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François C, Chabannes É, Kleinclauss F, Frontczak A. ProACT™ (Uromedica, Plymouth, USA) balloons for male urinary incontinence: A fourteen-year-old cohort. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102662. [PMID: 38821385 DOI: 10.1016/j.fjurol.2024.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/14/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Male urinary incontinence is attributed to SUI consecutive to benign prostate hypertrophy surgery, trauma, neurological diseases, or injury. Medical devices are developed to treat male urinary incontinence among them proACT® balloons. This technique was chosen in our center to achieve continence. Our study aims to evaluate safety and efficacy of proACT® balloons implanted in our center by measuring the rate of efficacy. METHODS We performed a retrospective and single centre study. A single expert surgeon performed all surgeries. Seventy-one balloons were implanted in 57 male patients between 2007 and 2020. Primary endpoint was the efficacy time lapse of the balloons after surgery. The analysis was performed using Kaplan-Meier method. Factors, which could affect the efficacy of the balloons, were analysed using a Cox regression analysis. RESULTS In all, 45 balloons successfully cured stress urinary incontinence among the 57 men implanted resulting in a 63.38% success rate. Twenty-six balloons failed to treat stress urinary incontinence and were retrieved out of the 71 implanted. Ten balloons failed to treat urinary stress incontinence without organic cause, 6 balloons deflated, 5 balloons migrated out of the initial implantation site, 2 eroded, and 3 ended up infected. Fifty percent of the balloons were successful for a median time of 95 months. Univariate analysis did not reveal any predictive factor of failure. CONCLUSIONS Our study showed 50% success rate at 95 months follow-up, therefore allowing a life expectancy of 7.9 years for the balloons. This safe mini-invasive technique ensured stress urinary incontinence in men. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Catherine François
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Éric Chabannes
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - François Kleinclauss
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; University of Franche-Comté, Besançon, France; EA 4662, Nanomedicine Lab, Imagery and Therapeutics, Besançon, France
| | - Alexandre Frontczak
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; University of Franche-Comté, Besançon, France; EA 4662, Nanomedicine Lab, Imagery and Therapeutics, Besançon, France.
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Tricard T, Song QX, Munier P, Li JY, Leng J, Saussine C, Pan JH, Xue W. Adjustable continence therapy (proACT) for the treatment of male stress urinary incontinence post-prostatectomy: a systematic review and meta-analysis (2023 update). World J Urol 2023; 41:1793-1802. [PMID: 37311990 DOI: 10.1007/s00345-023-04452-6] [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: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) is a key factor for post-prostatectomy (RP) quality of life. Current international guidelines struggle to find the adequate place for each kind of surgeries. The aim of this systematic review and meta-analysis considering updated evidence is to assess the efficacy and safety of proACT in treating male patients with post-RP SUI. METHODS A review of the literature was performed by searching the PubMed database. We narrowed included studies with adult male patients with SUI; outcomes included pads or pad weight per day and quality of life (QOL) questionnaires, as well as safety outcomes. RESULTS 18 studies involving 1570 patients mean age of 68.8 (EC 2.1) were included. The mean follow-up reported was 34.7 months (EC 17.7; median 38.5; range 1-128 months). An average of 60.7% (EC 27) and 40.4% of patients suffered from mild-to-moderate and severe incontinence, respectively. The overall dryness rate was 55.1% (EC 19.3) while respecting the definition of 0-1 pads per day, and the mean dryness rate was 53% (EC 0.2). The mean overall complication rate was 31.2% (EC 18.3%), including an explantation rate of 26.5% (EC 15.3) and a reoperation rate of 22.7% (EC 8.7). The methodological quality of the 18 studies was very heterogeneous. CONCLUSION Implantation of proACT adjustable balloons is a minimally invasive technique that provides medium outcomes (53%) with a strict definition of dryness (0-1 PPD) and important complication rate (31.2%). Past of irradiation is a negative predictive factor for incontinence.
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Affiliation(s)
- Thibault Tricard
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France.
| | - Qi-Xiang Song
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pierre Munier
- Centre d'Urologie UROVAR, Avenue Bizet, 83000, Toulon, France
| | - Jia Yi Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Leng
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Jia Hua Pan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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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de Guerry ML, Demeestere A, Bergot C, de Hauteclocque A, Hascoet J, Bajeot AS, Ternynck C, Gamé X, Peyronnet B, Capon G, Perrouin-Verbe MA, Biardeau X. Adjustable Continence Therapy (ACT®) balloons to treat female stress urinary incontinence: effectiveness, safety and risk factors of failure and complication. Int Urogynecol J 2023; 34:877-883. [PMID: 35751672 DOI: 10.1007/s00192-022-05275-6] [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: 04/03/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To assess the effectiveness, safety and risk factors of failure and complications associated with Adjustable Continence Therapy (ACT®) balloons as a treatment for female stress urinary incontinence (SUI). METHODS In the present multicentric retrospective study, all women implanted with ACT® balloons between 2000 and 2018 were considered eligible. Effectiveness and safety were assessed at 1 year, and risk factors for failure and complications were sought. The effectiveness was categorized into three distinct groups: Success = maximum 1 pad/day and patient's impression of improvement using a numerical rating scale (NRS) ≥ 8/10; Improvement = decrease of daily pad use and NRS ≥ 5/10; Failure = increase or stability of daily pad use or NRS < 5/10. The intra- and postoperative surgical complications were collected. RESULTS Over the study period, 281 women were included. Among them, 104 (37.0%), 94 (33.5%) and 83 (29.5%) were categorized as success, improvement, and failure, respectively. Intra-, early and late postoperative complications occurred in 13 (4.6%), 35 (12.5%) and 75 (26.7%) women, respectively. Most early surgical complications were minor according to the Dindo-Clavien classification. Of women that presented a late postoperative surgical complication, 64 (22.8%) underwent an explantation performed under local or general anesthesia without associated sequalae. CONCLUSIONS The short-term effectiveness associated with ACT® balloons, their minimally invasive implantation and the frequent but easily manageable and sequelae-free complications suggest that they should be part of the therapeutic arsenal for female SUI.
