high level.
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Affiliation(s)
- Ireneusz Ostrowski
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Emil Śledź
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Jacek Wilamowski
- Collegium Medicum of Nicolaus Copernicus University, Clinic of General and Oncological Urology, Bydgoszcz, Poland
| | - Mateusz Józefczak
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Wojciech Dyś
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Janusz Ciechan
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Tomasz Drewa
- Collegium Medicum of Nicolaus Copernicus University, Clinic of General and Oncological Urology, Bydgoszcz, Poland
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17
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Complications after male adjustable suburethral sling implantation. Wideochir Inne Tech Maloinwazyjne 2020; 15:496-502. [PMID: 32904554 PMCID: PMC7457203 DOI: 10.5114/aoms.2020.97413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Argus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI). Aim To determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI. Material and methods A total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects. Results Overall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system. Conclusions Argus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.
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18
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Alam S, Kershen R, Staff I, McLaughlin T, Tortora J, Wagner J. Use of EPIC 26 to identify men likely to benefit from surgical interventions for urinary incontinence after radical prostatectomy. World J Urol 2020; 39:1439-1443. [PMID: 32594227 DOI: 10.1007/s00345-020-03325-6] [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: 04/24/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To examine outcomes of surgical procedures for urinary incontinence after radical prostatectomy (post-RP UI) and to identify patients who may benefit from a surgical intervention to treat post-RP UI. METHODS A retrospective chart review identified men who underwent radical prostatectomy (RP) from July 2004 through July 2016 at our institution. Cases underwent surgical interventions for UI following RP. Controls had RP during the study period but did not have an intervention for UI following RP. We used the UI scale of the Expanded Prostate Index Composite (EPIC) 26 to: (1) quantify post-RP UI before and after UI intervention overall and for specific surgical procedures; (2) evaluate the significance of improvement in post-RP UI before and after UI intervention and (3) identify controls with levels of post-RP UI that were comparable to the cases. RESULTS Two thousand nine hundred and sixty-eight RPs were performed; 48 patients underwent further surgical intervention (39 slings, 9 artificial urinary sphincter, AUS). For 20 cases with complete EPIC UI data (15 slings, 5 AUS), the median (IQR) pre-UI intervention score was 27.00 (IQR 22.75-42.75). Improvement was significant overall (p < 0.001) and for slings (p = 0.001). 71/2085 controls had post-prostatectomy UI scores ≤ 27.0, suggesting that they may have benefited from a post-RP surgical intervention for UI. CONCLUSION Data support the effectiveness of surgery to treat post-RP UI. A sizeable population of unidentified men may benefit from a surgical intervention to treat urinary incontinence after RP.
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Affiliation(s)
- Syed Alam
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
| | - Richard Kershen
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Tara McLaughlin
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA.
| | - Joseph Tortora
- Hartford Hospital Research Program, Hartford Hospital, Hartford, CT, 06106, USA
| | - Joseph Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, 85 Seymour Street, Suite 416, Hartford, CT, 06106, USA
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19
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Simforoosh N, Dadpour M, Mousapour P, Honarkar Ramezani M. Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience. Urologia 2020; 87:178-184. [PMID: 32493134 DOI: 10.1177/0391560320925570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is a growing concern about postsurgical outcomes of radical prostatectomy, especially in the younger population and patients with earlier tumor stages. Here, we present our 17 years' experience of sutureless vesico-urethral alignment after radical prostatectomy with a focus on postoperative functional urinary outcomes. METHODS Data of 784 patients who underwent radical prostatectomy during 2001-2017 were evaluated retrospectively. Before surgery, patients' demographic information, pathologic stage, margin of surgery, prostate-specific antigen, and Gleason score were obtained. Then, serum prostate-specific antigen level, urinary continence, potency, and other functional outcomes of surgery were recorded after each postoperative visit. RESULTS The mean age (±standard deviation) of patients was 61.3 (±6.30) years. The median (IQ25-75) duration of follow-up was 30 (12-72) months. Full continence was achieved in 90% and 95.9% of patients at 3 and 6 months post surgery and 96.4% of the patients were continent at the last follow-up visit. Bladder neck stricture occurred in 167 patients (21.3%). During the follow-up period, none of the patients complained of total incontinence and at the last visit, 36.6% of patients reported potency. The frequency of grade 2 continence was significantly higher in patients with high-stage tumors (T3/T4), high Gleason score (⩾8), high preoperative serum prostate-specific antigen (>20 ng/dL), and positive margin of surgery. Potency had a significant relationship with age, stage of the disease, and preoperative prostate-specific antigen. CONCLUSION Maximal sparing of intrapelvic urethral length through sutureless vesico-urethral alignment technique results in excellent early urinary continence recovery after radical prostatectomy. A more advanced tumor stage (T1/T2), a higher Gleason score, high preoperative prostate-specific antigen, as well as positive surgical margin are risk factors of postoperative incontinence in patients who undergo radical prostatectomy.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouria Mousapour
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Honarkar Ramezani
