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Yang B, Lavigne A, Carugo D, Turney B, Somani B, Stride E. Mitigating infections in implantable urological continence devices: risks, challenges, solutions, and future innovations. A comprehensive literature review. Curr Opin Urol 2024:00042307-990000000-00175. [PMID: 39105299 DOI: 10.1097/mou.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence is a growing issue in ageing men, often following treatment for prostate cancer or bladder outflow obstruction. While implantable urological devices offer relief, infections are a significant concern. These infections can lead to device removal, negating the benefits and impacting patient outcomes. This review explores the risks and factors contributing to these infections and existing strategies to minimize them. These strategies encompass a multifaceted approach that considers patient-specific issues, environmental issues, device design and surgical techniques. However, despite these interventions, there is still a pressing need for further advancements in device infection prevention. RECENT FINDINGS Faster diagnostics, such as Raman spectroscopy, could enable early detection of infections. Additionally, biocompatible adjuncts like ultrasound-responsive microbubbles hold promise for enhanced drug delivery and biofilm disruption, particularly important as antibiotic resistance rises worldwide. SUMMARY By combining advancements in diagnostics, device design, and patient-specific surgical techniques, we can create a future where implantable urological devices offer men a significant improvement in quality of life with minimal infection risk.
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Affiliation(s)
- Bob Yang
- Royal Berkshire NHS Foundation Trust
- Oxford University, Oxford
| | | | | | | | - Bhaskar Somani
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
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Juliebø-Jones P, Roth I, Tzelves L, Hjelle KM, Moen CA, Esperto F, Somani BK, Beisland C. Current status of the adjustable transobturator male system (ATOMS TM) for male stress urinary incontinence. Front Surg 2024; 11:1377788. [PMID: 38567359 PMCID: PMC10985136 DOI: 10.3389/fsurg.2024.1377788] [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: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Male stress urinary incontinence is a debilitating condition, which can occur after prostate surgery. In persistent cases, surgery is indicated and a number of options are available. This includes one of the male slings, Adjustable transobturator male system (ATOMSTM, A.M.I, Austria). There are now an increasing number of studies published. This review provides an overview of the current status of this implant device including technical considerations, surgical outcomes and potential advantages and disadvantages compared to alternatives such as the artificial urinary sphincter.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Roth
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Karin M. Hjelle
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Arvei Moen
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Yanaral F, Gültekin MH, Halis A, Akbulut F, Sarilar O, Ozgor F. Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results. Cureus 2023; 15:e43280. [PMID: 37692721 PMCID: PMC10492627 DOI: 10.7759/cureus.43280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.
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Affiliation(s)
- Fatih Yanaral
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | | | - Ahmet Halis
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Fatih Akbulut
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Omer Sarilar
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Faruk Ozgor
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
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Chung E. Contemporary male slings for stress urinary incontinence: advances in device technology and refinements in surgical techniques. Ther Adv Urol 2023; 15:17562872231187199. [PMID: 37528956 PMCID: PMC10387683 DOI: 10.1177/17562872231187199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
Synthetic male sling (MS) is considered an effective surgical treatment to restore male stress urinary incontinence. The modern MS can be categorised into adjustable or non-adjustable types, while the surgical techniques can be divided into retropubic or transobturator approaches. This narrative review paper evaluates the contemporary MS devices in the current commercial market regarding clinical outcomes and refinements in surgical techniques. Scientific advances in device design and technology, coupled with further surgical refinements will enhance the clinical outcomes and improve the safety profile of MS surgery. The newer generation of modern MS not only provides direct compression of the bulbar urethra but also allows for proximal urethral relocation by realigning the mobile sphincter complex to provide further urethral sphincter complex coaptation. Strict patient selection, use of MS with proven clinical records, adherence to safe surgical principles and judicious postoperative care are critical to ensure a high continence rate, good patient satisfaction and low postoperative complications.
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Grabbert M, Bauer RM, Hüsch T, Kretschmer A, Kirschner-Hermanns R, Anding R, Brehmer B, Naumann CM, Queissert F, Khoder WY, Gratzke C, Hofmann T, Haferkamp A, Huebner WA. Patient Selection in Surgical Centers of Expertise in the Treatment of Patients with Moderate to Severe Male Urinary Stress Incontinence. Urol Int 2020; 104:902-907. [DOI: 10.1159/000509444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Objective:</i></b> To analyze decision-making in patients with male urinary incontinence (SUI) in centers of expertise. The artificial urinary sphincter (AUS) remains the gold standard for male patients with moderate to severe SUI but adjustable male slings are a minimally invasive treatment option with good results, hence without a high level of evidence regarding the optimal patient selection. <b><i>Materials and Methods:</i></b> In total, 220 patients (88 AUS; 132 adjustable slings) were investigated from the DOMINO database that underwent surgery between 2010 and 2012 in 5 urological departments that offer adjustable sling systems as well as AUS systems for patients with moderate to severe urinary incontinence. For statistical analysis, the Mann-Whitney <i>U</i> test was used to identify differences between both groups. <b><i>Results:</i></b> Patients selected for an adjustable male sling were less likely to have a neurological disease (5.3 vs. 9.1%; <i>p</i> = 0.030), a prior urethral stricture (22.7 vs. 50.0%; <i>p</i> = 0.001), a prior incontinence surgery (24.4 vs. 45.5%; <i>p</i> = 0.01), or a prior radiation therapy (26.5 vs. 40.1%; <i>p</i> = 0.001). The severity of preoperative incontinence was higher in patients selected for an AUS with a mean pad usage per day of 7.60 versus 5.80 (<i>p</i> < 0.001). Mean postoperative pad usage and patients’ subjective perception were comparable in both groups. <b><i>Conclusion:</i></b> In centers offering both options, the decision-making is mainly based upon presence of radiation therapy and previous failed incontinence surgery. Despite the more complex patient cohort selected for an AUS implantation with a possible impact on the postoperative outcome, the functional results seem to be comparable indicating a proper preoperative patient assessment and selection in this cohort.