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Affiliation(s)
| | - Amélie Demeestere
- University of Lille, Department of Urology, CHU Lille, F-59000, Lille, France
| | - Christophe Bergot
- Department of Urology, CHU Nantes, Université de Nantes, Nantes, France
| | | | - Juliette Hascoet
- Department of Urology, CHU Rennes, Université de Rennes, Rennes, France
| | - Anne-Sophie Bajeot
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Xavier Gamé
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Benoît Peyronnet
- Department of Urology, CHU Rennes, Université de Rennes, Rennes, France
| | - Grégoire Capon
- Department of Urology, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Xavier Biardeau
- University of Lille, Department of Urology, CHU Lille, F-59000, Lille, France.
- University of Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, 59000, Lille, France.
- University of Lille, Department of Urology, Lille University Hospital, 1 rue Polonovski, 59037, Lille Cedex, France.
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Ruggiero M, Pinar U, Popelin MB, Rod X, Denys P, Bazinet A, Chartier-Kastler E. Single center experience and long-term outcomes of implantable devices ACT and Pro-ACT (Uromedica, Irvin, CA, USA) - Adjustable continence Therapy for treatment of stress urinary incontinence. Prog Urol 2023; 33:96-102. [PMID: 36572628 DOI: 10.1016/j.purol.2022.12.004] [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: 08/15/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE In this study, we aimed at evaluating the long-term adjustable peri-urethral balloons (PUB) durability in both male and female with neurogenic or non-neurogenic stress urinary incontinence. MATERIAL AND METHODS Each consecutive patient who underwent surgery for PUB placement before 2008 was included in this study. A PUB was proposed for patients with refractory to perineal reeducation stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency. There were no exclusion criteria. Demographic, clinical and perioperative data were collected retrospectively from our clinical follow-up notes. RESULTS A total of 177 patients were included in the study. Median [IQR] follow-up was 5 years [1.8-11.2]. The 3 main causes of SUI were radical prostatectomy (n=82, 46.3%), idiopathic intrinsic sphincter deficiency (n=55, 31.1%) and neurogenic sphincter deficiency (n=32, 18.1%). Complete continence (no pad necessary) was achieved for 109 patients (61.6%). At the end of the follow-up, the PUB global survival rate was 47.5% (Fig. 1). Median [IQR] PUB survival without removal was 57.8 months [42.3-81.7]. PUB survival without failure rate was 68.4% accounting for a median [IQR] survival duration of 116.9 months [86.2-176.9] CONCLUSION: In this study, we evidenced acceptable long-term efficiency and survival of PUB in the management of SUI in both neurogenic and non-neurogenic population. Given those results it could be a good alternative to AUS on unfit or unwilling population. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- M Ruggiero
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - U Pinar
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - M-B Popelin
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - X Rod
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - P Denys
- Université Paris Saclay, hôpital R.-Poincaré, AP-HP, neurourology department, Garches, France
| | - A Bazinet
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - E Chartier-Kastler
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France.
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6
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Bada M, Crocetto F, Barone B, Arcaniolo D, Rapisarda S, Aliberti A, Zeccolini G, Celia A. ProACT in the management of stress urinary incontinence after radical prostatectomy. What happens after 8 years of follow up? monocentric analysis in 42 patients. J Basic Clin Physiol Pharmacol 2023; 34:49-54. [PMID: 35390245 DOI: 10.1515/jbcpp-2021-0295] [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: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Stress urinary incontinence is defined by a complaint of any involuntary loss of urine on effort or physical exertion or on sneezing or coughing and represents a major complication after radical prostatectomy. According to surgical technique, incidence of post-prostatectomy incontinence varies from open (7-39.5%), laparoscopic (5-33.3%) or robotic-assisted (4-31%) approaches. The ProACT® device (Uromedica, Inc., MN) is a possible surgical option for the treatment of this condition. METHODS We retrospectively analyzed surgical records of consecutive patients underwent ProACT® implantation in our department between January 2006 to November 2010. We collected data at 6 and 12 months after surgical approach about the daily pad use, International Prostatic Symptoms Score and its quality of life domain. RESULTS 42 patients were included in the final analysis. Most patients (92.9%) received minimally invasive surgery for treating prostate cancer. During the follow up after 6 and 12 months, the daily pad, International Prostatic Symptom Score and its quality of life domain significantly improved compared to preoperative outcomes. The logistic regression analysis found that presence of comorbidities was the only predictive factor of low satisfaction rate (PGE-I > 2) in patients who underwent ProACT® implant. CONCLUSIONS ProACT® implant represents an effective and safe treatment for post-prostatectomy stress urinary incontinence with a high satisfaction degree and a low rate of complications.
