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Reus C, Tran S, Mozer P, Lenfant L, Beaugerie A, Chartier-Kastler E. Artificial urinary sphincter: recent developments and the way forward. Curr Opin Urol 2024:00042307-990000000-00178. [PMID: 39143947 DOI: 10.1097/mou.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE OF REVIEW The AMS 800 has dominated the treatment of postprostatectomy urinary incontinence (PPUI) due to intrinsic sphincter deficiency (ISD) for five decades. A narrative review from June 2022 to June 2024 was conducted using 'artificial urinary sphincter' (AUS) MeSH terms in Embase. We extracted information on innovative AUS, randomized controlled trials (RCTs) or prospective studies, and systematic reviews. We evaluated the latest guidelines and consensus and analyzed current trends to discuss options for advancing AUS practices. RECENT FINDINGS Of 465 papers identified, 320 were excluded (irrelevant, duplicates, non-AUS devices, non-English, veterinary), and 145 were reviewed, with 24 selected: seven on novel AUS in development, 7 with higher-level evidence (1 RCT, 1 prospective, 4 systematic reviews, 1 nonsystematic review), and 9 retrospective relevant studies [pressure regulating balloon (PRB), revision strategies, radiotherapy history, manual dexterity/cognition, transscrotal vs. transperineal approach]. The final paper summarized current guidelines from Asia & Pacific on AUS. SUMMARY In the past 2 years, six novel AUS have emerged, two female RCTs are ongoing, the SATURN study published its 1-year outcomes, and four systematic reviews on female AUS were conducted. These findings enhance evidence levels and position novel AUS to challenge the Gold Standard.
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Affiliation(s)
- Christine Reus
- Section of Urology, Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Stephanie Tran
- Department of Urology, Academic Hospital Pitié-Salpétrière, AP-HP, Paris Sorbonne University, Paris, France
| | - Pierre Mozer
- Department of Urology, Academic Hospital Pitié-Salpétrière, AP-HP, Paris Sorbonne University, Paris, France
| | - Louis Lenfant
- Department of Urology, Academic Hospital Pitié-Salpétrière, AP-HP, Paris Sorbonne University, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, Academic Hospital Pitié-Salpétrière, AP-HP, Paris Sorbonne University, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Academic Hospital Pitié-Salpétrière, AP-HP, Paris Sorbonne University, Paris, France
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Mumm JN, Abrarova B, Schütz J, Klehr B, Rodler S, Vilsmaier T, Gozzi C, Rehder P, May F, Homberg R, Gebhartl P, Stief CG, Buchner A, Bauer RM. Age at surgery is not a prognostic factor for the AdVance-XP male sling efficacy: A post-hoc analysis of a prospective 7-year multicentric study. Neurourol Urodyn 2021; 40:1616-1624. [PMID: 34082470 DOI: 10.1002/nau.24727] [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: 03/18/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the factor age at the surgery on long-term postoperative outcomes in patients with postprostatectomy incontinence (PPI) after AdVance XP transobturator male sling implantation. METHODS A total of 115 male patients with PPI, who had undergone AdVance XP sling implantation, were included. Patients had PPI with endoscopically confirmed good sphincteric-contractility and a positive coaptive response. Kruskal-Wallis test with Dunn post-hoc tests were used to analyze the postoperative outcome differences between the patient groups aged less than 66, 66-75, and over greater than 75 years. Outcome measures were the 24 h pad test, the number of daily pads used, the International Consultation on Incontinence Questionnaire short form (ICIQ-SF), International Quality of Life Score (IQOL), Patient Global Impression of Improvement (PGI-I), International Index of Erectile Function-5 (IIEF-5), International Prostate Symptom Score (IPSS), and Visual Analog Scale scores. Observation time points were 3, 6, 12, 24, 36, 48, 60, and 84 months after surgery. RESULTS Between the age groups, there was no difference in the success rate of the procedure (defined as 0 pads/24 h and less than 5 g in the 24-h pad test) at any point in time. Subjective parameters measures using the ICIQ-SF, PGI-I, IQOL, and IPSS scores showed no differences between the two cohorts. Only erectile function (IIEF-5 score) was lower in older patients in comparison to the cohort aged less than 66 years (p < 0.05 at 3, 6, 12, 24, 36, and 48 months). CONCLUSIONS The present study complements the European multicentre AdVance XP follow-up study. Here, we show that age at surgery does not affect the objective success, subjective success, or the complication rate. Thus, we do not recommend factoring in chronological age into surgical selection criteria for the AdVance XP implantation.