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Dosanjh A, Baldwin S, Mytton J, King D, Trudgill N, Belal M, Patel P. A national study of artificial urinary sphincter and male sling implantation after radical prostatectomy in England. BJU Int 2019; 125:467-475. [PMID: 31755624 DOI: 10.1111/bju.14955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To consider the provision of post-radical prostatectomy (RP) continence surgery in England. MATERIALS AND METHODS Patients with an Office of Population Census and Surveys Classification of Interventions and Procedures, version 4 code for an artificial urinary sphincter (AUS) or male sling between 1 January 2010 and 31 March 2018 were searched for within the Hospital Episode Statistics (HES) dataset. Those without previous RP were excluded. Multivariable logistic regressions for repeat AUS and sling procedures were built in stata. Further descriptive analysis of provision of procedures was performed. RESULTS A total of 1414 patients had received index AUS, 10.3% of whom had undergone prior radiotherapy; their median follow-up was 3.55 years. The sling cohort contained 816 patients; 6.7% of these had received prior radiotherapy and the median follow-up was 3.23 years. Whilst the number of AUS devices implanted had increased each year, male slings peaked in 2014/2015. AUS redo/removal was performed in 11.2% of patients. Patients in low-volume centres were more likely to require redo/removal (odds ratio [OR] 2.23 95% confidence interval [CI] 1.02-4.86; P = 0.045). A total of 12.0% patients with a sling progressed to AUS implantation and 1.3% had a second sling. Patients with previous radiotherapy were more likely to require a second operation (OR 2.03 95% CI 1.01-4.06; P = 0.046). Emergency re-admissions within 30 days of index operation were 3.9% and 3.6% fewer in high-volume centres, for AUS and slings respectively. The median time to initial continence surgery from RP was 2.8 years. Increased time from RP conferred no reduced risk of redo surgery for either procedure. CONCLUSION There is a volume effect for outcomes of AUS procedures, suggesting that they should only be performed in high-volume centres. Given the known impact of incontinence on quality of life, patients should be referred sooner for post-prostatectomy continence surgery.
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Affiliation(s)
- Amandeep Dosanjh
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Baldwin
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Dominic King
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nigel Trudgill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Mohammed Belal
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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21
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Ostrowski I, Golabek T, Ciechan J, Śledź E, Przydacz M, Dyś W, Blewniewski M, von Heyden B, Pottek T, Neugart F, Carrieri G, Selvaggio O, Iori F, Arjona MF, Foley S, Yang B, Llorens C, Różanski W, Chłosta PL. Preliminary outcomes of the European multicentre experience with the ZSI 375 artificial urinary sphincter for treatment of stress urinary incontinence in men. Cent European J Urol 2019; 72:263-269. [PMID: 31720028 PMCID: PMC6830485 DOI: 10.5173/ceju.2019.1920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction The ZSI 375 is a new artificial urinary sphincter utilised in men suffering from stress urinary incontinence (SUI). We present the first European multicentre study on the effectiveness of ZSI 375. Material and methods This study was conducted in a retrospective, non-randomized format in centres across Europe. Between May 2009 and December 2014, ZSI 375 was fitted in 109 SUI patients following radical prostatectomy, transurethral resection of prostate (TURP), rectal surgery and high intensity focused ultrasound (HIFU). Patients with history of pelvic radiotherapy or previous surgical treatment for incontinence or stricture were excluded from the series. Follow-up was completed by December 2016. The key outcome measures included overall improvement and complication rates. Results A total of 109 patients in 10 European centres were recruited and had the ZSI 375 device implanted. The average patient age was 72 years old. The indication for the majority of patients was incontinence following radical prostatectomy (100/109 patients, 91.74%). On average, patients were incontinent for 48.6 months prior to treatment. All patients used ≥4 pads daily at baseline and thus were classified as suffering from ‘severe incontinence’. The average follow-up until the final visit was 43 months. The pad usage decreased to 0.84 on average by the last visit. There were no reported cases of device infection. A total of 9 patients had urethral cuff erosion (8.25%),which was the most common complication in this series. A further 3 men (2.75%) experienced mechanical failure requiring subsequent device reimplantation. The implantation of the ZSI 375 device was considered successful in 92.66% of patients. Conclusions The ZSI 375 is an effective surgical treatment option in men with severe stress urinary incontinence.
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Affiliation(s)
- Ireneusz Ostrowski
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Tomasz Golabek
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
| | - Janusz Ciechan
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Emil Śledź
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
| | - Wojciech Dyś
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Mariusz Blewniewski
- Department of General, Oncological and Functional Urology, II Clinic of Urology, Łódź, Poland
| | | | - Tobias Pottek
- Department of Reconstructive Urology, Vivantes Urban Hospital, Berlin, Germany
| | | | | | | | - Francesco Iori
- Department of Urology, University Hospital Policlinic Umberto I, Rome, Italy
| | | | - Steve Foley
- Department of Urology, Reading, United Kingdom
| | - Bob Yang
- Department of Urology, Reading, United Kingdom
| | | | - Waldemar Różanski
- Department of General, Oncological and Functional Urology, II Clinic of Urology, Łódź, Poland
| | - Piotr L Chłosta
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
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22
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Sussman RD, Peyronnet B, Brucker BM. The current state and the future of robotic surgery in female pelvic medicine and reconstructive surgery. Turk J Urol 2019; 45:331-339. [PMID: 31509506 DOI: 10.5152/tud.2019.19068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
In this article, we review the current uses and future directions of robotic surgery in the field of female pelvic medicine and reconstructive surgery. Pelvic surgery is ideal for the use of surgical robots, which provide improved visualization and ease of suturing deep within the pelvis. Robots have been successfully used for the treatment of pelvic organ prolapse, in procedures such as sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication. Surgeons have used the robotic successfully to treat various etiologies of female pelvic pain including fibroids, endometriosis, and nerve entrapment. Robotic repair of iatrogenic injury has been described with excellent outcomes and avoidance of conversion to open surgery in the event of an injury caused using the robotic platform. While more data is needed on this topic, there has been increasing interest in using the robot for urologic reconstruction including repair of vesico-vaginal fistula, cystectomy, augmentation cystoplasty, and continent and non-continent diversions. Recently the use of the robot has been described in the treatment of stress urinary incontinence in females, with robotic placement of an artificial urinary sphincter. While robotic surgery is associated with increased cost, the outcomes of robotic surgery in female urology are promising. More studies that properly evaluate the benefits of robotic surgery as compared to open and laparoscopic approaches are needed.