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Affiliation(s)
- Maida Bada
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Davide Arcaniolo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Sebastiano Rapisarda
- Department of Urology, Hospital "Pederzoli", Via Monte Baldo 24, 37019, Peschiera del Garda (VR), Italy
| | - Antonio Aliberti
- Department of Urology, Hospital "San Leonardo", ASL Napoli 3 Sud, Via Salvador Allende 68, 80053, Castellammare di Stabia (NA), Italy
| | - Guglielmo Zeccolini
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
| | - Antonio Celia
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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Ricard H, Léon G, Branchereau J, Bouchot O, Karam G, Le Normand L, Rigaud J, Perrouin-Verbe MA. Adjustable continence balloons in postprostatectomy incontinence: Outcomes and complications. Neurourol Urodyn 2022; 41:1414-1422. [PMID: 35686550 DOI: 10.1002/nau.24967] [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: 02/01/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to assess the mid-term efficacy and safety of adjustable continence therapy (ProACT™) for the treatment of male stress urinary incontinence (SUI) after radical prostatectomy (RP). PATIENTS AND METHODS Single-center retrospective study including male patients implanted with ProACT™ periurethral balloons for SUI after RP between 2007 and 2017, mainly with flexible cystoscopic guidance. Efficacy was assessed using a composite endpoint with subjective (patient's impression of improvement (PII), using a 0-100 numeral rating scale) and objective outcomes (decrease in daily pad use). Postoperative success was defined as a PII ≥ 80%, associated with the use of 0-1 pad daily. Improvement was defined as a PII ≥ 50% and a decrease ≥50% in the number of daily pads used. RESULTS Two hundred men with a median age of 68 (64-73) years were included. Seventeen percent (n = 34) had had prior radiotherapy and 15.5% (n = 31) had had prior SUI surgery. The median follow-up was 43 (19-71) months. The severity of SUI was as follows: mild in 119 (59.5%), moderate in 48 (24%), and severe in 33 patients (16.5%). Severe SUI and a history of prior radiotherapy were associated with a lower success rate (p = 0.033 and p < 0.0001). The overall reoperation rate was 34%, with 5.6% (n = 11) requiring a third implantation. Of the patients, 29.4% (n = 58) required an artificial urinary sphincter to treat SUI. At the last follow up, among the overall population, the success rate was 40.1% and the median PII was 18.3%. For patients in whom the balloons were still in place (n = 132), the cumulative success and improvement rate was 78%, with a median PII of 72%. CONCLUSION The minimally invasive ProACT™ device provides a clear beneficial continence outcome in patients with SUI after radical prostatectomy. Severe SUI or prior radiotherapy were associated with a lower success rate in our study.
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Affiliation(s)
- Hélène Ricard
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Grégoire Léon
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Julien Branchereau
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Olivier Bouchot
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Georges Karam
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Loic Le Normand
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
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9
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Bajeot AS, Brierre T, Beauval JB, Roulette P, Bordier B, Zgheib J, Huyghe É, Soulié M, Roumiguié M, Gamé X. [Survival analysis of adjustable continence therapy device (ACT®/proACT®): a new message for patients]. Prog Urol 2020; 31:215-222. [PMID: 33339737 DOI: 10.1016/j.purol.2020.10.005] [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: 04/18/2020] [Revised: 09/18/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The main purpose was to assess the failure free survival of adjustable continence therapy ACT®/proACT® after continence was obtained and to seek factors influencing it. MATERIAL AND METHODS Retrospective, single-center survival study of peri-urethral balloons implanted between 2007 and 2014. Efficacy was defined by the wearing of 0 or 1 safety pad per day. The primary end point was time to failure estimated from a survival curve (Kaplan-Meier). Factors that could influence failure free survival were: sex, age, radiotherapy, diabetes, number of pad before surgery, number of balloon inflation, early complications, mixed urinary incontinence and previous ACT®/proACT® placement. They were analyzed in a COX regression. RESULTS Of the 82 peri-urethral balloons placed, 41 were effective in 36 patients. The failure free survival was 50 % at 60 months. Radiotherapy, diabetes and previous peri-urethral balloon placement appeared to significantly decrease survival (P=0.031;P=0.025;P=0.029, respectively). Fifteen peri-urethral balloons were still effective at the last follow-up, one was lost to follow-up and 25 required re-intervention for loss of efficacy. The main cause of efficacy loss was system leakage. Fifty-two percent of peri-urethral balloons that became ineffective were replaced by new peri-urethral balloons and 28% by an artificial urinary sphincter. CONCLUSION Patients who became continent with adjustable continence therapy (ACT®/proACT®) had a 50 % new surgery probability at 5 years for a loss of efficacy. Radiotherapy seems to be the main risk factor of the efficacy loss. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A-S Bajeot
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France.
| | - T Brierre
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - J-B Beauval
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - P Roulette
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - B Bordier
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - J Zgheib
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - É Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - M Soulié
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - M Roumiguié
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
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Giammò A, Ammirati E, Tullio A, Morgia G, Sandri S, Introini C, Canepa G, Timossi L, Rossi C, Mozzi C, Carone R. Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: an Italian multicentric study. MINERVA UROL NEFROL 2020; 72:770-777. [DOI: 10.23736/s0393-2249.19.03457-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Munier P, Nicolas M, Tricard T, Droupy S, Costa P, Saussine C. What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling. Neurourol Urodyn 2020; 39:1417-1422. [PMID: 32249971 DOI: 10.1002/nau.24355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable. AIMS This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings. MATERIALS & METHODS This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported. RESULTS Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement. CONCLUSION The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.
