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Ghaffar U, Abbasi B, Fuentes JLG, Sudhakar A, Hakam N, Smith A, Jones C, Shaw NM, Breyer BN. Urethral Slings for Irradiated Patients With Male Stress Urinary Incontinence: A Meta-analysis. Urology 2023; 180:262-269. [PMID: 37543118 DOI: 10.1016/j.urology.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To systematically compare success, cure and complication rates of urethral sling surgeries in stress urinary incontinence patients with and without a history of pelvic radiotherapy (RT). MATERIALS AND METHODS We searched PUBMED, EMBASE, and Web of Science to identify relevant articles. The primary outcomes were the success and cure rates. The secondary outcomes included the rates of infection, urethral erosion, total complications, explantation, and satisfaction. Outcomes were analyzed using a random-effects model to calculate the unadjusted odds ratio (OR) in patients with a history of RT compared with those without prior RT. RESULTS On pooled analysis, we found significantly lower odds of success (OR 0.68; 95% confidence interval [CI] 0.53-0.87, P < .001) and cure (OR 0.67; 95% CI 0.55-0.82, P < .001) in radiated patients than in nonirradiated patients. Subgroup analysis by type of sling showed significantly lower odds of success in Advance subgroup (OR 0.66; 95% CI 0.45-0.95, P < .001) and significantly lower odds of cure in Advance (OR 0.59; 95% CI 0.36-0.95, P < .001) and Atoms subgroups (OR 0.70; 95% CI 0.54-0.93, P < .001). We also found significantly greater odds of sling explantation (OR 2.93; 95% CI 1.62-5.29, P < .001) and infection (OR 3.06, 95% CI 1.03-9.07, P < .001) in radiated patients than in nonradiated patients. CONCLUSION Patients with a history of pelvic RT have lower odds of success and cure and higher odds of infection and sling explantation than those without a history of pelvic RT.
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Affiliation(s)
- Umar Ghaffar
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | - Architha Sudhakar
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Allen Smith
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Charles Jones
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Urology, MedStar Georgetown University Hospital, Washington, DC; Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
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Meisterhofer K, Herzog S, Strini KA, Sebastianelli L, Bauer R, Dalpiaz O. Male Slings for Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:575-592. [PMID: 30718160 DOI: 10.1016/j.euf.2019.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Male slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model. OBJECTIVE To evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence. EVIDENCE ACQUISITION This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords "incontinence," "prostatectomy," and "male sling/system" was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients' quality of life. EVIDENCE SYNTHESIS The literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45-0.56, I2=82%). Subjective cure was achieved in 33-94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51-0.71, I2=88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings. CONCLUSIONS Both fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed. PATIENT SUMMARY Fixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
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Affiliation(s)
| | - Sereina Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karin A Strini
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Research Unit for Neurorehabilitation South Tyrol, Hospital of Vipiteno, Vipiteno, Italy
| | - Ricarda Bauer
- Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria.
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Chen YC, Lin PH, Jou YY, Lin VCH. Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review. PLoS One 2017; 12:e0130867. [PMID: 28467435 PMCID: PMC5415174 DOI: 10.1371/journal.pone.0130867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background This meta-analysis was designed to assess the efficacy of the male sling and artificial urinary sphincter on treating post-prostatectomy incontinence by evaluating daily pad use, cure rate, frequency of improvement in incontinence, and quality of life. Methods Medline, Cochrane, Google Scholar, and ClinicalTrials.gov were searched (until March 31, 2014) for studies that investigated the effectiveness of artificial urinary sphincter or sling surgical treatments for prostate cancer. The primary outcome was daily pad use before and after surgery and secondary outcomes were quality of life before and after surgery, and frequency of cures (no need to use of a pad for at least 1 day) and improvements (decreased pad usage) in incontinence after surgery. Results We found that that both the sling and artificial urinary sphincter significantly decreased the number of pads used per day by about 3 (P-values <0.001) and increased the quality of life compared with before intervention (P-values < 0.001). In addition, the cure rate and was around 60%. Intervention resulted in improvement in incontinence by about 25% (P < 0.001). Conclusion Our findings indicate that both sling and artificial urinary sphincter interventions are effective in reducing incontinence and improving the patient’s quality of life.