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Abdullah A, Machkour F, Bouchet E, Plainard X, Descazeaud A. Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study. Prog Urol 2019; 29:490-495. [PMID: 31387835 DOI: 10.1016/j.purol.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 12/01/2022]
Abstract
AIM To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling. MATERIAL AND METHOD Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL. RESULTS Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered. CONCLUSION The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Abdullah
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France; Department of surgery (Urology unit), Al-Amiri hospital, Kuwait City, Kuwait.
| | - F Machkour
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - E Bouchet
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - X Plainard
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - A Descazeaud
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France.
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24
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Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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25
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Borges RC, Tobias-Machado M, Gabriotti EN, Dos Santos Figueiredo FW, Bezerra CA, Glina S. Post-radical prostatectomy urinary incontinence: is there any discrepancy between medical reports and patients' perceptions? BMC Urol 2019; 19:32. [PMID: 31060521 PMCID: PMC6501406 DOI: 10.1186/s12894-019-0464-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background Post-radical prostatectomy urinary incontinence (PPI) negatively affects the quality of life of patients. Accurate identification of the problem by physicians is essential for adequate postoperative management. In this study we sought to access whether there is, for urinary incontinence, any discrepancy between medical reports and the perception of patients. Methods We performed a retrospective analysis of medical records of 337 patients subjected to radical retropubic prostatectomy (RRP) between 2005 and 2010. Sociodemographic variables were collected, as well as continence status over the course of treatment. Next, we contacted patients by phone to determine continence status at present and at time of their last appointment, as well as to apply ICIQ – SF questionnaire. Poisson regression model with robust variance was used to estimate the factors associated with discrepancy, using the stepwise backward strategy. Software used was Stata® (StataCorp, LC) version 11.0. Results There is discrepancy between medical reports and patients’ perceptions in 42.2% of cases. This discrepancy was found in 56% of elderly patients and 52% of men with low schooling, with statistical significance in these groups (p = 0.069 and 0.0001, respectively), whereas in multivariate regression analysis the discrepancy rate was significantly higher in black men (discrepancy rate of 52.6%) with low schooling (p = 0.004 and 0.043, respectively). Conclusion There is discrepancy between medical reports and the perception of black men with low schooling in respect to post-radical prostatectomy urinary incontinence and a need for more thorough investigation of this condition in patients that fit this risk profile.
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Affiliation(s)
- Rafael Castilho Borges
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil.
| | - Marcos Tobias-Machado
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | - Estefânia Nicoleti Gabriotti
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | | | - Carlos Alberto Bezerra
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
| | - Sidney Glina
- Department of Urology, Faculdade de Medicina do ABC, No.2000, Avenue Lauro Gomes, Santo André, 09051-040, Brazil
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26
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Noordhoff TC, Finazzi-Agrò E, Scheepe JR, Blok BFM. Outcome and complications of adjustable continence therapy (ProACT TM ) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study. Neurourol Urodyn 2019; 38:1111-1119. [PMID: 30848845 PMCID: PMC6850145 DOI: 10.1002/nau.23966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/28/2018] [Accepted: 02/07/2019] [Indexed: 11/11/2022]
Abstract
Aim To evaluate the outcome of adjustable continence balloons in the treatment of stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods In two tertiary centers, adjustable continence balloons were implanted in 29 patients with post‐TURP SUI between 2007 and 2018. Endpoints of this retrospective multicenter study were patient‐reported changes in pad count and complications. Dry was defined as no pad or one security pad. Results Preoperative urinary incontinence was mild in 7 (24%), moderate in 12 (41%), and severe in 10 (35%) patients. The median follow‐up duration was 21 (interquartile range [IQR], 11‐43) months. Within 30 days postoperatively, a Clavien‐Dindo grade less than or equal to II complication occurred in 24% of the patients. Reintervention rate was 24%. Six and 12 months after implantation, the International Prostate Symptom Score (IPSS) quality‐of‐life item improved significantly from 5 (IQR, 5‐6) preoperatively to 3 (IQR, 1‐4.5) and 1 (IQR, 0‐3), respectively. At last visit (median 21 months after implantation), the outcome on continence had improved in 76% of the patients, including, 45% dry patients. After a median follow‐up of 28 months (IQR, 13‐63; N = 23), all but one patient reported improvement on the Patient Global Impression of Improvement (PGI‐I) scale. In detail, 10 patients reported “very much better” condition compared with before the implantation, 10 patients “much better,” two patients “a little better,” and one patient “no change.” Daily pad use decreased from three (IQR, 2‐5) to one (IQR, 0‐2) pads/day (P < 0.001). Conclusions This is hitherto, the first study reporting results of adjustable continence balloons in the treatment of post‐TURP SUI. The therapy was found to be safe and efficient. The majority of our study population reported improvement on their condition and greater than or equal to 50% reduction in daily pad use.