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Complications after male adjustable suburethral sling implantation. Wideochir Inne Tech Maloinwazyjne 2020; 15:496-502. [PMID: 32904554 PMCID: PMC7457203 DOI: 10.5114/aoms.2020.97413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Argus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI). Aim To determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI. Material and methods A total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects. Results Overall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system. Conclusions Argus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.
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Abstract
The combination of a severe urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a "devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with a wide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. A potential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of a refunctionalization of the original bladder, supravesical urinary diversion is indicated as a last-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for a devastated bladder outlet.
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Affiliation(s)
- A Kocot
- Klinik und Poliklinik für Urologie und Kinderurologie, Julius Maximilians Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Loertzer H, Huesch T, Kirschner-Hermanns R, Anding R, Rose A, Brehmer B, Naumann CM, Queissert F, Nyarangi-Dix J, Homberg R, Grabbert M, Hofmann T, Pottek T, Hübner W, Haferkamp A, Bauer RM, Kretschmer A. Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study. Neurourol Urodyn 2020; 39:987-993. [PMID: 32125722 DOI: 10.1002/nau.24316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/02/2020] [Indexed: 11/10/2022]
Abstract
AIMS To comparatively analyse outcomes after ARGUS classic and ArgusT adjustable male sling implantation in a real-world setting. METHODS Inclusion criteria encompassed: non-neurogenic, moderate-to-severe stress urinary incontinence (≥2 pads), implantation of an ARGUS classic or ArgusT male sling between 2010 and 2012 in a high-volume center (>150 previous implantations). Functional outcomes were assessed using daily pad usage, 24-hour pad testing, and International Consultation on Incontinence (ICIQ-SF) questionnaires. Continence was defined as zero pads per 24 hours. Complications were graded using Clavien-Dindo scale. For multivariate analysis, binary logistic regression models were used (P < .05). RESULTS A total of 106 patients (n = 74 [ARGUS classic], n = 32 [ArgusT]) from four centers were eligible. Median follow-up was 44.0 months (24-64). Patient cohorts were well-balanced. We observed a statistical trend in favor of ARGUS classic regarding postoperative urine loss based on standardized 24-hour pad test (71 ± 162 g [ARGUS classic] vs 160 ± 180 g [ArgusT]); P = .066]. Dry rates were 33.3% (ARGUS classic) and 11.8% (ArgusT, P = .114). In multivariable analysis, ArgusT male sling could not be confirmed as an independent predictor of decreased success (OR, 0.587; 95% CI; 0.166-2.076, P = .408). There were no Clavien IV and V complications. Inguinal pain was significantly higher after ArgusT implantation (P = .033). Explantation rates were higher for ArgusT compared to ARGUS classic (14.0 vs 23.3%; P = .371). Longer device survival for the ARGUS classic male sling was observed in Kaplan-Meier analysis (P = .198). CONCLUSIONS In the largest comparative analysis of ARGUS classic and ArgusT male sling with the longest follow-up to date, we observed low continence rates with superior functional outcomes and decreased explantation rates after ARGUS classic implantation.
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Affiliation(s)
- Hagen Loertzer
- Department of Urology, Westpfalzklinikum Kaiserslautern, Kaiserslautern, Germany
| | - Tanja Huesch
- Department of Urology, University Medical Center Mainz, Mainz, Germany.,Promedon GmbH, Kolbermoor, Germany
| | | | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Armin Rose
- Department of Urology, Helios Klinikum Duisburg, Duisburg, Germany
| | - Bernhard Brehmer
- Department of Urology, Diakonie Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Carsten Maik Naumann
- Department of Urology, Marienhaus klinikum Bendorf - Neuwied - Waldbreitbach, Germany
| | - Fabian Queissert
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | | | - Roland Homberg
- Department of Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Wilhelm Hübner
- Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria
| | - Axel Haferkamp
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | | | - Alexander Kretschmer
- Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany
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Sling Surgery for Male Urinary Incontinence Including Post Prostatectomy Incontinence: A Challenge to the Urologist. Int Neurourol J 2019; 23:185-194. [PMID: 31607097 PMCID: PMC6790820 DOI: 10.5213/inj.1938108.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/02/2019] [Indexed: 11/22/2022] Open
Abstract
The management of postprostatectomy urinary incontinence (PPI) is still challenging for urologists. In recent decades, various kinds of male sling system have been developed and introduced; however, they have not yet shown as good a result as that of artificial urinary sphincter (AUS). However, a male sling is still in an important position because patients have a high demand for sling implantation, and it can allow the avoidance of the use of mechanical devices like AUS. Recently, the male sling has been widely used in mild-to-moderate PPI patients; however, there are no studies that compare individual devices. Thus, it is hard to directly compare the success rate of operation, and it is impossible to judge which sling system is more excellent. It is expected that many sling options will be available in addition to AUS in the near future with the technological development of various male slings and the accumulation of long-term surgical outcomes. In that in patients with PPI, sling implantation is an option that must be explained rather than an option that need not be explained to them, this review would share the latest outcomes and complications.
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Silva LAD, Simonetti R, Silva EMKD. Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis. EINSTEIN-SAO PAULO 2019; 17:eRW4508. [PMID: 31553360 PMCID: PMC6748345 DOI: 10.31744/einstein_journal/2019rw4508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/08/2019] [Indexed: 11/05/2022] Open
Abstract
Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).
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Sling Procedures for Post Prostatectomy Incontinence: What Devices Are Out There? and What Are Their Results? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Grabbert M, Hüsch T, Kretschmer A, Kirschner-Hermanns R, Anding R, Rose A, Friedl A, Obaje A, Heidenreich A, Brehmer B, Naumann CM, Queissert F, Loertzer H, Pfitzenmaier J, Nyarangi-Dix J, Kurosch M, Olianas R, Homberg R, Abdunnur R, Schweiger J, Hofmann T, Wotzka C, Pottek T, Huebner W, Haferkamp A, Bauer RM. Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status. World J Urol 2018; 37:1415-1420. [PMID: 30341450 DOI: 10.1007/s00345-018-2523-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. RESULTS Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). CONCLUSIONS Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.