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Affiliation(s)
- Yu-Chi Chen
- Department of Urology, E-Da Hospital, Kaohsiung City, Taiwan
| | - Pin-Hsuan Lin
- Department of Health and Beauty, Shu-Zen College of Medicine and Management, Kaohsiung City, Taiwan
| | - Yann-Yuh Jou
- Taiwan Food and Drug Administration, Taipei City, Taiwan
| | - Victor Chia-Hsiang Lin
- Department of Urology, E-Da Hospital, Kaohsiung City, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
- Taiwanese Urological Association, Taipei, Taiwan
- * E-mail:
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Male Readjustable Sling (MRS) System for Postprostatectomy Incontinence: Experiences of 2 Centers. Urology 2015; 88:195-200. [PMID: 26505836 DOI: 10.1016/j.urology.2015.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the outcomes of Male Readjustable Sling (MRS) in patients with postprostatectomy incontinence at 2 unrelated centers and to determine preoperative factors relevant to the outcome. MATERIALS AND METHODS From January 2007 to January 2014, a total of 64 men with urinary incontinence following radical prostatectomy were treated with MRS at 2 centers. Patients were evaluated based on medical history, daily pad usage, urodynamics, and cystoscopy. The clinical outcome was evaluated according to daily pad usage and questionnaires. Success was defined according to reductions in the number of pads used per day after surgery, and factors related to surgical outcome were investigated. RESULTS The median age of the patients was 70 years (range: 53-84), and the mean follow-up duration was 46.0 ± 19.47 months (range: 12-89). During follow-up, readjustment of the sling was required 1.9 times on average. Daily pad usage decreased significantly from 3.42 ± 2.00 to 0.84 ± 1.20 (P <.001), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score improved (18.65 ± 2.61 to 10.55 ± 6.21, P <.001) without deterioration of voiding symptoms at the last follow-up. MRS was successful in 46 of 64 patients (71.9%). Of the 18 patients who experienced surgical failure, 12 patients required secondary artificial urethral sphincter implantation. The number of daily used pads (odds ratio 1.414) and a history of pelvic irradiation (odds ratio 8.400) were potential risk factors for surgical failure. CONCLUSION According to our midterm follow-up data, MRS is an effective and a safe treatment option for radiation-naïve patients with a mild degree of postprostatectomy incontinence.
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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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Male stress urinary incontinence: a review of surgical treatment options and outcomes. Adv Urol 2012; 2012:287489. [PMID: 22649446 PMCID: PMC3356867 DOI: 10.1155/2012/287489] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 01/22/2023] Open
Abstract
Introduction and Objective. Iatrogenic male stress urinary incontinence (SUI) affects a percentage of men undergoing urologic procedures with a significant impact on quality of life. The treatment of male SUI has evolved significantly with multiple current options for treatment available. The current paper discusses preoperative evaluation of male SUI, available surgical options with reported outcomes, and postoperative complication management. Methods. A pubMed review of available literature was performed and summarized on articles reporting outcomes of placement of the artificial urinary sphincter (AUS) or male slings including the bone anchored sling (BAS), retrourethral transobturator sling (RTS), adjustable retropubic sling (ARS), and quadratic sling. Results. Reported rates of success (variably defined) for BAS, RTS, ARS, and AUS are 36-67%, 9-79%, 13-100%, and 59-91% respectively. Complications reported include infection, erosion, retention, explantation, and transient pain. Male slings are more commonly performed in cases of low-to-moderate SUI with decreasing success with higher degrees of preoperative incontinence. Conclusions. An increasing number of options continue to be developed for the management of male SUI. While the AUS remains the gold-standard therapy for SUI, male sling placement is a proven viable alternative therapy for low-to-moderate SUI.