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Affiliation(s)
| | | | | | | | | | - Theresa Vilsmaier
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | | | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Florian May
- Department of Urology, Klinikum Dachau, Dachau, Germany
| | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | - Peter Gebhartl
- Department of Urology, Salzkammergut Klinikum Vocklabruck, Vocklabruck, Austria
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Ziegelmüller B, Bauer RM, Sommer A. [Urinary incontinence in men: causes, diagnostic steps and treatment options]. MMW Fortschr Med 2021; 163:62-69. [PMID: 33710573 DOI: 10.1007/s15006-021-9631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brigitte Ziegelmüller
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
| | - Ricarda M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany
| | - Anne Sommer
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
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Casteleijn NF, Cornel EB. Argus-T adjustable male sling: A follow-up study on urinary incontinence and patient's satisfaction. Neurourol Urodyn 2021; 40:802-809. [PMID: 33527521 DOI: 10.1002/nau.24619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/09/2022]
Abstract
AIMS The use of Argus-T adjustable sling may be a promising alternative option for the treatment of urinary incontinence after radical prostatectomy, however long-term data is lacking. The aim of this study is to evaluate the long-term results of the Argus-T sling on incontinence rates, patient's quality of life and tape-related complications. METHODS Patients were eligible if persistent stress incontinence was present ≥12 months after radical prostatectomy. Measurements included 24 h frequency volume micturition list, 24 h pad test, 24 h pad count and quality of life questionnaires. Argus-T adjustable sling was placed with a single perineal route incision approach. RESULTS Seventy-eight patients were included, 69 ± 6 years, pre-intervention 24 h urinary loss 212 (75-385) g. Directly after surgery, 63.6% of the patients was completely dry, 79.2% of the patients reported greater than 90% improvement of their urinary loss and 92.2% > 50% improvement. Median follow-up time was 3.2 (2.5-6.1) years. After 5 years of follow-up, 53.3% of the patients were completely dry, 71.5% reported an improvement greater than 90% and 79.6% reported an improvement of greater than 50%. Patients with preoperative urinary loss less than 250 g reported significantly higher improvement of their urinary loss compared to patients with urinary loss ≥250 g (p = .02). Patients satisfaction was still increased after 5 years follow-up (70 ± 21 vs.16 ± 9, p < .001) and patients quality of life remained high (85 ± 20 vs. 88 ± 13, p = .1). Complications were mainly observed directly after surgery. Two patients (2.6%) needed reimplantation of the sling. CONCLUSION These data indicate that Argus-T sling is an effective treatment option in obtaining substantial long-term incontinence relief in patients with invalidating moderate stress urinary incontinence after radical prostatectomy.
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Affiliation(s)
- Niek F Casteleijn
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands.,Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik B Cornel
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands
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Mumm JN, Klehr B, Rodler S, Kretschmer A, Vilsmaier T, Westhofen T, Chaloupka M, Schulz GB, Gozzi C, Rehder P, May F, Homberg R, Stief CG, Grabbert M, Bauer RM. Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors. Urol Int 2021; 105:421-427. [PMID: 33517334 DOI: 10.1159/000512881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. METHODS In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. RESULTS The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. CONCLUSIONS The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.
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Affiliation(s)
- Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany,
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Theresa Vilsmaier
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Florian May
- Department of Urology, Klinikum Dachau, Dachau, Germany
| | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
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Artificial Urinary Sphincter for Postradical Prostatectomy Urinary Incontinence - Is It the Best Option? Int Neurourol J 2019; 23:265-276. [PMID: 31905273 PMCID: PMC6944792 DOI: 10.5213/inj.1938210.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/13/2019] [Indexed: 01/13/2023] Open
Abstract
Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.