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Affiliation(s)
- M Grabbert
- Department of Urology, University Hospital Cologne, Cologne, Germany.
| | - T Hüsch
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | - A Kretschmer
- Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany
| | | | - R Anding
- Department of Neurourology, University Bonn, Bonn, Germany
| | - A Rose
- Department of Urology, Helios Klinikum Duisburg, Duisburg, Germany
| | - A Friedl
- Department of Urology, Krankenhaus Der Barmherzigen Schwestern Wien, Vienna, Austria
| | - A Obaje
- Department of Urology, St. Bernward Krankenhaus Hildesheim, Hildesheim, Germany
| | - A Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - B Brehmer
- Department of Urology, Diankonie Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany
| | - C M Naumann
- Department of Urology, University Hospital SH, Kiel, Germany
| | - F Queissert
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | - H Loertzer
- Department of Urology, Westpfalzklinikum Kaiserslautern, Kaiserslautern, Germany
| | - J Pfitzenmaier
- Department of Urology, Evangelische Klinikum Bethel Bielefeld, Bielefeld, Germany
| | - J Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Kurosch
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | - R Olianas
- Department of Urology, Klinikum Lueneburg, Lueneburg, Germany
| | - R Homberg
- Department of Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | - R Abdunnur
- Department of Urology, Helios Klinikum Schwelm, Schwelm, Germany
| | - J Schweiger
- Department of Urology, Catholic Hospital Erfurt, Erfurt, Germany
| | - T Hofmann
- Department of Urology, Diankonie Klinikum Schwaebisch Hall, Schwaebisch Hall, Germany
| | - C Wotzka
- Department of Urology, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - T Pottek
- Department of Urology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - W Huebner
- Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria
| | - A Haferkamp
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | - R M Bauer
- Department of Urology, University Hospital Munich Grosshadern (LMU), Munich, Germany
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Aagaard MF, Khayyami Y, Hansen FB, Tofft HP, Nordling J. Implantation of the argus sling in a hard-to-treat patient group with urinary stress incontinence. Scand J Urol 2018; 52:448-452. [PMID: 30298753 DOI: 10.1080/21681805.2018.1517823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Awareness of prostate cancer is growing in the Western population, and an increasing number of patients are being referred to prostate surgery. This is a significant contributor to male stress urinary incontinence (SUI). Implantation of an artificial sphincter (AUS) is considered the gold standard treatment of SUI. This study investigates the role of minimally invasive treatment with the Argus sling in a heterogenic hard-to-treat patient group. METHOD The study was a retrospective follow-up study with patients as their own controls. Forty-one patients were enrolled and treated with the Argus sling. Patients enrolled had persisting SUI after prostate surgery for more than 12 months, despite conservative treatment. The pre-operative daily usage of pads and the 24 hours urinary leakage were compared to the post-operative findings. The primary goal was to achieve complete continence or a reduction of more than 50% in pad usage or urinary leakage. RESULTS In total, 71% of the 41 patients enrolled met our primary objective. Complete continence was obtained in 56%, and a reduction of 50% or more was obtained in an additional 15%. CONCLUSION This study has reproduced continence rates seen in previous studies, but in the hard-to-treat patients with urgency or formerly failed surgery, the continence rate was found to be inferior. The AUS has produced similar results and must still be considered the gold standard treatment of SUI, but the Argus sling is an alternative for patients who want a passive system or for patients not suitable for AUS.
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Affiliation(s)
| | - Yasmine Khayyami
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Frank Bohn Hansen
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Hans Peter Tofft
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
| | - Jørgen Nordling
- b Department of Urology at Herlev Hospital , University of Copenhagen , Herlev , Denmark
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Shamout S, Huang YQ, Kabbara H, Corcos J, Campeau L. Short‐term evaluation of the adjustable bulbourethral male sling for post‐prostatectomy urinary incontinence. Low Urin Tract Symptoms 2018; 11:O111-O116. [DOI: 10.1111/luts.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Samer Shamout
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
| | - Yu Qing Huang
- Faculty of MedicineMcGill University Montreal Canada
| | - Hani Kabbara
- StatRAC Statistical Research and Analysis Consultancy Firm Montreal Canada
| | - Jacques Corcos
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
| | - Lysanne Campeau
- Division of Urology, Department of SurgeryJewish General Hospital, McGill University Montreal Canada
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15
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Kim M, Choi D, Hong JH, Kim CS, Ahn H, Choo MS. Factors contributing to treatment outcomes of post-prostatectomy incontinence surgery for the selection of the proper surgical procedure for individual patients: A single-center experience. Neurourol Urodyn 2018; 37:1978-1987. [DOI: 10.1002/nau.23543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/15/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Myong Kim
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
| | - Daehun Choi
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
| | - Choung-Soo Kim
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
| | - Hanjong Ahn
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
| | - Myung-Soo Choo
- Department of Urology; University of Ulsan College of Medicine; Asan Medical Center; Seoul Republic of Korea
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16
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Siracusano S, Visalli F, Favro M, Tallarigo C, Saccomanni M, Kugler A, Diminutto A, Talamini R, Artibani W. Argus-T Sling in 182 Male Patients: Short-term Results of a Multicenter Study. Urology 2017; 110:177-183. [DOI: 10.1016/j.urology.2017.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
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Al Adem KM, Bawazir SS, Hassen WA, Khandoker AH, Khalaf K, McGloughlin T, Stefanini C. Implantable Systems for Stress Urinary Incontinence. Ann Biomed Eng 2017; 45:2717-2732. [PMID: 29022114 DOI: 10.1007/s10439-017-1939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023]
Abstract
Stress urinary incontinence (SUI), the involuntary urine leakage due to failure of the urethral closure mechanism, is a global health challenge with substantial human suffering and socioeconomic costs. Approximately 167 million male and female patients are predicted to suffer from SUI in 2018, worldwide. A wide range of surgical interventions are available for the treatment of SUI. Severe cases, however, usually require the implantation of artificial urinary sphincter devices. This review comparatively presents and analyzes the working principles, as well as the challenges, associated with the current implantable SUI systems in clinical use. These include slings, urethral bulking agents, artificial urinary sphincters, and adjustable continence devices. It further reports on recent research progress and state-of-the-art in the field of SUI implants, including an original approach proposed by the authors with a pressure feedback sensory mechanism. The new emerging field of artificial muscle devices, including electroactive polymers, provides a promising innovative solution for replacing the weakened urethral sphincter in SUI patients.