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Affiliation(s)
- Pierre Munier
- Department of Urology, Hopitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, Strasbourg, France
| | - Marc Nicolas
- Department of Urology, Hospital Universitaire Carémeau de Nimes, 4 rue du Professeur Debré, Nimes, France
| | - Thibault Tricard
- Department of Urology, Hopitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, Strasbourg, France
| | - Stéphane Droupy
- Department of Urology, Hospital Universitaire Carémeau de Nimes, 4 rue du Professeur Debré, Nimes, France
| | - Pierre Costa
- Department of Urology, Hospital Universitaire Carémeau de Nimes, 4 rue du Professeur Debré, Nimes, France
| | - Christian Saussine
- Department of Urology, Hopitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, Strasbourg, France
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Angulo JC, Schönburg S, Giammò A, Abellán FJ, Arance I, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence. PLoS One 2019; 14:e0225762. [PMID: 31790490 PMCID: PMC6886794 DOI: 10.1371/journal.pone.0225762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Urinary incontinence is one of the most serious complications of prostate cancer treatment. The objective of this study was to assess efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to Adjustable Continence Therapy (proACT) for male stress urinary incotinence according to literature findings. MATERIAL AND METHODS A systematic review and meta-analysis on adjustable devices ATOMS and ProACT is presented. Studies on female or neurogenic incontinence were excluded. Differences between ATOMS and proACT in primary objective: dryness status (no-pad or one safety pad/day) after initial device adjustment, and in secondary objectives: improvement, satisfaction, complications and device durability, were estimated using random-effect model. Statistical heterogeneity among studies included in the meta-analysis was assessed using tau2, Higgins´s I2 statistics and Cochran´s Q test. RESULTS Combined data of 41 observational studies with 3059 patients showed higher dryness (68 vs. 55%; p = .01) and improvement (91 vs. 80%; p = .007) rate for ATOMS than ProACT. Mean pad-count (-4 vs. -2.5 pads/day; p = .005) and pad-test decrease (-425.7 vs. -211.4 cc; p < .0001) were also significantly lower. Satisfaction was higher for ATOMS (87 vs. 56%; p = .002) and explant rate was higher for proACT (5 vs. 24%; p < .0001). Complication rate for ProACT was also higher, but not statistically significant (17 vs. 26%; p = .07). Mean follow-up was 25.7 months, lower for ATOMS than ProACT (20.8 vs. 30.6 months; p = .02). The rate of working devices favoured ATOMS at 1-year (92 vs. 76; p < .0001), 2-years (85 vs. 61%; p = .0008) and 3-years (81 vs. 58%; p = .0001). Significant heterogeneity was evidenced, due to variable incontinence severity baseline, difficulties for a common reporting of complications, different number of adjustments and time of follow-up and absence of randomized studies. CONCLUSIONS Despite the limitations that studies available are exclusively descriptive and the follow-up is limited, literature findings confirm ATOMS is more efficacious, with higher patient satisfaction and better durability than ProACT to treat male stress incontinence.
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Affiliation(s)
- Javier C. Angulo
- Departamento Clínico, Universidad Europea de Madrid, Madrid
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, Spain
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO-Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Ignacio Arance
- Departamento Clínico, Universidad Europea de Madrid, Madrid
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital "12 de Octubre" (i+12), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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Larson T, Jhaveri H, Yeung LL. Adjustable continence therapy (ProACT) for the treatment of male stress urinary incontinence: A systematic review and meta‐analysis. Neurourol Urodyn 2019; 38:2051-2059. [DOI: 10.1002/nau.24135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/22/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Troy Larson
- Department of Urology, College of MedicineUniversity of Florida Gainesville Florida
| | - Hasan Jhaveri
- Department of Urology, College of MedicineUniversity of Florida Gainesville Florida
| | - Lawrence L. Yeung
- Department of Urology, College of MedicineUniversity of Florida Gainesville Florida
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Choiniere R, Richard PO, Morin M, Tu LM, Guyatt GH, Violette PD. Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol. F1000Res 2019; 8:1155. [PMID: 33381297 PMCID: PMC7689604 DOI: 10.12688/f1000research.19484.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Post-radical prostatectomy urinary incontinence (PPI) is a frequent and feared complication that can affect approximately 25% of patients. Between 1 and 10% of patients suffering from PPI will require surgery. The effectiveness of the available surgical interventions has only been compared in a few randomized controlled trials and the available reviews have important limitations regarding both benefits and harms that make them insufficient to inform decision-making. The aim of the study is to provide systematic summaries of benefits and harms of contemporary surgical treatment options for PPI through systematic review and meta-analysis using GRADE methodology and reporting in accord with the PRISMA-P statement. Methods: Studies pertaining to bulking agents, male synthetic slings, compressive balloon systems (ProACT) or artificial urinary sphincters (AUS) used for the treatment of patients suffering from PPI will be included. A systematic search will be conducted using the OVID and PubMED platforms in MEDLINE, Embase and Cochrane databases, and reference lists of relevant reviews and guidelines. Trained independent reviewers will conduct study selection and data extraction. Outcomes will include the number of pads used per day, the 24-h pad weight test, the Patient Global Impression of Improvement (PGI-I) and the Incontinence Quality of Life (IQOL) as possible benefits and the reoperations, the Clavien-Dindo complications and the other reported adverse events as the harms. When possible, pooled analyses will be completed. Risk of bias will be assessed using the CLARITY tools and a new tool for the before-and-after studies without a control group. Finally, study heterogeneity will be assessed, publication bias will be evaluated with funnel plots and quality of evidence rated for each outcome. Discussion: Our study will address patient-important outcomes and will be useful in clinical decision-making as well as identifying key elements for future research. Study registration: PROSPERO: CRD42018073923 05/12/2018.