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Abdullah A, Machkour F, Bouchet E, Plainard X, Descazeaud A. Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study. Prog Urol 2019; 29:490-495. [PMID: 31387835 DOI: 10.1016/j.purol.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 12/01/2022]
Abstract
AIM To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling. MATERIAL AND METHOD Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL. RESULTS Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered. CONCLUSION The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Abdullah
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France; Department of surgery (Urology unit), Al-Amiri hospital, Kuwait City, Kuwait.
| | - F Machkour
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - E Bouchet
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - X Plainard
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France
| | - A Descazeaud
- Service de chirurgie urologique et andrologique, CHU de Limoges, 2, avenue de Martin Luther-King, 87100 Limoges, France.
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Grabbert M, Mumm JN, Klehr B, Kretschmer A, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Bauer RM. Extended follow-up of the AdVance XP male sling in the treatment of male urinary stress incontinence after 48 months: Results of a prospective and multicenter study. Neurourol Urodyn 2019; 38:1973-1978. [PMID: 31297894 DOI: 10.1002/nau.24101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the AdVance XP male sling in a midterm follow-up for the treatment of male urinary incontinence in a selected patient cohort. MATERIALS AND METHODS In all, 115 patients with postprostatectomy incontinence were prospectively enrolled. A previous endoscopic evaluation of a sufficient coaptive zone in the repositioning test was mandatory. Patients with urine leakage in supine position or previous incontinence surgery were excluded. Postoperatively a standardized 24-hour pad test and pad usage were evaluated. To compare pre- and postoperative continence status nonparametric t test was used. A P-value of <.05 was seen as statistically significant. RESULTS Median preoperative urine loss in the 24-hour pad test was 272 g (min. 42-max. 1600) and was significantly improved at any point in follow-up. Success was defined as 0 pads per day and a maximum of 5 g in the 24-hour pad test. After a follow-up of 48 months, 71.7% of the patients were cured, whereas 15.0% of patients had an improved continence situation and 13.3% were classified as failed. Mean urine loss decreased significantly to 24.4 g (P ≤ .001). No severe intra- or postoperative complications are to be reported. Median follow-up was 4.2 years. CONCLUSIONS A stable effectiveness in a selected patient cohort can also be demonstrated in an extended follow-up. The complication rates are low and no late postoperative complications occurred, indicating the safety of the procedure.
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Affiliation(s)
- Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Peter Gebhartl
- Department of Urology, Salzkammergut Klinikum Voecklabruck, Voecklabruck, Austria
| | | | - Roland Homberg
- Department of Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | - Florian May
- Department of Urology, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | | | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
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Zemp L, Tong S, Hoy N, Rourke KF. Preoperative pad usage is independently associated with failure of non-adjustable male trans-obturator slings in otherwise well-selected patients. Can Urol Assoc J 2019; 13:120-124. [PMID: 30273118 PMCID: PMC6456352 DOI: 10.5489/cuaj.5468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our objective was to determine which clinical factors are associated with failure to achieve continence after nonadjustable trans-obturator sling in otherwise well-selected men undergoing treatment for post-prostatectomy incontinence (PPI). METHODS A retrospective review of AdVance/AdVance™ XP male sling procedures was performed from December 2006 to May 2017. Patients with known risk factors for sling failure, including severe incontinence (>5 pads), radiation therapy, or detrusor dysfunction, were excluded. The primary outcome was failure to achieve continence, defined as ≤1 pad per day when pad use was ≥2 preoperatively (or 0 pads if preoperative pad use was 1). Covariates included patient age, Charlson comorbidity index (CCI), diabetes, obesity (body mass index [BMI] ≥35), type of prostatectomy, and number of preoperative pads. Descriptive statistics and Cox regression analysis was performed. RESULTS Of 158 patients, continence was achieved in 82.3% (n=130) with a mean followup of 42.7 months. Patient-reported satisfaction was 86.7% (n=137) and the 90-day complication rate was 12% (n=19). On univariate Cox regression analysis, increasing age (p=0.02), CCI (p=0.02), and preoperative pad use (p<0.0001) were associated with sling failure, whereas obesity (p=0.95), diabetes (p=0.49), and type of prostatectomy (p=0.88) were not. On multivariate analysis, only increasing preoperative pad use remained associated with sling failure (hazard ratio [HR] 1.3; 95% confidence interval [CI] 1.1-16; p=0.008). Patients wearing >3 pads per day were more likely to experience failure (35.5% vs. 13.4%; p=0.007). CONCLUSIONS Increasing preoperative pad use is independently associated with an increased risk of failure after non-adjustable sling for post-prostatectomy incontinence in otherwise well-selected patients.