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Affiliation(s)
- Kenana M Al Adem
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Sarah S Bawazir
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Waleed A Hassen
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Tim McGloughlin
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Cesare Stefanini
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE.
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Chung E. Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Transl Androl Urol 2017; 6:S112-S121. [PMID: 28791230 PMCID: PMC5522789 DOI: 10.21037/tau.2017.04.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Male stress urinary incontinence (SUI) remains a debilitating condition that adversely impacts all domains of quality of life and is associated with significant social stigma and health economic burden. The incidence of post-prostatectomy urinary incontinence (PPI) depends on the definition of urinary incontinence and the length of patient follow up. In patients with persistent PPI following failure of conservative measures, surgical treatment is recommended although there is no published guideline on when surgery should be performed, and what the best surgical option is. Male slings (MS) can be divided into adjustable or non-adjustable types, and offers an attractive option for patients who wish to avoid mechanical handling during urinary voiding. Published intermediate data supports good safety and efficacy rate in men with mild to moderate degree of SUI. The AMS 800 artificial urinary sphincter (AUS) remains the standard of treatment for complete continence and has the longest efficacy and safety records. Other AUS-like devices are designed to address current AMS 800 limitations but themselves are fraught with their own issues.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia.,AndroUrology Centre, St Andrew's War Memorial Hospital, Brisbane QLD, Australia
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19
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Lima JPC, Pompeo ACL, Bezerra CA. Argus T® versus Advance® Sling for postprostatectomy urinary incontinence: A randomized clinical trial. Int Braz J Urol 2017; 42:531-9. [PMID: 27286117 PMCID: PMC4920571 DOI: 10.1590/s1677-5538.ibju.2015.0075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the results of two slings, Argus T® and Advance®, for the treatment of postprostatectomy urinary incontinence (PPUI). Material and Methods: From December 2010 to December 2011, 22 patients with PPUI were randomized as follows: 11 (mean age 62.09(±5.30)) underwent treatment with Advance® and 11 (mean age 62.55(±8.54)) with Argus T®. All patients were evaluated preoperatively with urodynamic testing, quality of life questionnaire (ICIQ-SF), voiding diary and 24-hour pad test. Exclusion criteria were: neurological diseases, severe detrusor overactivity and urethral stenosis. Evaluation was performed at 6, 12 and 18 months after the surgery. After implantation of the Argus T® sling, patients who experienced urine leakage equal to or greater than the initial volume underwent adjustment of the sling tension. Results were statistically analyzed using the Fisher’s test, Kolmogorov-Smirnov test, Friedman’s non-parametric test or the Mann-Whitney test. Results Significant improvement of the 24-hour pad test was observed with the Argus T® sling (p=0.038) , With regard to the other parameters, there was no significant difference between the two groups. Removal of the Argus T® device due to perineal pain was performed in one patient (9%). Despite non uniform results, both devices were considered useful to improve quality of life (ICIQ-SF): Argus T® (p=0.018) and Advance® (p=0.017). Conclusions Better results were observed in the 24h pad test and in levels of satisfaction with the Argus T® device. Both slings contributed to improve quality of life (ICIQ-SF), with acceptable side effects.
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Targeting Moderate and Severe Male Stress Urinary Incontinence With Adjustable Male Slings and the Perineal Artificial Urinary Sphincter: Focus on Perioperative Complications and Device Explantations. Int Neurourol J 2017; 21:109-115. [PMID: 28673058 PMCID: PMC5497191 DOI: 10.5213/inj.1632626.313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/30/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To analyze perioperative complications and postoperative explantation rates for selected readjustable male sling systems and the perineal single-cuff artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. METHODS Two hundred eighty-two male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in the study (n=127 adjustable male sling [n=95 Argus classic, n=32 Argus T], n=155 AUS). Perioperative characteristics and postoperative complications were analyzed. The explantation rates of the respective devices were assessed using the Fisher exact test and the Mann-Whitney U-test. A Kaplan-Meier curve was generated. Potential features associated with device explantation were analyzed using a multiple logistic regression model (P<0.05). RESULTS We found significantly increased intraoperative complication rates after adjustable male sling implantation (15.9% [adjustable male sling] vs. 4.2% [AUS], P=0.003). The most frequent intraoperative complication was bladder perforation (n=17). Postoperative infection rates did not vary significantly between the respective devices (P=0.378). Device explantation rates were significantly higher after AUS implantation (9.7% [adjustable male sling] vs. 21.5% [AUS], P=0.030). In multivariate analysis, postoperative infection was a strong independent predictor of decreased device survival (odds ratio, 6.556; P=0.001). CONCLUSIONS Complication profiles vary between adjustable male slings and AUS. Explantation rates are lower after adjustable male sling implantation. Any kind of postoperative infections are independent predictors of decreased device survival. There is no significant effect of the experience of the implanting institution on device survival.