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Affiliation(s)
- Toscane C Noordhoff
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Enrico Finazzi-Agrò
- Department of Eperimental Medicine and Surgery, University of Rome "Tor Vergata", Urology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Jeroen R Scheepe
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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27
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Effect of Radiation on Male Stress Urinary Incontinence and the Role of Urodynamic Assessment. Urology 2019; 125:58-63. [DOI: 10.1016/j.urology.2018.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 02/03/2023]
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28
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Urethral Bulking and Salvage Techniques for Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Nicolas M, Droupy S, Costa P. Efficacité des ballons Pro-ACT™ dans le traitement de seconde ligne de l’incontinence urinaire d’effort post-prostatectomie après échec des bandelettes sous-urétrales. Prog Urol 2019; 29:36-44. [DOI: 10.1016/j.purol.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 05/28/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
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30
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Tutolo M, Cornu JN, Bauer RM, Ahyai S, Bozzini G, Heesakkers J, Drake MJ, Tikkinen KAO, Launonen E, Larré S, Thiruchelvam N, Lee R, Li P, Favro M, Zaffuto E, Bachmann A, Martinez-Salamanca JI, Pichon T, De Nunzio C, Ammirati E, Haab F, Van Der Aa F. Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn 2018; 38:710-718. [PMID: 30575997 DOI: 10.1002/nau.23901] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 11/08/2022]
Abstract
AIMS To assess efficacy and safety as well as predictive factors of dry rate and freedom from surgical revision in patients underwent AUS placement. The artificial urinary sphincter (AUS) is still considered the standard for the treatment of moderate to severe post-prostatectomy stress urinary incontinence (SUI). However, data reporting efficacy and safety from large series are lacking. METHODS A multicenter, retrospective study was conducted in 16 centers in Europe and USA. Only primary cases of AUS implantation in non-neurogenic SUI after prostate surgery, with a follow-up of at least 1 year were included. Efficacy data (continence rate, based on pad usage) and safety data (revision rate in case of infection and erosion, as well as atrophy or mechanical failure) were collected. Multivariable analyses were performed in order to investigate possible predictors of the aforementioned outcomes. RESULTS Eight hundred ninety-two men had primary AUS implantation. At 32 months mean follow-up overall dry rate and surgical revision were 58% and 30.7%, respectively. Logistic regression analysis showed that patients without previous incontinence surgery had a higher probability to be dry after AUS implantation (OR: 0.51, P = 0.03). Moreover institutional case-load was positively associated with dry rate (OR: 1.18; P = 0.005) and freedom from revision (OR: 1.51; P = 0.00). CONCLUSIONS The results of this study showed that AUS is an effective option for the treatment of SUI after prostate surgery. Moreover previous incontinence surgery and low institutional case-load are negatively associated to efficacy and safety outcomes.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Sascha Ahyai
- Department of Urology, University-Medical-Center Hamburg, Hamburg, Germany.,Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | | | - John Heesakkers
- Department of Urology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
| | - Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
| | - Kari A O Tikkinen
- Department of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ene Launonen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, United Kingdom
| | - Richard Lee
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Philip Li
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Michele Favro
- Department of Urology, Ospedale Maggiore Della Carità Di Novara, Novara, Italy
| | - Emanuele Zaffuto
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas Pichon
- Department of Urology, Angers University Hospital, Angers, France
| | - Cosimo De Nunzio
- Department of Urology, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Enrico Ammirati
- Department of Urology, Azienda Ospedaliera Universitaria, Città Della Salute E Della Scienza, Ospedale Molinette, Turin, Italy
| | | | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Viers BR, VanDyke ME, Pagliara TJ, Shakir NA, Scott JM, Morey AF. Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity? UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Boyd R. Viers
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maia E. VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis J. Pagliara
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nabeel A. Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeremy M. Scott
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allen F. Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Angulo JC, Fonseca J, Esquinas C, Ojea A, Rodríguez A, Rabassa M, Teba F, Escribano G, Cruz F. Adjustable transobturator male system (ATOMS ®) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate. Actas Urol Esp 2018; 42:567-573. [PMID: 29929737 DOI: 10.1016/j.acuro.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS®) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. MATERIALS AND METHODS Twenty patients were implanted ATOMS® for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). RESULTS Median age was 76.5years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5ml. Median pad-test decreased from 375±855ml baseline to 10±31.5ml and pad-count from 4±3 to 0±1.5 after adjustment (1±3fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. CONCLUSION Based on short-term efficacy and patient satisfaction ATOMS® can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments.