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Affiliation(s)
| | - Patrick O. Richard
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Melanie Morin
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Le-Mai Tu
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Gordon H. Guyatt
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
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16
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Efficacy and safety of adjustable balloons (Proact™) to treat male stress urinary incontinence after prostate surgery: Medium and long‐term follow‐up data of a national multicentric retrospective study. Neurourol Urodyn 2019; 38:1979-1984. [DOI: 10.1002/nau.24103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/25/2019] [Indexed: 11/07/2022]
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17
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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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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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Nash S, Aboseif S, Gilling P, Gretzer M, Samowitz H, Rose M, Slutsky J, Siegel S, Tu LM. Four-year follow-up on 68 patients with a new post-operatively adjustable long-term implant for post-prostatectomy stress incontinence: ProACT™. Neurourol Urodyn 2018; 38:248-253. [DOI: 10.1002/nau.23838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | | | - Marc Rose
- Indian River Urology; Vero Beach Florida
| | | | | | - Le Mai Tu
- Division of Urology; Hospitalier Universitaire de Sherbrooke-Fleurimont; Quebec Canada
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Long-term results of ProACT primary and repeat implantation for treatment of stress urinary incontinence in men. World J Urol 2018; 37:1173-1179. [DOI: 10.1007/s00345-018-2483-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022] Open
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Nash S, Aboseif S, Gilling P, Gretzer M, Samowitz H, Rose M, Slutsky J, Siegel S, Tu LM. Treatment with an adjustable long-term implant for post-prostatectomy stress incontinence: The ProACT™ pivotal trial. Neurourol Urodyn 2018; 37:2854-2859. [PMID: 30178536 DOI: 10.1002/nau.23802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/18/2018] [Indexed: 11/06/2022]
Abstract
AIMS This paper presents 18-month follow-up results for patients enrolled in a pivotal study conducted to support an FDA premarket approval application (PMAA). The trial evaluated the safety and efficacy of the ProACT Adjustable Continence Therapy for the treatment of post-prostatectomy stress urinary incontinence (SUI). METHODS The clinical study involved 11 clinical sites and enrolled 160 subjects. A total of 124 subjects met study criteria and 123 underwent ProACT implantation from July 2005 through June 2007, of whom 98 completed 18-month follow-up. Endpoints included 24-h pad weight, Incontinence Quality of Life Questionnaire (I-QOL), UCLA Prostate Cancer Index-Urinary Function (PCI-UF), residual volume, and device or procedure-related adverse events (AEs). RESULTS The mean surgical time was 32 min. Statistically significant improvements during follow-up were observed in 24-h pad weight, for which the cohort mean pre-implant urine loss was 399 g, which was reduced at 18 months to 160 g (P < 0.001). Reductions in pad weight were observed across all levels of pre-implant SUI severity. Significant improvements were also seen in quality of life as measured by the I-QOL (P < 0.001) as well as measures of urinary function and pad count. One procedure-related serious adverse event (SAE), retention, was reported among the 124 subjects; the SAE was resolved without clinical meaningful sequalae. CONCLUSIONS These results demonstrate the safety and efficacy of this newly FDA-approved therapy, showing significant improvements in objective and subjective measures of SUI in mild, moderate, and severely incontinent male patients. The duration of the implant procedure is short, and complications are mild and easily resolvable.
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Affiliation(s)
| | | | | | | | | | - Marc Rose
- Indian River Urology, Vero Beach, Florida
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Noordhoff TC, Scheepe JR, Blok BFM. Outcome and complications of adjustable continence therapy (ProACT™) after radical prostatectomy: 10 years' experience in 143 patients. Neurourol Urodyn 2017; 37:1419-1425. [PMID: 29266406 DOI: 10.1002/nau.23463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/13/2017] [Indexed: 11/08/2022]
Abstract
AIMS To evaluate our outcomes of the adjustable continence balloons ProACT™ for the treatment of male stress urinary incontinence after radical prostatectomy. METHODS Between May 2007-August 2016 the ProACT™ was implanted in 143 patients without a history of radiotherapy. Endpoints were patient-reported changes in pad counts and complications. Treatment was considered successful if no pad or just one "security" pad per day sufficed, and improved if daily pad use was reduced by ≥50%. RESULTS Incontinence before implantation was mild in 36 (25%), moderate in 57 (40%), and severe in 50 (35%) patients. Complications within 30 days were classified by the Clavien-Dindo classification; eight (5.6%) grade I, three (2.1%) grade II, three (2.1%) grade IIIb, and 129 (90.2%) patients had no complication. Revision was done in 43 (30%) patients. The IPSS quality of life item improved significantly from 5.0 (IQR 4.0-5.0) preoperative to 2.0 (IQR 1.0-4.0) and 1.0 (IQR 0.0-3.0) 6 and 12 months after implantation, respectively. After a median follow up of 56 months (range 28 to 79, n = 112), 72 (64%) patients were improved, including 51 (45%) patients were successful. Daily pad use decreased from 3.0 to 1.0 (67% reduction). The median outcome on the Patient Global Impression of Improvement scale was "much better," and 97 (87%) patients perceived improvement. CONCLUSIONS The minimally invasive ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of the patients were satisfied and perceived improvement ≥50% on daily pad use on the long term.
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Affiliation(s)
| | - Jeroen R Scheepe
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Baron MG, Delcourt C, Nouhaud FX, Gillibert A, Pfister C, Grise P, Cornu JN. Sequential treatment with ProACT™ device implantation after male sling failure for male urinary incontinence. Prog Urol 2017; 27:1098-1103. [PMID: 28847446 DOI: 10.1016/j.purol.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is no strong evidence for second line therapy after male sling failure for post-prostatectomy urinary incontinence (PPUI). We report the outcomes after periurethral balloons implantation for persistence or recurrence of mild PPI symptoms after male sling implantation. METHODS All patients implanted of a ProACT™ device (Uromedica, Inc., MN, USA) following I-STOP transobturator male sling (TOMS) failure, in a tertiary reference center between 2009 and 2016, were included. Patients were evaluated by 24-hour pad-test before and after implantation, and after each balloon repressurizing procedure. PGI-I and Likert scale patient satisfaction were estimated during a telephone interview conducted in 2016. Objective and subjective cure of urinary incontinence were defined by a 24-hour pad-test<8g and the use of zero or one pad per day, respectively. RESULTS Fourteen patients were included. Median follow-up was 34months [4-89]. Objective and subjective cure were 29% (n=4) and 57% (n=8), respectively. Median pad-test decreased from 95g [IQR: 130] to 34g [IQR: 83] (P=0.022). ProACT™ significantly decreased median pad-test by a factor 2.73 [1.19-6.29]. Eighty-eight percent patients were feeling a little better, much better or very much better and 77% were satisfied or very satisfied at the end of follow-up. Reoperation rate was 28% (n=4): 3 balloons were changed for caudally migration (n=2) or deflation (n=1) and 1 had a urinary sphincter implanted for severe UI. CONCLUSIONS ProACT™ is a safe and efficient treatment that can be used in second line therapy after TOMS failure for PPUI. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M G Baron
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France.