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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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22
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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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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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Use of the adjustable trans-obturator male sling system for the treatment of male incontinence. An initial experience. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Balci M, Tuncel A, Bilgin O, Aslan Y, Atan A. Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence. Int Braz J Urol 2015; 41:312-8. [PMID: 26005973 PMCID: PMC4752095 DOI: 10.1590/s1677-5538.ibju.2015.02.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/10/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. MATERIALS AND METHODS An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. RESULTS The mean age of the patients was 66.2 ± 7.3 (50-79) years and mean pad usage was 6.4 ± 0.6 per day. The mean follow-up time was 40.1 ± 23.2 (6-74) months. The balloon was postoperatively inflated on average with 11.6 ± 5.7 (5-25) mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2%) were dry (11 patients, 0 pads; 5 patients using safety pads), 3 patients (14%) had mild and 2 (9.8%) had moderate degree post-prostatectomy urinary incontinence (PPI). The average maximum urine flow rate of the patients was 15.6 ± 4.7 (10-31) mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. CONCLUSIONS Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.
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Affiliation(s)
- Melih Balci
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey
| | - Altug Tuncel
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey
| | - Ovunc Bilgin
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey
| | - Yilmaz Aslan
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey
| | - Ali Atan
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey
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A Review of Adjustable Continence Devices for the Treatment of Stress Urinary Incontinence with Neurogenic Etiology. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Romano SV, Huebner W, Rocha FT, Vaz FP, Muller V, Nakamura F. A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study. Int Braz J Urol 2015; 40:781-9. [PMID: 25615246 DOI: 10.1590/s1677-5538.ibju.2014.06.09] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/03/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). MATERIALS AND METHODS From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild-moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. RESULTS AND CONCLUSIONS One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12-21) to 1 (0-10). Retrograde leak point pressure increased from 18 (5-29) to 35 (22-45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.
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Affiliation(s)
| | - Wilhelm Huebner
- Department of Urology, Humanis Clinic, Korneuburg, Lower Austria, Austria
| | | | - Fernando Pires Vaz
- Department of Urology, Hospital dos Servidores, Rio de Janeiro, RJ, Brazil
| | - Valter Muller
- Department of Urology, Hospital dos Servidores, Rio de Janeiro, RJ, Brazil
| | - Fabio Nakamura
- CIEM - Centro de Especialidades Médicas de Florianopolis, Florianopolis, SC, Brazil
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Bauer RM, Rutkowski M, Kretschmer A, Casuscelli J, Stief CG, Huebner W. Efficacy and complications of the adjustable sling system ArgusT for male incontinence: results of a prospective 2-center study. Urology 2015; 85:316-20. [PMID: 25623675 DOI: 10.1016/j.urology.2014.10.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate prospectively the efficacy and the safety of the ArgusT in male patients with persistent stress urinary incontinence. METHODS A prospective 2-center evaluation was conducted on consecutive patients treated for persistent stress incontinence. Forty-two patients were implanted with the ArgusT male sling system with no associated surgery. Measurements included daily pad usage, 24-hour pad weight test, International Quality of Life questionnaire, International Consultation on Incontinence Questionnaire short form, and the Patient Global Impression of Improvement. Postoperative complications were assessed using the Clavien-Dindo classification. The definitions used were cured, 0-5 g in 24-hour pad weight test; improved, reduction of urine loss in 24-hour pad weight test >50%; and failed, all others. RESULTS After a mean follow-up of 28.8 months (20-38 months), 26 patients were dry (61.9%) with a pad test of 0-5 g/24 hours. Eleven patients (26.2%) improved. Five patients are considered failures. Overall daily pad use, urine loss in the 24-hour pad test, and quality of life scores improved significantly after sling implantation. Median adjustment rate was 1.7. There were no perioperative complications. Postoperative complications were mainly grade I and II complications according to the Clavien-Dindo classification. CONCLUSION The ArgusT sling system offers an effective and safe treatment option for male patients with moderate to severe stress urinary incontinence in a follow-up >2 years, even after radiotherapy.
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Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Wilhelm Huebner
- Department of Urology, Clinic of Korneuburg, Korneuburg, Austria
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Chung E, Smith P, Malone G, Cartmill R. Adjustable versus non-adjustable male sling for post-prostatectomy urinary incontinence: A prospective clinical trial comparing patient choice, clinical outcomes and satisfaction rate with a minimum follow up of 24 months. Neurourol Urodyn 2015; 35:482-6. [DOI: 10.1002/nau.22731] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 12/11/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Chung
- Department of Urology; University of Queensland, Princess Alexandra Hospital; Brisbane QLD Australia
- St. Andrew's Pelvic Medicine Centre; St. Andrew's War Memorial Hospital; Brisbane QLD Australia
| | - Philip Smith
- Department of Urology; University of Queensland, Princess Alexandra Hospital; Brisbane QLD Australia
| | - Gregory Malone
- Department of Urology; University of Queensland, Princess Alexandra Hospital; Brisbane QLD Australia
| | - Ross Cartmill
- Department of Urology; University of Queensland, Princess Alexandra Hospital; Brisbane QLD Australia
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[Diagnosis and surgical treatment of postprostatectomy stress incontinence: recommendation of the working group Urologische Funktionsdiagnostik und Urologie der Frau]. Urologe A 2015; 53:847-53. [PMID: 24903836 DOI: 10.1007/s00120-014-3531-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Today, for the surgical treatment of postprostatectomy incontinence, several treatment options are available, e.g., adjustable and functional sling systems, artificial sphincter, bulking agents, and balloons. However, no recommendations in terms of specific diagnostic tools and differentiated treatment options for everyday life are available. Our aim is to provide some clinically relevant recommendations for the necessary diagnostic workup and different treatment options of postprostatetectomy incontinence to support clinical decisions in everyday life. Treatment selection should be based on contraindications. However, there is a broad overlap of the various surgical options.
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31
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Surgery for Male Urinary Incontinence: Where are we now and what is in the Pipeline? Urologia 2014; 82:139-50. [DOI: 10.5301/uro.5000103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 02/06/2023]
Abstract
Male stress urinary incontinence, which has radical prostatectomy as the main aetiology, affects about 39% of the adult male population and is one of the complications of radical prostatectomy with the greatest impact on the quality of life of patients. There are a wide range of treatments for stress urinary incontinence available to the urologist, ranging from conservative treatments to surgical treatments, from minimally invasive procedures to the implant of artificial sphincter prosthesis. The aim of this work is to define the state-of-the-art of surgical treatments for male stress urinary incontinence, analyzing the most recent studies in the literature and evaluating the available scientific evidence.
