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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: 2] [Impact Index Per Article: 2.0] [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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Chung E. Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques. Ther Adv Urol 2023; 15:17562872231187199. [PMID: 37528956 PMCID: PMC10387683 DOI: 10.1177/17562872231187199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.
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Bole R, Hebert KJ, Gottlich HC, Bearrick E, Kohler TS, Viers BR. Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications. Transl Androl Urol 2021; 10:2682-2694. [PMID: 34295753 PMCID: PMC8261433 DOI: 10.21037/tau-20-1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Male stress urinary incontinence (SUI) following prostate treatment is a devastating complaint for many patients. While the artificial urinary sphincter is the gold standard treatment for male SUI, the urethral sling is also popular due to ease of placement, lack of mechanical complexity, and absence of manual dexterity requirement. A literature review was performed of male urethral sling articles spanning the last zz20 years using the PubMed search engine. Clinical practice guidelines were also reviewed for comparison. Four categories of male urethral sling were evaluated: the transobturator AdVance and AdVance XP, the bone-anchored InVance, the quadratic Virtue, and the adjustable sling series. Well selected patients with mild to moderate urinary incontinence and no prior history of radiation experienced the highest success rates at long-term follow up. Patients with post-prostatectomy climacturia also reported improvement in leakage after sling. Concurrent penile prosthesis and sling techniques were reviewed, with favorable short-term outcomes demonstrated. Male urethral sling is a user-friendly surgical procedure with durable long-term outcomes in carefully selected men with mild stress urinary incontinence. Multiple sling types are available with varying degrees of efficacy and complication rates. Longer follow-up and larger cohort sizes are needed for treatment of newer indications such as climacturia as well as techniques involving dual placement of sling and penile prosthesis.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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Giammò A, Falcone M, Blecher G, Ammirati E, Geretto P, Manassero A, Bottero D, Lorusso V, Signorello D, Gontero P, Carone R. A Novel Artificial Urinary Sphincter (VICTO®) for the Management of Postprostatectomy Urinary Incontinence: Description of the Surgical Technique and Preliminary Results from a Multicenter Series. Urol Int 2021; 105:414-420. [PMID: 33611317 DOI: 10.1159/000512722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
AIMS The objective of the study was to analyze short-term outcomes and safety profile of the newly designed artificial urinary sphincters (AUSs) VICTO® and VICTOplus®. METHODS Data from the implant of VICTO® or VICTOplus® AUSs on a series of consecutive male patients with stress urinary incontinence (SUI) following radical prostatectomy (RP) were retrospectively collected in 3 tertiary referral centers between May 2017 and December 2019. Patients were affected by moderate-severe genuine SUI (200-400 or >400 g urine leakage in 24-h pad test) refractory to conservative treatment. Outcomes were evaluated through the 24-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Follow-up was scheduled after 3, 6, and 12 months and then when clinically needed. Nonparametric tests were applied in subgroup analyses. RESULTS Seventeen patients were enrolled: 8 were implanted with the VICTO® device and 9 with VICTOplus®. The median age at surgery was 69 (interquartile range (IQR) 60-75) years. The median follow-up was 15 (IQR 12-18) months. At 12 months, the dry rate was 76.4% and the social continence rate was 94%. The postoperative complication rate was 17.6%. All complications were classified as Clavien-Dindo I. No difference in terms of outcomes was observed between the VICTO® and the VICTOplus® subgroups. CONCLUSIONS Preliminary outcomes of the VICTO® and VICTOplus® implantation are satisfactory. These devices may represent a safe and realistic solution for patients with moderate-severe SUI following RP.
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Affiliation(s)
- Alessandro Giammò
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Falcone
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy, .,Department of Urology, University of Turin, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy,
| | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,The Alfred Hospital, Melbourne, Victoria, Australia
| | - Enrico Ammirati
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Urology, University of Turin, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Geretto
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Urology, University of Turin, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alberto Manassero
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Danilo Bottero
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Vito Lorusso
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Diego Signorello
- Department of Urology, Bressanone Hospital, Bressanone, Bolzano, Italy
| | - Paolo Gontero
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Urology, University of Turin, Molinette Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, CTO-Spinal Cord Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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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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Falcone M, Preto M, Ammirati E, Blecher G, Carone R, Gontero P, Giammò A. Dual implantation of penile prosthesis and ATOMS® system for post-prostatectomy erectile dysfunction and urinary incontinence: a feasibility study. Int J Impot Res 2020; 33:577-582. [DOI: 10.1038/s41443-020-0320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
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