| | - C Delcourt
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France
| | - F-X Nouhaud
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France
| | - A Gillibert
- Statistic department, Charles-Nicolle Hospital, 76000 Rouen, France
| | - C Pfister
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France
| | - P Grise
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France
| | - J-N Cornu
- Urology department, Charles-Nicolle Hospital, Rouen university Hospital, 1, rue de Germont, 76000 Rouen, France
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Leizour B, Chevrot A, Wagner L, Droupy S, Costa P. [Adjustable retropubic suburethral sling Remeex ® in the treatment of male stress urinary incontinence: One-year results]. Prog Urol 2016; 27:238-243. [PMID: 28043779 DOI: 10.1016/j.purol.2016.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the adjustable suburethral sling Remeex® in the treatment of male stress urinary incontinence (SUI). PATIENTS AND METHODS Single-center prospective study of patients treated for SUI after radical prostatectomy or transurethral resection of prostate. The severity of incontinence was evaluated by the number of pads used per day. Success rate, complications and number of adjustments were studied. RESULTS From February 2011 to May 2015, Remeex® was implanted in 25 patients. The average preoperative number of pads used per day was 3,8 (±1,8). Sling tension has been adjusted the day after surgery in all patients. Mean follow-up was 31 months (±15). During follow-up, 6 patients did not need any readjustment (24%) and 15 patients (60%) had to be readjusted. One Remeex system had to be completely removed because of a sub-occlusive syndrome. Three patients had early infection requiring partial system removal (Varitensor). At the end of follow-up, 9 patients were cured (36%), 9 patients (36%) were significantly improved and 7 patients (28%) were not improved. Five patients are waiting for a new readjustment. CONCLUSION In this short series of patients who had prostatic surgery, at mid-term follow-up, the placement of a BSUA-R was associated with an improvement or cure of urinary incontinence symptoms in two-thirds of cases. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- B Leizour
- Service d'urologie-andrologie, CHU de Nîmes, place du Pr R. Debré, 30029 Nîmes, France.
| | - A Chevrot
- Service d'urologie-andrologie, CHU de Nîmes, place du Pr R. Debré, 30029 Nîmes, France
| | - L Wagner
- Service d'urologie-andrologie, CHU de Nîmes, place du Pr R. Debré, 30029 Nîmes, France
| | - S Droupy
- Service d'urologie-andrologie, CHU de Nîmes, place du Pr R. Debré, 30029 Nîmes, France
| | - P Costa
- Service d'urologie-andrologie, CHU de Nîmes, place du Pr R. Debré, 30029 Nîmes, France
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Chevrot A, Jaffard A, Medici M, Costa P, Wagner L, Moreau-Gaudry A, Droupy S, Voros S. [Rigid cystoscopy versus retrovision for adjustable peri-urethral balloons guidance: Comparison of precision thanks to a surgical navigation system]. Prog Urol 2016; 26:566-72. [PMID: 27473788 DOI: 10.1016/j.purol.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/05/2016] [Accepted: 06/27/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The main goal of our phantom study was to compare the precision of adjustable periurethral balloons positioning depending whether the guidance was obtained by retrovision or rigid cystoscopy. MATERIAL AND METHODS A navigation guidance system was used to localize the introduction mandrel which was equipped with tracking targets. Two ideal sites of implantation were predefined and recorded into the navigation system. The two points were placed symmetrically to the phantom reproducing the urethra. Four different users were asked to position the tip of the introduction mandrel as close as possible to the ideal site of implantation with the help of each method of guidance. For each attempt, the distance (mm) between the tip of the introduction mandrel and the ideal position was recorded by the navigation system. RESULTS For each method of guidance, a total of 20 attempts on each side were made by direct puncture on one side and a symmetrical contralateral puncture. For direct puncture, the median distances were 5.20 (±3.96) and 4.38 (±1.55) mm with rigid cystoscopy and retrovision respectively (P=0.29). For symmetrical contralateral puncture, the median distance were 7,19 (±3,78) and 6,86 (±2,76) mm with rigid cystoscopy and retrovision respectively (P=0,32) CONCLUSION: This study could not demonstrate any significant difference between the two guidance systems. Nevertheless, it showed that navigation guidance system could be used to compare the precision of surgical interventions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Chevrot
- Service d'urologie et andrologie, CHU de Nîmes, place du Professeur-Debré, 30029 Nîmes cedex 09, France; Laboratoire TIMC-IMAG (techniques de l'ingénierie médicale et de la complexité-informatique, mathématiques et applications-Grenoble), unité mixte de recherche CNRS 5525, domaine de la Merci, 38700 Grenoble, France.