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Lim B, Kim A, Song M, Chun JY, Park J, Choo MS. Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence. J Exerc Rehabil 2014; 10:337-42. [PMID: 25426474 PMCID: PMC4237852 DOI: 10.12965/jer.140152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/15/2014] [Indexed: 11/22/2022] Open
Abstract
Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2-4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.
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Affiliation(s)
- Bumjin Lim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Aram Kim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miho Song
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Youn Chun
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsoo Park
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Piedrahita RS, Shek Á, Jaimes JEA. Manejo de la incontinencia urinaria masculina. Experiencia de un cirujano. Rev Urol 2014. [DOI: 10.1016/s0120-789x(14)50033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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How to Best Predict Success of the Transobturator Male Sling. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
PURPOSE OF REVIEW The use of synthetic slings for the treatment of male stress urinary incontinence (SUI) has increased over the last decade. Several sling designs and techniques are now available. The purpose of this review is to summarize the past literature with a focus on more recent contributions. RECENT FINDINGS The recent literature focusses on the retrourethral transobturator sling (RTS), which is considered noncompressive. MRI of patients undergoing RTS has shown an increase in membranous urethral length and elevation of the external urethral sphincter, whereas a recent large series demonstrated approximately a half and a quarter of patients are cured or improved, respectively, at 1 year after RTS implantation, with results sustained through to 3 years. Serious complications such as urethral erosion occur rarely. SUMMARY The available evidence suggests that male slings can be an efficacious and well tolerated treatment modality for men with SUI. Nevertheless, important questions remain with regard to the durability of repair, device safety and comparative efficacy. The mechanism of action and factors that predict failure remain to be fully elucidated.
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Silwal Gautam S, Imamura T, Ishizuka O, Lei Z, Yamagishi T, Yokoyama H, Minagawa T, Ogawa T, Kurizaki Y, Kato H, Nishizawa O. Implantation of autologous adipose-derived cells reconstructs functional urethral sphincters in rabbit cryoinjured urethra. Tissue Eng Part A 2014; 20:1971-9. [PMID: 24568564 DOI: 10.1089/ten.tea.2013.0491] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We investigated the ability of autologous adipose-derived cells injected into cryoinjured rabbit urethras to improve urinary continence and explored the possible mechanisms by which it occurred. Adipose tissue was harvested from the perivesical region of nine 10-week-old female New Zealand White rabbits and cultured for 7 days. Immediately after harvesting the tissue, we injured the internal urethral orifice by spraying liquid nitrogen for 20 s. The cultured cells expressed the mesenchymal cell marker STRO1, but not muscle cell markers myoglobin or smooth muscle actin (SMA). Just before implantation, the adipose-derived cells were labeled with the PKH26 fluorescent cell linker. Autologous 2.0×10(6) adipose-derived cells (five rabbits) or a cell-free control solution (four rabbits) was injected around the cryoinjured urethras at 7 days after injury. Fourteen days later, the leak point pressure (LPP) was measured, and the urethras were harvested for immunohistochemical analyses. At 14 days after implantation, LPP of the cell-implanted group was significantly higher compared with the cell-free control group (p<0.05). In immunohistochemical examination, the reconstructed skeletal and smooth muscle areas in the cell-implanted regions were significantly more developed than those in controls (p<0.01). Implanted PKH26-labeled adipose-derived cells were immunohistochemically positive for myoglobin, SMA, and Pax7 antibodies, which are markers for skeletal muscles, smooth muscles, and myoblast progenitor cells, respectively. In addition, these implanted cells were positive for the nerve cell markers, tubulin β3, S100, and the vascular endothelial cell marker, von Willebrand factor. Furthermore, some of the implanted cells were positive for the transforming growth factor β1, nerve growth factor, and vascular endothelial growth factor. In conclusion, implantation of autologous adipose-derived cells into the cryoinjured rabbit urethras promoted the recovery of urethral function by myogenic differentiation, neuroregeneration, and neoangiogenesis of the implanted cells and/or the surrounding tissues as well as by bulking effects. Thus, treatment of human radical prostatectomy-related stress urinary incontinence by adipose-derived cell implantation could have significant therapeutic effects.