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Affiliation(s)
- J C Angulo
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, España; Fundação Champalimaud, Lisboa, Portugal.
| | - J Fonseca
- Fundação Champalimaud, Lisboa, Portugal
| | - C Esquinas
- Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, España
| | - A Ojea
- Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - A Rodríguez
- Hospital Arquitecto Marcide, Ferrol, La Coruña, España
| | | | - F Teba
- Hospital Universitario de La Princesa, Madrid, España
| | | | - F Cruz
- Centro Hospitalar São João, Oporto, Portugal
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Lima SVC, de Barros EGC, Vilar FDO, Pinto FCM, Barros TDP, Truzzi JC, de Toledo LGM, Kanasiro F, Amaro JL. Artificial sphincter "BR - SL - AS 904" in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study. Int Braz J Urol 2018; 44:1215-1223. [PMID: 30325613 PMCID: PMC6442165 DOI: 10.1590/s1677-5538.ibju.2018.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/26/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter “BR - SL - AS – 904” in the control of urinary incontinence in post - PR patients and to evaluate their complications. Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant “BR - SL - AS – 904” according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. Results: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. Conclusion: The artificial sphincter implant “BR - SL - AS 904” was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.
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Affiliation(s)
- Salvador Vilar Correia Lima
- Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil.,Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil
| | | | - Fabio de Oliveira Vilar
- Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil
| | - Flavia Cristina Morone Pinto
- Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil
| | - Thomé Décio Pinheiro Barros
- Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil.,Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil
| | - José Carlos Truzzi
- Departamento de Urologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | - João Luiz Amaro
- Disciplina de Urologia, Unesp - Universidade Estadual Paulista, São Paulo, SP, Brasil
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Aagaard MF, Khayyami Y, Hansen FB, Tofft HP, Nordling J. Implantation of the argus sling in a hard-to-treat patient group with urinary stress incontinence. Scand J Urol 2018; 52:448-452. [PMID: 30298753 DOI: 10.1080/21681805.2018.1517823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Awareness of prostate cancer is growing in the Western population, and an increasing number of patients are being referred to prostate surgery. This is a significant contributor to male stress urinary incontinence (SUI). Implantation of an artificial sphincter (AUS) is considered the gold standard treatment of SUI. This study investigates the role of minimally invasive treatment with the Argus sling in a heterogenic hard-to-treat patient group. METHOD The study was a retrospective follow-up study with patients as their own controls. Forty-one patients were enrolled and treated with the Argus sling. Patients enrolled had persisting SUI after prostate surgery for more than 12 months, despite conservative treatment. The pre-operative daily usage of pads and the 24 hours urinary leakage were compared to the post-operative findings. The primary goal was to achieve complete continence or a reduction of more than 50% in pad usage or urinary leakage. RESULTS In total, 71% of the 41 patients enrolled met our primary objective. Complete continence was obtained in 56%, and a reduction of 50% or more was obtained in an additional 15%. CONCLUSION This study has reproduced continence rates seen in previous studies, but in the hard-to-treat patients with urgency or formerly failed surgery, the continence rate was found to be inferior. The AUS has produced similar results and must still be considered the gold standard treatment of SUI, but the Argus sling is an alternative for patients who want a passive system or for patients not suitable for AUS.
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Affiliation(s)
| | - Yasmine Khayyami
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Frank Bohn Hansen
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Hans Peter Tofft
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Jørgen Nordling
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
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Fuchs JS, Shakir N, McKibben MJ, Scott JM, Morey AF. Prolonged Duration of Incontinence for Men Before Initial Anti-incontinence Surgery: An Opportunity for Improvement. Urology 2018; 119:149-154. [DOI: 10.1016/j.urology.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
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Peyronnet B, Capon G, Belas O, Manunta A, Allenet C, Hascoet J, Calves J, Belas M, Callerot P, Robert G, Descazeaud A, Fournier G. Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence. Eur Urol 2018; 75:169-175. [PMID: 30139632 DOI: 10.1016/j.eururo.2018.07.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Widespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach. OBJECTIVE To describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique. DESIGN, SETTINGS, AND PARTICIPANTS We retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery. SURGICAL PROCEDURE The AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection. MEASUREMENTS The primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence. RESULTS AND LIMITATIONS Forty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%). CONCLUSIONS In this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers. PATIENT SUMMARY Robot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.
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Affiliation(s)
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Olivier Belas
- Department of Urology, Pole Santé Sud, Le Mans, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Clément Allenet
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Jehanne Calves
- Department of Urology, University of Brest, Brest, France
| | - Michel Belas
- Department of Urology, Pole Santé Sud, Le Mans, France
| | | | - Grégoire Robert
- Department of Urology, University of Bordeaux, Bordeaux, France
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Ostrowski I, Ciechan J, Sledz E, Dys W, Golabek T, Chłosta PL. Four-year follow-up on a Zephyr Surgical Implants 375 artificial urinary sphincter for male urinary incontinence from one urological centre in Poland. Cent European J Urol 2018; 71:320-325. [PMID: 30386654 PMCID: PMC6202622 DOI: 10.5173/ceju.2018.1704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The treatment of choice for patients who have iatrogenic urinary incontinence is the implantation of an artificial urinary sphincter. We performed a prospective study on the outcomes of men undergoing artificial urinary sphincter (AUS) implantation (ZSI 375; Zephyr Surgical Implants, Geneva, Switzerland). Material and methods Patients with moderate-to-severe stress incontinence urinary were included. The ZSI 375 device is a one-piece device with a cuff and a pump unit. Patients underwent a perineal incision for cuff insertion and an inguinal incision for the pump unit to be placed in the scrotum. Complications and number of pads used to manage incontinence were recorded. Perioperative complications were categorized according to the Clavien-Dindo classification. Pain connected with implantation of AUS was assessed with the visual analogue scale (VAS). Results Between July 2013 and June 2017, 50 patients underwent ZSI 375 device insertion in the Department of Urology and Urological Oncology in Puławy, Poland. The follow-up stopped at the end of September 2017. The median (range) follow-up was 21.04 (1-50) months. No patient experienced bladder hyperactivity. Complications leading to a revision or permanent device removal arose in 12 patients (erosion = 9, infection = 0, mechanical failure = 3). Social continence (0 or 1 pad/day) was achieved in 29/50 patients (58%). An improvement (50% less pads/day) was achieved in 15/50 patients (30%). A failure was seen in 6/50 patients (12%). Perioperatively, all patients were classified as grade I in the Clavien-Dindo classification. Mean value of pain intensity in VAS was 0.82. Conclusions The ZSI 375 device is safe, effective and the follow-up period was long enough to identify all potential complications.