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Affiliation(s)
- Logan Zemp
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Stephen Tong
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Nathan Hoy
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada
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MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shamout S, Nazha S, Dragomir A, Campeau L. A cost-utility analysis of artificial urinary sphincter versus AdVance male sling in post prostatectomy stress urinary incontinence: A publicly funded health care perspective. Neurourol Urodyn 2018; 37:2195-2203. [DOI: 10.1002/nau.23559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/26/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Samer Shamout
- Division of Urology; Department of Surgery; McGill University; Montreal Quebec Canada
| | - Sara Nazha
- Division of Urology; Department of Surgery; McGill University Health Center; Montreal Quebec Canada
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - Alice Dragomir
- Division of Urology; Department of Surgery; McGill University Health Center; Montreal Quebec Canada
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - Lysanne Campeau
- Division of Urology; Department of Surgery; McGill University; Montreal Quebec Canada
- Faculty of Medicine; McGill University; Montreal Quebec Canada
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Romero Hoyuela A, Reina Alcaina L, Izquierdo Morejon E, Rosino Sanchez A, Carrillo George C, Rivero Guerra A, Barcelo Bayonas I, Pardo Martinez A, Muñoz Guillermo V, Pietricica B, Fernandez Aparicio T, Hita Villaplana G, Miñana Lopez B. Long-term follow-up of the AdVance ®/AdVanceXP ® sling. What are the surgeons' impressions? What are the patients'? Actas Urol Esp 2018; 42:185-190. [PMID: 29132933 DOI: 10.1016/j.acuro.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.
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Affiliation(s)
- A Romero Hoyuela
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España.
| | - L Reina Alcaina
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - E Izquierdo Morejon
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Rosino Sanchez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - C Carrillo George
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Rivero Guerra
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - I Barcelo Bayonas
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Pardo Martinez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - V Muñoz Guillermo
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - B Pietricica
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | | | - G Hita Villaplana
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - B Miñana Lopez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
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14
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Grabbert MT, Kretschmer A, Stief C, Bauer R. [Male urinary incontinence - causes and therapeutic approaches for male stress incontinence]. MMW Fortschr Med 2017; 159:52-56. [PMID: 29124582 DOI: 10.1007/s15006-017-0278-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Markus Tobias Grabbert
- Univ.-Klinikum Köln, Klinik für Urologie, Uro-Onkologie, spezielle und roboter-assistierte Chirurgie, Kerpener Str. 62, D-50634, Köln, Deutschland.
| | - Alexander Kretschmer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
| | - Christian Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
| | - Ricarda Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
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15
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Kretschmer A, Nitti V. Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts. Eur Urol Focus 2017; 3:364-376. [DOI: 10.1016/j.euf.2017.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/12/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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Sahai A, Abrams P, Dmochowski R, Anding R. The role of male slings in post prostatectomy incontinence: ICI-RS 2015. Neurourol Urodyn 2017; 36:927-934. [PMID: 28444702 DOI: 10.1002/nau.23264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/28/2017] [Indexed: 11/08/2022]
Abstract
AIMS Post prostatectomy stress urinary incontinence can significantly impact on quality of life and is bothersome for patients. The artificial urinary sphincter is still considered the gold standard surgical treatment. Male slings are an alternative surgical option and several designs are currently available. This review will focus on efficacy, adverse events, and mechanism of action of male slings. The context of this review was a proposal at the ICI-RS meeting 2015. Following synthesis of the evidence we address the question: does it matter how male slings work? METHODS The proposal lecture was reviewed and a comprehensive review of the literature undertaken utilising the PubMed database. RESULTS Male slings can be broadly divided into adjustable retropubic and suburethral transobturator slings. Male slings are efficacious and can improve quality of life. Adjustable retropubic slings appear to be compressive but studies suggest efficacy can be achieved without voiding dysfunction. Transobturator slings work by urethral compression and/or re-locating the urethral bulb. There is a recognized failure rate in all sling types and most studies suggest radiotherapy as a risk factor for failure. Adjustable slings have the ability to be altered to optimize continence or to prevent retention of urine. However, there appears to be a higher explantation rate in some of these systems. CONCLUSIONS It is important to understand how male slings work and by doing so we are more reliably able to choose the appropriate sling, predict outcomes, and as a result counsel patients. Suggestions for future research are proposed.