| | - A Jaffard
- Laboratoire TIMC-IMAG (techniques de l'ingénierie médicale et de la complexité-informatique, mathématiques et applications-Grenoble), unité mixte de recherche CNRS 5525, domaine de la Merci, 38700 Grenoble, France
| | - M Medici
- Centre d'investigation clinique, innovation technologique (CIC-IT) centre hospitalier de Grenoble, domaine de la Merci, 38700 Grenoble, France
| | - P Costa
- Service d'urologie et andrologie, CHU de Nîmes, place du Professeur-Debré, 30029 Nîmes cedex 09, France
| | - L Wagner
- Service d'urologie et andrologie, CHU de Nîmes, place du Professeur-Debré, 30029 Nîmes cedex 09, France
| | - A Moreau-Gaudry
- Laboratoire TIMC-IMAG (techniques de l'ingénierie médicale et de la complexité-informatique, mathématiques et applications-Grenoble), unité mixte de recherche CNRS 5525, domaine de la Merci, 38700 Grenoble, France; Centre d'investigation clinique, innovation technologique (CIC-IT) centre hospitalier de Grenoble, domaine de la Merci, 38700 Grenoble, France
| | - S Droupy
- Service d'urologie et andrologie, CHU de Nîmes, place du Professeur-Debré, 30029 Nîmes cedex 09, France
| | - S Voros
- Laboratoire TIMC-IMAG (techniques de l'ingénierie médicale et de la complexité-informatique, mathématiques et applications-Grenoble), unité mixte de recherche CNRS 5525, domaine de la Merci, 38700 Grenoble, France
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Re: Adjustable Continence Balloons in Men: Adjustments Do Not Translate into Long-Term Continence. J Urol 2016; 195:687-8. [PMID: 26887730 DOI: 10.1016/j.juro.2015.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and Management of Postprostatectomy Incontinence: A Systematic Review of Current Literature. Eur Urol Focus 2016; 2:245-259. [PMID: 28723370 DOI: 10.1016/j.euf.2016.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/22/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still uncertainty about its diagnostic and therapeutic management. OBJECTIVE To evaluate current evidence regarding the diagnosis and therapy of postprostatectomy incontinence (PPI). EVIDENCE ACQUISITION A systematic review of the literature was performed in October 2015 using the Medline database. EVIDENCE SYNTHESIS Diagnosis and conservative treatment of PPI are currently mostly based on expert opinions. Pelvic floor muscle training is the noninvasive treatment of choice of PPI. For invasive management of moderate to severe PPI, the artificial urinary sphincter is still the treatment of choice, but an increasing number of adjustable and nonadjustable, noncompressive as well as compressive devices are used more frequently. However, no randomized controlled trial has yet investigated the outcome of one specific surgical treatment or compared the outcome of different surgical treatment options. CONCLUSIONS The level of evidence addressing the surgical management of PPI is still unsatisfactory. Further research is urgently needed. PATIENT SUMMARY Incontinence after the removal of the prostate (postprostatectomy incontinence) is the most common cause of male stress urinary incontinence. First-line therapy is physiotherapy and lifestyle changes. If no satisfactory improvement is obtained, various surgical treatment options are available. The most commonly used is the artificial urinary sphincter, but other treatment options like male slings are also available.
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Affiliation(s)
- Alexander Kretschmer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany.
| | - Wilhelm Hübner
- Landesklinikum Weinviertel Korneuburg, Klinik für Urologie, Kornneuburg, Austria
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricarda M Bauer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany
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Ostrowski I, Śledź E, Ciechan J, Golabek T, Bukowczan J, Przydacz M, Wiatr T, Stangel-Wojcikiewicz K, Chłosta PL. Current interventional management of male stress urinary incontinence following urological procedures. Cent European J Urol 2015; 68:340-7. [PMID: 26568879 PMCID: PMC4643709 DOI: 10.5173/ceju.2015.616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/09/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Despite improvements in surgical techniques and implementation of minimally invasive procedures, male stress urinary incontinence affects a substantial number of patients after prostatic surgery. In response to increasing demand of optimal treatment modality, new alternatives to artificial urinary sphincter have recently been introduced. This review summarises the therapeutic surgical options with their outcomes in management of postprostatectomy stress incontinence. Material and methods We performed a literature review by searching the PubMed, Web of Science and Embase databases for articles published from January 2000 until April 2015 based on clinical relevance. Results Artificial urinary sphincter is currently considered the “gold standard” treatment of male stress urinary incontinence. Although the new devices in this group have recently been investigated, the AMS 800 remains the only widely used implant. Male slings and adjustable continence devices, achieve the social continence rates up to 60%. Periurethral injections of bulking agents, have limited efficacy of male stress incontinence. Argus sling and ProACT are both associated with substantial explantation rates. Stem cell therapy is a promising option but still requires additional testing. Conclusions The development of new alternatives to artificial urinary sphincter is constantly progressing. Although recently introduced minimally invasive treatment options have not yet surpassed the outcomes of the artificial urinary sphincter they should continue to be evaluated and compared against the gold standard.
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Affiliation(s)
| | - Emil Śledź
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Janusz Ciechan
- Department of Urology, Regional Hospital in Puławy, Poland
| | - Tomasz Golabek
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes Mellitus, Northumbria NHS Foundation Trust, North Shields, United Kingdom
| | - Mikolaj Przydacz
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | | | - Piotr L Chłosta
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
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A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence. Curr Opin Urol 2015; 24:566-70. [PMID: 25203242 DOI: 10.1097/mou.0000000000000112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW To highlight the recent developments in the past 12 months in the field of postprostatectomy incontinence. RECENT FINDINGS The evaluation of postprostatectomy incontinence is mainly based on clinical details and symptoms assessment. The situation in which urodynamics will change the management and influence clinical decision-making is still unknown. MRI may play a role in the future for postprostatectomy incontinence assessment. Artificial urinary sphincter is the most widely used treatment, and the literature is full of technical reports to improve the management of challenging cases and minimize the risk of complications. Advance male sling has been the subject of multiple reports that support its safety and efficacy. Many other innovative devices have been presented but not adequately tested. SUMMARY Evaluation of postprostatectomy incontinence is based on clinical data, involving symptoms assessment, quality of life, and incontinence severity. Endoscopy is requested, and urodynamic study indications are debated. The treatment is mainly focused on surgical options, of which artificial urinary sphincter and transobturator male slings are the two leaders. The field is critically lacking of comparative studies.