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Affiliation(s)
- Ireneusz Ostrowski
- Department of Urology and Urological Oncology, Regional Specialist Hospital, Puławy, Poland
| | - Janusz Ciechan
- Department of Urology and Urological Oncology, Regional Specialist Hospital, Puławy, Poland
| | - Emil Sledz
- Department of Urology and Urological Oncology, Regional Specialist Hospital, Puławy, Poland
| | - Wojciech Dys
- Department of Urology and Urological Oncology, Regional Specialist Hospital, Puławy, Poland
| | - Tomasz Golabek
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
| | - Piotr L Chłosta
- Department of Urology, Jagiellonian University, Medical College, Cracow, Poland
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Shamout S, Huang YQ, Kabbara H, Corcos J, Campeau L. Short‐term evaluation of the adjustable bulbourethral male sling for post‐prostatectomy urinary incontinence. Low Urin Tract Symptoms 2018; 11:O111-O116. [DOI: 10.1111/luts.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Samer Shamout
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
| | - Yu Qing Huang
- Faculty of MedicineMcGill University Montreal Canada
| | - Hani Kabbara
- StatRAC Statistical Research and Analysis Consultancy Firm Montreal Canada
| | - Jacques Corcos
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
| | - Lysanne Campeau
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
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Manso M, Alexandre B, Antunes-Lopes T, Martins-da-Silva C, Cruz F. Is the adjustable transobturator system ATOMS® useful for the treatment of male urinary incontinence in low to medium volume urological centers? Actas Urol Esp 2018; 42:267-272. [PMID: 29174630 DOI: 10.1016/j.acuro.2017.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment is the artificial urinary sphincter, however, new treatments have been investigated. OBJECTIVE To examine the outcome of an adjustable transobturator male system (ATOMS®) in men with UI after prostatic surgery in a low to medium volume continence center. MATERIALS AND METHODS Twenty-five men with UI were implanted with ATOMS® system between 2012 and 2014. The most common indication was UI after RP (92%), followed by UI after TURP (8%). Eleven patients (44%) had received adjuvant external beam radiotherapy (RT). Patients were considered to be 'dry' if they stopped wearing pads or needed just one protective pad per day; and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire (ICIQ-SF) was used, adding a verbal question about the satisfaction of the patient considering the outcome. RESULTS After a mean follow-up of 21.56 months, 64% were dry and 8% revealed a significant improvement. The success of the procedure was negatively correlated with the severity of the previous UI and with previous treatment with RT. Concerning patients satisfaction, 84% of the patients would repeat the procedure. CONCLUSION ATOMS® offers good rates of cure and improvement of UI after prostatic surgery with a reasonable rate of minor complications. The results of this study, performed in a low to medium volume continence center, are comparable to the results achieved in high volume continence centers.
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Affiliation(s)
- M Manso
- Urology Department, Centro Hospitalar São João, Porto, Portugal.