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Welk BK, Herschorn S. The male sling for post-prostatectomy urinary incontinence: a review of contemporary sling designs and outcomes. BJU Int 2011; 109:328-44. [PMID: 22004176 DOI: 10.1111/j.1464-410x.2010.10502.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the outcomes and adverse events associated with novel male sling designs described in the last decade. METHODS A literature review was carried out using Medline, EmBase, Cochrane Registered Trials Database and the Center for Reviews and Dissemination Database. RESULTS Three principal slings are described in the literature. The bone-anchored sling has success rates of 40-88%, with some series having a mean follow-up of 36-48 months. It is associated with a mesh infection rate of 2-12%, which usually requires sling explantation. The retrourethral transobturator sling has a success rate of 76-91% among three large case series with follow-ups of 12-27 months. There is a low reported explantation rate. The adjustable retropubic sling has a success rate of 72-79% with follow-ups of 26-45 months. Erosion (3-13%) and infection (3-11%) can lead to explantation. CONCLUSIONS Most male slings have a similar reported efficacy. Most case series define success as either dry or improved. True cure rates are lower. Mid- and long-term data are now available that indicate the male sling is a viable option for PPI. The use of male slings in severe UI, radiated patients, and non-radical prostatectomy patients is still unclear. Further study is needed to try and define criteria for the use of male slings, and to directly compare different procedures.
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Affiliation(s)
- Blayne K Welk
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Stress incontinence in men is still a common problem after surgical treatment of prostatic disease. This article reviews the techniques and results of recently described surgical slings available to treat male stress incontinence. RECENT FINDINGS Medium-term follow-up (mean 3-4 years) of patients treated with bone-anchored slings has been recently published, suggesting a success rate (cured or improved) of 70-80%. Short-term follow-up (mean of 6-12 months) of transobturator retrourethral slings demonstrates a success rate of 62-83%. Novel sling designs include mechanisms to manipulate the tension postoperatively and inside-out transobturator trocar passage. Common complications associated with slings are acute urinary retention and perineal pain. Rare complications include urethral erosion and infection. Retropubic approaches are associated with a risk of bladder perforation. SUMMARY Male slings are a valid option for treating male stress incontinence, and do offer several advantages over the artificial urinary sphincter. However, long-term data and multicenter series are needed in order to compare directly with the artificial urinary sphincter.
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Herschorn S, Bruschini H, Comiter C, Grise P, Hanus T, Kirschner-Hermanns R, Abrams P. Surgical treatment of stress incontinence in men. Neurourol Urodyn 2010; 29:179-90. [DOI: 10.1002/nau.20844] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Giberti C, Gallo F, Schenone M, Cortese P, Ninotta G. The Bone Anchor Suburethral Synthetic Sling for Iatrogenic Male Incontinence: Critical Evaluation at a Mean 3-Year Followup. J Urol 2009; 181:2204-8. [DOI: 10.1016/j.juro.2009.01.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Indexed: 11/27/2022]
Affiliation(s)
- Claudio Giberti
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - Fabrizio Gallo
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - Maurizio Schenone
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - Pieluigi Cortese
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
| | - Gaetano Ninotta
- Division of Urology, Department of Surgery, San Paolo Hospital, Savona, Italy
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Comiter CV. Surgery Insight: surgical management of postprostatectomy incontinence--the artificial urinary sphincter and male sling. ACTA ACUST UNITED AC 2007; 4:615-24. [PMID: 17982438 DOI: 10.1038/ncpuro0935] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 08/21/2007] [Indexed: 11/09/2022]
Abstract
Stress urinary incontinence in men is usually a result of intrinsic sphincter deficiency following prostate cancer surgery. Active conservative management with fluid restriction, medication management and pelvic floor exercises is indicated for the first 12 months. If bothersome incontinence persists, urodynamic evaluation is indicated in order to assess detrusor storage function, contractility and sphincteric integrity. Standard surgical options include urethral bulking agents, artificial urinary sphincter (AUS) and male sling. Periurethral injection of bulking agents is satisfactory in only a minority of patients, leaving AUS and male sling as the most common surgical treatments. In patients with severe urinary incontinence, AUS seems to have a higher rate of success than the male sling. Furthermore, AUS is indicated in men with detrusor hypocontractility as adequate detrusor contractility is needed to overcome the fixed resistance of the sling. In patients with milder levels of stress incontinence, the two techniques have approximately equal efficacy in the short-to-intermediate term. While current reports of the male sling are generally limited to 1-4 years' follow-up, the infection, erosion, and revision rate for the male sling seem somewhat lower than that for the AUS in appropriately chosen patients.
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Affiliation(s)
- Craig V Comiter
- Department of Urology, Stanford University, Stanford, CA 94305-5118, USA.
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