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Affiliation(s)
- Arun Sahai
- Department of Urology, Guy's Hospital, Kings College London, London, UK
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK
| | - Roger Dmochowski
- Department of Urologic Surgery, Medical Center North, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralf Anding
- Department of Neuro-Urology, University Hospital, Bonn, Germany
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17
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Barski D, Gerullis H, Otto T. Review of surgical implant procedures for male incontinence after radical prostatectomy according to IDEAL framework. Updates Surg 2017; 69:327-338. [DOI: 10.1007/s13304-017-0460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/01/2017] [Indexed: 12/27/2022]
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18
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Mason J, Erickson B. The Male Transobturator Sling for Stress Incontinence After the Treatment of Prostate Cancer. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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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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20
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Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate. Int Neurourol J 2016; 20:335-341. [PMID: 28043113 PMCID: PMC5209579 DOI: 10.5213/inj.1632648.324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/18/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods A total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05). Results Follow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041). Conclusions The findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.
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Bauer RM, Grabbert MT, Klehr B, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Kretschmer A. 36-month data for the AdVance XP ® male sling: results of a prospective multicentre study. BJU Int 2016; 119:626-630. [PMID: 27862836 DOI: 10.1111/bju.13704] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence (SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape. PATIENTS AND METHODS In all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of <1 cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, quality-of-life scores [International Quality of Life score (IQOL) and International Consultation on Incontinence Questionnaire short form (ICIQ-UI SF)], visual analogue scale (VAS) for pain, five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and Patient Global Impression of Improvement (PGI-I) score, were performed. All patients with a 0-5 g pad test were defined as cured and improved with a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. RESULTS The mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g (P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g (P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred. CONCLUSION The AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months.
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Affiliation(s)
| | | | - Benedikt Klehr
- Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | | | | | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Peter Rehder
- Department of Urology, University of Innsbruck, Innsbruck, Austria
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22
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Cunningham KG, Westney OL. Post Prostatectomy Bladder Dysfunction: Where Are We Now? CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Friedl A, Mühlstädt S, Zachoval R, Giammò A, Kivaranovic D, Rom M, Fornara P, Brössner C. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int 2016; 119:785-792. [PMID: 27868328 DOI: 10.1111/bju.13684] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. PATIENTS AND METHODS In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (<10 mL/day and 0-1 pad/day), device durability, treatment failure, and device complications were recorded. Nonparametric tests were used for statistical analyses. RESULTS After a median (interquartile range [IQR]) follow-up of 31 (10-54) months and a median (IQR) of 3 (2-4) adjustments, the overall success rate was 90% (258 men) and the dry rate was 64% (184). Daily pad test and pad use decreased from a median of 400 mL/day and 4 pads/day to a median of 18 mL/day and 1 pad/day (both P < 0.001), concomitantly QoL ratings significantly improved and changed to a high level of satisfaction (PGI-I 4 to 2, ICIQ-SF 17 to 5; both P < 0.001). The UI results at 12 months were comparable to those at final follow-up. Chronic pain and intraoperative complications did not occur. Most of the postoperative complications were Clavien-Dindo grade I-III (no grade IV or V). At present, 231 (80%) of all the ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P < 0.001) were prognostic factors for beneficial treatment outcome. CONCLUSION The ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Danijel Kivaranovic
- Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Maximilian Rom
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Clemens Brössner
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
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Kretschmer A, Grimm T, Buchner A, Grimm J, Grabbert M, Jokisch F, Schneevoigt BS, Apfelbeck M, Schulz G, Bauer RM, Stief CG, Karl A. Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort. J Urol 2016; 197:210-215. [PMID: 27506691 DOI: 10.1016/j.juro.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE We objectively quantified daytime and nocturnal continence rates, and defined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation. MATERIALS AND METHODS At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p <0.05. RESULTS A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p = 0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p <0.001). CONCLUSIONS Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.
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Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany; Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Julia Grimm
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | | | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Gerald Schulz
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-University Munich, Germany
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