| | - B Alexandre
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - T Antunes-Lopes
- Urology Department, Centro Hospitalar São João, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
| | - C Martins-da-Silva
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Cruz
- Urology Department, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; i3S Institute for Innovation and Health Research, Porto, Portugal
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Management of Postradical Prostatectomy Urinary Incontinence: A Review. Urology 2018; 113:13-19. [DOI: 10.1016/j.urology.2017.09.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/20/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
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Constable L, Cotterill N, Cooper D, Glazener C, Drake MJ, Forrest M, Harding C, Kilonzo M, MacLennan G, McCormack K, McDonald A, Mundy A, Norrie J, Pickard R, Ramsay C, Smith R, Wileman S, Abrams P. Male synthetic sling versus artificial urinary sphincter trial for men with urodynamic stress incontinence after prostate surgery (MASTER): study protocol for a randomised controlled trial. Trials 2018; 19:131. [PMID: 29467024 PMCID: PMC5822657 DOI: 10.1186/s13063-018-2501-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is a frequent adverse effect for men undergoing prostate surgery. A large proportion (around 8% after radical prostatectomy and 2% after transurethral resection of prostate (TURP)) are left with severe disabling incontinence which adversely effects their quality of life and many are reliant on containment measures such as pads (27% and 6% respectively). Surgery is currently the only option for active management of the problem. The overwhelming majority of surgeries for persistent bothersome SUI involve artificial urinary sphincter (AUS) insertion. However, this is expensive, and necessitates manipulation of a pump to enable voiding. More recently, an alternative to AUS has been developed – a synthetic sling for men which elevates the urethra, thus treating SUI. This is thought, by some, to be less invasive, more acceptable and less expensive than AUS but clear evidence for this is lacking. The MASTER trial aims to determine whether the male synthetic sling is non-inferior to implantation of the AUS for men who have SUI after prostate surgery (for cancer or benign disease), judged primarily on clinical effectiveness but also considering relative harms and cost-effectiveness. Methods/design Men with urodynamic stress incontinence (USI) after prostate surgery, for whom surgery is judged appropriate, are the target population. We aim to recruit men from secondary care urological centres in the UK NHS who carry out surgery for post-prostatectomy incontinence. Outcomes will be assessed by participant-completed questionnaires and 3-day urinary bladder diaries at baseline, 6, 12 and 24 months. The 24-h urinary pad test will be used at baseline as an objective assessment of urine loss. Clinical data will be completed at the time of surgery to provide details of the operative procedures, complications and resource use in hospital. At 12 months, men will also have a clinical review to evaluate the results of surgery (including another 24-h pad test) and to identify problems or need for further treatment. Discussion A robust examination of the comparative effectiveness of the male synthetic sling will provide high-quality evidence to determine whether or not it should be adopted widely in the NHS. Trial registration International Standard Randomised Controlled Trial Registry: Number ISRCTN49212975. Registered on 22 July 2013. First patient randomised on 29 January 2014. Electronic supplementary material The online version of this article (10.1186/s13063-018-2501-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Chris Harding
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Anthony Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Robert Pickard
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
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Zhang F, Liao L. Artificial urinary sphincter implantation: an important component of complex surgery for urinary tract reconstruction in patients with refractory urinary incontinence. BMC Urol 2018; 18:3. [PMID: 29310634 PMCID: PMC5759840 DOI: 10.1186/s12894-018-0314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 01/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background We review our outcomes and experience of artificial urinary sphincter implantation for patients with refractory urinary incontinence from different causes. Methods Between April 2002 and May 2017, a total of 32 patients (median age, 40.8 years) with urinary incontinence had undergone artificial urinary sphincter placement during urinary tract reconstruction. Eighteen patients (56.3%) were urethral injuries associated urinary incontinence, 9 (28.1%) had neurogenic urinary incontinence and 5 (15.6%) were post-prostatectomy incontinence. Necessary surgeries were conducted before artificial urinary sphincter placement as staged procedures, including urethral strictures incision, sphincterotomy, and augmentation cystoplasty. Results The mean follow-up time was 39 months. At the latest visit, 25 patients (78.1%) maintained the original artificial urinary sphincter. Four patients (12.5%) had artificial urinary sphincter revisions. Explantations were performed in three patients. Twenty-four patients were socially continent, leading to the overall success rate as 75%. The complication rate was 28.1%; including infections (n = 4), erosions (n = 4), and mechanical failure (n = 1). The impact of urinary incontinence on the quality of life measured by the visual analogue scale dropped from 7.0 ± 1.2 to 2.2 ± 1.5 (P <0.001). Conclusions The primary sources for artificial urinary sphincter implantation in our center are unique, and the procedure is an effective treatment as a part of urinary tract reconstruction in complicated urinary incontinence cases with complex etiology.
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Affiliation(s)
- Fan Zhang
- Department of Urology, China Rehabilitation Research Center, Beijing, 100068, China.,Department of Urology, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Beijing, 100068, China. .,Department of Urology, Capital Medical University, Beijing, China.
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Siracusano S, Visalli F, Favro M, Tallarigo C, Saccomanni M, Kugler A, Diminutto A, Talamini R, Artibani W. Argus-T Sling in 182 Male Patients: Short-term Results of a Multicenter Study. Urology 2017; 110:177-183. [DOI: 10.1016/j.urology.2017.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
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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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Santos ACSD, Rodrigues LDO, Azevedo DC, Carvalho LMDA, Fernandes MR, Avelar SDOS, Horta MGC, Kelles SMB. Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015. Int Braz J Urol 2017; 43:150-154. [PMID: 28124538 PMCID: PMC5293396 DOI: 10.1590/s1677-5538.ibju.2016.0244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/23/2016] [Indexed: 12/29/2022] Open
Abstract
This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.