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Résultats initiaux de l’utilisation des ballons périurétraux ajustables (ACT™ et pro ACT™) dans le traitement de l’incontinence urinaire d’effort par insuffisance sphinctérienne de l’adulte. Prog Urol 2014; 24:1132-8. [DOI: 10.1016/j.purol.2014.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 11/22/2022]
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Yiou R, Butow Z, Baron T, Salomon L, Audureau E. Adjustable continence therapy (ProACT™) after male sling failure for patients with post-radical prostatectomy urinary incontinence: a prospective study with one-year follow-up. World J Urol 2014; 33:1331-6. [PMID: 25416348 DOI: 10.1007/s00345-014-1447-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the effects of the ProACT™ device as a second-line treatment for persistent incontinence after male sling insertion. METHODS Twenty consecutive patients were treated with the ProACT™ device due to persistent urinary incontinence following male sling insertion (9 AdVance™, 9 TOMS™, 2 InVance™). All balloons were implanted using a combination of fluoroscopic imaging and fibroscopic retrovision. Urinary symptoms were assessed prior to male sling insertion (T0) and before (T1) and 1 year after the ProACT™ insertion (T2) using questionnaires (ICIQ, USP, and ULCA-PCI-urinary bother) and by determining the number of pads used daily. RESULTS The mean age of the study population at T1 was 68.6 ± 9 years. The mean volume of adjustment at T2 was 4.5 ± 2.7 mL. The previous sling did not cause any technical difficulties during ProACT™ insertion. Late wound infections occurred in the two patients who had been previously treated with the InVance sling and required removal of all implanted materials (Clavien-Dindo classification IIIb). Improvement in mean urinary scores was noted in the remaining patients (n = 18) through T0, T1, and T2, respectively: The ICIQ scores were 16.8 ± 2.6, 13.1 ± 3.4, and 5.7 ± 5.7 (P < 0.0001); USP stress urinary incontinence scores were 8 ± 1.8, 5.6 ± 2.2, and 2.4 ± 2.8, (P < 0.0001); USP overactive bladder symptom scores were 6.8 ± 4.3, 7.6 ± 4.3, and 4.1 ± 3.5 (P = 0.008), UCLA-PCI urinary bother scores were 7.1 ± 11.3, 28.6 ± 12.9, and 69.6 ± 31.6 (P < 0.0001), and number of pads used were 2.9 ± 1, 2 ± 1, and 0.3 ± 0.9 (P < 0.0001). USP obstructive symptoms were 0.4 ± 1, 1 ± 1.6, and 1.3 ± 1.4 (P = 0.19). CONCLUSIONS The Pro-ACT™ device may provide additional benefits for improving continence in case of persistent incontinence following male sling insertion.
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Caremel R, Corcos J. Incontinence after radical prostatectomy: Anything new in its management? Can Urol Assoc J 2014; 8:202-12. [PMID: 25024791 DOI: 10.5489/cuaj.1349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION With the increasing number of radical prostatectomies (RP) performed, male stress urinary incontinence (SUI) has become common. The artificial urinary sphincter (AUS) is the gold standard to treat SUI post-RP, but new devices have recently been developed. We review the recent studies on the treatment of SUI post-RP; we also describe the surgical techniques, mechanisms of action and results of these new procedures. METHODS We conducted a literature review search in the PubMed/Medline and Embase databases. Our search was restricted to recent articles. We included studies even if the urinary incontinence was due to sphincter deficiency after RP in non-neurologic patients. RESULTS We found 8 cohort studies for the surgical procedure: 3 studies concerning slings, 1 involving balloons adjustable implant, and 4 involving new devices. The only randomized controlled trial (RCT) was a pharmacologic clinical trial comparing duloxetine to placebo. The social continence rates were analyzed for 6 studies and were up to 66%. CONCLUSION New minimally invasive surgical procedures have emerged as the main alternative to AUS, with social continence rates up to 60% despite just 1 RCT studying the pharmacologic approach. There is an urgent need for well-designed clinical trials to clarify the role of new surgical alternatives in the management of SUI post-RP. New technologies should continue to be evaluated and compared with the AUS, which remains the gold standard.
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Affiliation(s)
- Romain Caremel
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC
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Ej-Jennane A, Mouracade P, Lang H, Jacqmin D, Saussine C. Incontinence urinaire d’effort postopératoire chez l’homme : résultats du traitement par bandelette transobturatrice I-STOP TOMS®. Prog Urol 2014; 24:127-31. [DOI: 10.1016/j.purol.2013.08.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/08/2013] [Accepted: 08/01/2013] [Indexed: 11/29/2022]
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A systematic review of the treatment for female stress urinary incontinence by ACT® balloon placement (Uromedica, Irvine, CA, USA). World J Urol 2013; 32:495-505. [DOI: 10.1007/s00345-013-1117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022] Open
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Costa P, Poinas G, Ben Naoum K, Bouzoubaa K, Wagner L, Soustelle L, Boukaram M, Droupy S. Long-Term Results of Artificial Urinary Sphincter for Women with Type III Stress Urinary Incontinence. Eur Urol 2013; 63:753-8. [DOI: 10.1016/j.eururo.2012.03.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/07/2012] [Indexed: 11/16/2022]
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Abstract
Different kinds of sling systems for the therapy of male urinary incontinence have been developed during the last decade. All systems work by compressing the male urethra. There are adjustable and non-adjustable systems. Implantation is mostly a minimally invasive procedure. On the other hand the well-established AMS 800 hydraulic artificial sphincter has been available since 1972. Recently, another hydraulic artificial sphincter (FlowSecure) has become available providing a boost of occlusive pressure during stress. The aim of this review is to compare effectiveness and indications of the different techniques compared to the artificial sphincter.
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Vayleux B, Rigaud J, Branchereau J, Larue S, Karam G, Glémain P, Bouchot O, Le Normand L. [Pelvic radiotherapy and artificial urinary sphincter in women]. Prog Urol 2012; 22:534-9. [PMID: 22732645 DOI: 10.1016/j.purol.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/12/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR). POPULATION AND METHODS From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n=206) and the other group with PR (group 2; n=9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure. RESULTS Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P<0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation. CONCLUSION AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.
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Affiliation(s)
- B Vayleux
- Clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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