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Affiliation(s)
- Sudha Silwal Gautam
- 1 Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine , Matsumoto, Japan
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Singla N, Singla AK. Post-prostatectomy incontinence: Etiology, evaluation, and management. Turk J Urol 2014; 40:1-8. [PMID: 26328137 PMCID: PMC4548645 DOI: 10.5152/tud.2014.222014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Ajay K. Singla
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
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Hoda MR, Primus G, Fischereder K, Von Heyden B, Mohammed N, Schmid N, Moll V, Hamza A, Karsch JJ, Brössner C, Fornara P, Bauer W. Early results of a European multicentre experience with a new self-anchoring adjustable transobturator system for treatment of stress urinary incontinence in men. BJU Int 2012. [PMID: 23186285 DOI: 10.1111/j.1464-410x.2012.11482.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Raschid Hoda
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Günter Primus
- Department of Urology; Medical University Graz; Austria
| | | | - Burkhard Von Heyden
- Department of Urology; Hospital SLK-Kliniken Heilbronn; Bad Friedrichshall; Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Norbert Schmid
- Department of Urology; Hospital Wels-Grieskirchen; Wels; Austria
| | | | - Amir Hamza
- Department of Urology; St. Georg Hospital; Leipzig
| | | | - Clemens Brössner
- Department of Urology; Hospital Göttlicher Heiland; Vienna; Austria
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation; Martin Luther-Medical School; Halle; Germany
| | - Wilhelm Bauer
- Department of Urology; Hospital Göttlicher Heiland; Vienna; Austria
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Évaluation du positionnement de la bandelette rétro-urétrale transobturatrice par IRM pelvienne statique et dynamique. Prog Urol 2012; 22:602-9. [DOI: 10.1016/j.purol.2012.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/27/2012] [Accepted: 03/01/2012] [Indexed: 11/23/2022]
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Kim JC, Cho KJ. Current trends in the management of post-prostatectomy incontinence. Korean J Urol 2012; 53:511-8. [PMID: 22949993 PMCID: PMC3427833 DOI: 10.4111/kju.2012.53.8.511] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/14/2012] [Indexed: 01/13/2023] Open
Abstract
One of the annoying complications of radical prostatectomy is urinary incontinence. Post-prostatectomy incontinence (PPI) causes a significant impact on the patient's health-related quality of life. Although PPI is stress urinary incontinence caused by intrinsic sphincter deficiency in most cases, bladder dysfunction and vesicourethral anastomotic stenosis can induce urine leakage also. Exact clinical assessments, such as a voiding diary, incontinence questionnaire, pad test, urodynamic study, and urethrocystoscopy, are necessary to determine adequate treatment. The initial management of PPI is conservative treatment including lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder training. An early start of conservative treatment is recommended during the first year. If the conservative treatment fails, surgical treatment is recommended. Surgical treatment of stress urinary incontinence after radical prostatectomy can be divided into minimally invasive and invasive treatments. Minimally invasive treatment includes injection of urethral bulking agents, male suburethral sling, and adjustable continence balloons. Invasive treatment includes artificial urinary sphincter implantation, which is still the gold standard and the most effective treatment of PPI. However, the demand for minimally invasive treatment is increasing, and many urologists consider male suburethral slings to be an acceptable treatment for PPI. The male sling is usually recommended for patients with persistent mild or moderate incontinence. It is necessary to improve our understanding of the pathophysiologic mechanisms of PPI and to compare different procedures for the development of new and potentially better treatment options.
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Affiliation(s)
- Joon Chul Kim
- Department of Urology, The Catholic University of Korea School of Medicine, Seoul, Korea
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Imamura T, Ishizuka O, Nishizawa O. Autologous Bone Marrow-Derived Cells Regenerate Urethral Sphincters. Low Urin Tract Symptoms 2012; 4 Suppl 1:87-94. [PMID: 26676706 DOI: 10.1111/j.1757-5672.2011.00136.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Regenerative medicine based on tissue engineering and/or stem cell therapy techniques has the potential to improve irreversibly damaged tissues. Surgical injury to the lower urinary tract can occur as a result of radical prostatectomy or bladder neck surgery. Regeneration of urethral sphincters could be an effective treatment for post-surgical intrinsic sphincter deficiency (ISD)-related urinary incontinence. The replacement, enhancement, and/or recovery the urethral sphincter striated and smooth muscles could increase urethral closure pressure to help patients regain continence. Stem cells from muscle-derived satellite or adipose-derived mesenchymal cells provide temporary improvement in urethral closure pressure but do not reconstruct the muscle layer structures. Our strategy to accomplish regeneration of urethral sphincters is the utilization of autologous bone marrow-derived cells. We have developed a freeze injury model of ISD in rabbits. Freezing of the urinary sphincter causes loss of the majority of striated and smooth muscle cells, and causes a significant decrease in leak point pressure. In this review, we show that the autologous bone marrow-derived cells implanted within the freeze-injured sphincters differentiate into striated or smooth muscle cells. These cells then develop to reconstitute muscle layer structures within the sphincter. Furthermore, the leak point pressure of cell-implanted rabbits is significantly higher than that of cell-free injected controls. We conclude that implantation of autologous bone marrow-derived cells could be an effective treatment for human post-surgical ISD-related urinary incontinence.
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Affiliation(s)
- Tetsuya Imamura
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, JapanDepartment of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Ishizuka
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, JapanDepartment of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Nishizawa
- Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine, Nagano, JapanDepartment of Urology, Shinshu University School of Medicine, Nagano, Japan
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Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM. Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol 2012; 62:140-5. [PMID: 22386196 DOI: 10.1016/j.eururo.2012.02.038] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking. OBJECTIVE Examine the intermediate-term outcome with the AdVance sling for PPI management. DESIGN, SETTING, AND PARTICIPANTS A multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres. INTERVENTION Patients were implanted with the AdVance male sling with no associated surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Measurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire-Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used. RESULTS AND LIMITATIONS Follow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p<0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p=0.0355 and p=0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test. CONCLUSIONS The transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI.
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Affiliation(s)
- Peter Rehder
- Department of Urology, Medical University, Innsbruck, Austria
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Grise P, Vautherin R, Njinou-Ngninkeu B, Bochereau G, Lienhart J, Saussine C. I-Stop TOMS Transobturator Male Sling, a Minimally Invasive Treatment for Post-prostatectomy Incontinence: Continence Improvement and Tolerability. Urology 2012; 79:458-63. [DOI: 10.1016/j.urology.2011.08.078] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/30/2011] [Accepted: 08/26/2011] [Indexed: 10/14/2022]
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Lai HH, Boone TB. Complex artificial urinary sphincter revision and reimplantation cases--how do they fare compared to virgin cases? J Urol 2012; 187:951-5. [PMID: 22264456 DOI: 10.1016/j.juro.2011.10.153] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE We compared artificial urinary sphincter complication rates, overall reoperative rates, and continence results in virgin cases, revision cases and secondary reimplant cases (with prior erosion or infection). MATERIALS AND METHODS Only male patients with post-prostatectomy stress incontinence with AMS 800™ placement in the bulbar urethra by a single surgeon were included in the study. A total of 169 virgin cases (no prior artificial urinary sphincter surgery), 37 revision cases (eg cuff revision for urethral atrophy, revision of failed components) and 21 secondary reimplant cases (eg after prior explant from urethral erosion or infection) were compared. RESULTS Secondary artificial urinary sphincter reimplant cases (eg after prior explant from urethral erosion or infection) had fourfold higher future erosion rates compared to virgin cases (p = 0.02, 14.3% vs 3.6%, RR 4.02). In addition, there was no difference in the rates of other complications (device infection, urethral atrophy, mechanical failure, leaks), overall reoperation rates and postoperative continence outcomes (measured by daily pad use) compared to virgin cases. Artificial urinary sphincter revision cases did not have higher complication rates (including subsequent urethral erosion), reoperation rates or worse postoperative continence outcomes compared to virgin cases. Although the difference was not statistically significant, a trend toward higher future device leak rates (10.8% vs 3.6%, RR 3.05, p = 0.063) and higher urethral atrophy rates (16.2% vs 8.9%, RR 1.83, p = 0.18) was noted in artificial urinary sphincter revision cases compared to virgin implant cases. CONCLUSIONS Patients with a history of artificial urinary sphincter explant have a fourfold increased risk of future cuff erosion. Nevertheless, a good functional outcome with an acceptable complication rate may be achieved in most complex reoperative artificial urinary sphincter cases.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine and St. Louis Veterans Affairs Medical Center, St. Louis, Missouri 63110, USA.