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Affiliation(s)
- Augusto Cesar Soares Dos Santos
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Luíza de Oliveira Rodrigues
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Daniela Castelo Azevedo
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Lélia Maria de Almeida Carvalho
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Mariana Ribeiro Fernandes
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Sandra de Oliveira Sapori Avelar
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Maria Glória Cruvinel Horta
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
| | - Silvana Márcia Bruschi Kelles
- Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.,Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil
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Lima JPC, Pompeo ACL, Bezerra CA. Argus T® versus Advance® Sling for postprostatectomy urinary incontinence: A randomized clinical trial. Int Braz J Urol 2017; 42:531-9. [PMID: 27286117 PMCID: PMC4920571 DOI: 10.1590/s1677-5538.ibju.2015.0075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the results of two slings, Argus T® and Advance®, for the treatment of postprostatectomy urinary incontinence (PPUI). Material and Methods: From December 2010 to December 2011, 22 patients with PPUI were randomized as follows: 11 (mean age 62.09(±5.30)) underwent treatment with Advance® and 11 (mean age 62.55(±8.54)) with Argus T®. All patients were evaluated preoperatively with urodynamic testing, quality of life questionnaire (ICIQ-SF), voiding diary and 24-hour pad test. Exclusion criteria were: neurological diseases, severe detrusor overactivity and urethral stenosis. Evaluation was performed at 6, 12 and 18 months after the surgery. After implantation of the Argus T® sling, patients who experienced urine leakage equal to or greater than the initial volume underwent adjustment of the sling tension. Results were statistically analyzed using the Fisher’s test, Kolmogorov-Smirnov test, Friedman’s non-parametric test or the Mann-Whitney test. Results Significant improvement of the 24-hour pad test was observed with the Argus T® sling (p=0.038) , With regard to the other parameters, there was no significant difference between the two groups. Removal of the Argus T® device due to perineal pain was performed in one patient (9%). Despite non uniform results, both devices were considered useful to improve quality of life (ICIQ-SF): Argus T® (p=0.018) and Advance® (p=0.017). Conclusions Better results were observed in the 24h pad test and in levels of satisfaction with the Argus T® device. Both slings contributed to improve quality of life (ICIQ-SF), with acceptable side effects.
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Urinary Artificial Sphincter ZSI 375 for Treatment of Stress Urinary Incontinence in Men: 5 and 7 Years Follow-Up Report. Urologia 2017; 84:263-266. [DOI: 10.5301/uj.5000243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/20/2022]
Abstract
Study Design This is a retrospective, non-randomised study. Objectives The aim of this study was to evaluate safety and efficacy of artificial urinary sphincter ZSI 375 inserted in male patients with stress urinary incontinence (SUI). Methods Between May 2009 and January 2017, 45 men with SUI underwent ZSI 375 device insertion. Operations were performed in two French centres by one surgeon. Complications and pad used to manage continence were recorded. Results From May 2009 to January 2012, 45 patients with a mean age of 70.42 years underwent placement of the ZSI 375 device in France. The most common cause for incontinence was radical prostatectomy (RP, 33/45 patients, 73.33%). The minimal period of incontinence was 6 months. Twenty-seven out of 45 patients (60.00%) had a severe incontinence (at least four pads per day), 13 patients (28.89%) had moderate incontinence (three pads per day) and five patients (11.11%) had two pads per day. With a long follow-up, the ZSI 375 device was considered to be successful in 73.33% patients after 5 years (60 months) and 72% of patients after 7 years (84 months). The infection rate was 2.2 % affecting one in 45 patients. Six out of 45 patients presented a urethral erosion (13.33%). Mechanical failure with a revision occurred in three patients (6.67%). Conclusions The ZSI 375 device is a safe and effective device to treat severe SUI in men.
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Buresova E, Vidlar A, Grepl M, Student V, Student V. Single-centre experience in using the adjustable transobturator male system in treatment of stress urinary incontinence in patients after radical prostatectomy. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817701054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context: Urinary incontinence is the most threatening complication after radical prostatectomy. This disorder has an important impact on the quality of life of patients and its treatment is a challenge for urologists as well. Objective: The objective of this article is to report our experience with the adjustable transobturator male system (ATOMS, AMI, Austria) for the treatment of post-prostatectomy incontinence. Material and methods: A total of 35 men with post-prostatectomy incontinence were treated. Before and after device implantation, the number of pads used per day was counted, and a one-hour pad test, uroflowmetry and postmicturition residual volume were assessed. Prior to surgery, anastomosis stricture was either ruled out or treated. To evaluate the success rate, ‘cured’ was defined as no pad use or one safety pad, ‘improved’ was defined as one or two pads or reduction of pad usage by more than 50%, respectively. All data about efficacy and safety were collected from all 35 patients. Results: After a median (range) follow-up of 21.2 (3–63) months, the success rate was 32 out of 35 patients (91.5%) with 22 patients (62.9%) ‘cured’ and 10 patients (28.6%) ‘improved’. Recovery of continence was achieved in seven patients (20.0%). The remaining patients (80%) needed an adjustment. The mean (range) number of adjustments to reach desired results (continence, improvement or patient satisfaction) was 4.3 (1–15). The most common adverse event was transient perineal pain, which was reported in 14 (40%) patients and disappeared within two weeks. Temporary urine retention appeared in one patient (2.9%). There were three cases (8.6%) of wound infection at the site of a port leading to explantation of the port in two patients (5.7%) and the removal of the system in one patient (2.9%). Conclusion: Treatment of post-prostatectomy incontinence with the self-anchoring ATOMS is safe and effective.
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Affiliation(s)
- Eva Buresova
- Clinic of Urology, University Hospital Olomouc, Czech Republic
| | - Ales Vidlar
- Clinic of Urology, University Hospital Olomouc, Czech Republic
| | - Michal Grepl
- Clinic of Urology, University Hospital Olomouc, Czech Republic
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[Not Available]. PRAXIS 2017; 106:1144. [PMID: 29041858 DOI: 10.1024/1661-8157/a002831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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