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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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Dalpiaz O, Knopf HJ, Orth S, Griese K, Aboulsorour S, Truss M. Mid-term complications after placement of the male adjustable suburethral sling: a single center experience. J Urol 2011; 186:604-9. [PMID: 21684559 DOI: 10.1016/j.juro.2011.03.131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Indexed: 12/30/2022]
Abstract
PURPOSE In recent years various sling systems have been proposed as a successful treatment option for male stress urinary incontinence. Reports about complication rates and failures are still scarce. MATERIALS AND METHODS We systematically reevaluated 29 male patients who received an Argus® suburethral sling for stress urinary incontinence between October 2006 and July 2007. RESULTS Overall 24 patients (83%) experienced a total of 37 complications at a median followup of 35 months (range 29 to 45), including 10 (35%) in acute urinary retention. The sling was removed in 10 patients (35%) due to urethral erosion (3), infection (2), system dislocation (2), urinary retention (2) and persistent pain (1). Eight men (27%) complained of significant perineal pain, necessitating continuous oral analgesics. In 1 patient ureteral reimplantation was done due to ureteral erosion from a dislocated sling. At followup only 5 men (17%) remained dry while 21 (72%) were dissatisfied with the clinical outcome. No available clinical variables were statistically significantly associated with any grade or high grade complications even on univariate analysis. CONCLUSIONS In our study cohort the Argus suburethral sling was associated with serious mechanical and infectious complications, and sparse functional results with negative impact on patient quality of life. Based on the results of this study significant changes are warranted in the sling system and in the implantation technique.
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Affiliation(s)
- Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria.
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Rouprêt M, Misraï V, Gosseine PN, Bart S, Cour F, Chartier-Kastler E. Management of Stress Urinary Incontinence Following Prostate Surgery With Minimally Invasive Adjustable Continence Balloon Implants: Functional Results From a Single Center Prospective Study. J Urol 2011; 186:198-203. [DOI: 10.1016/j.juro.2011.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Morgan Rouprêt
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Vincent Misraï
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Pierre-Nicolas Gosseine
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Stéphane Bart
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Florence Cour
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
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Claudon P, Spie R, Bats M, Saint F, Petit J. [Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance™]. Prog Urol 2011; 21:625-30. [PMID: 21943659 DOI: 10.1016/j.purol.2011.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 12/08/2010] [Accepted: 01/11/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the functional and urodynamic results of a compressive sub-urethral sling with bone anchoring InVance™. METHODS One hundred and six successive patients were operated with this system between August 2004 and March 2009. Urinary incontinence was classified according to the number of daily protections. All the patients have benefited from a clinical, endoscopic and urodynamic pre and post-operative evaluation. The results were classified in four groups, at three months and at one year, according to whether the patients were dry (A), very improved (B), little improved (C), or with no improvement (D). RESULTS The average age of the patients during the installation of the strip was 67.4 years (46-82). At three months, the rate of dry (A) or very improved patients (B) was of 81.2% (A=75.5%; B=5.7%), and at one year: 75.5% (A=61%; B=14.5%). At three months, the rate of patients little improved (C) or not improved (D) was of 18.8% (C=16%; D=2.8%), and at one year: 24.5% (C=20.3%; D=4.2%). These results deteriorated according to the initial rank of incontinence II, III, and I. Six patients (5.7%) were explanted because of a prosthetic infection which perished at an average of 9 months (3-18). Infection was linked to operative time (p=0.02), and patients age. No osteitis nor urethral erosion were noted. There was a significant rise in the pressures of maximum fence at rest and maximum urethral pressures in reserve (p=0.01). At one year, score ICIQ-UI SF decreased overall by 7.1 points. CONCLUSION The medium-term results of under-urethral supporting with bone anchoring InVance™ are very encouraging. This technique presents an acceptable morbidity and a good tolerance. It can be proposed in first intention for a urinary incontinence whatever the rank is, even if the effectiveness is particularly present in incontinences of rank I and II.
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Affiliation(s)
- P Claudon
- Service d'urologie-transplantation, CHU Sud, Amiens, France.
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Bauer RM, Gozzi C, Hübner W, Nitti VW, Novara G, Peterson A, Sandhu JS, Stief CG. Contemporary management of postprostatectomy incontinence. Eur Urol 2011; 59:985-96. [PMID: 21458914 DOI: 10.1016/j.eururo.2011.03.020] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT In recent years, despite improvement in the surgical technique, the prevalence of postprostatectomy incontinence has increased due to a rise in the number of radical prostatectomies performed annually. OBJECTIVE The aim of this review is to evaluate contemporary noninvasive and invasive treatment options for postprostatectomy incontinence. EVIDENCE ACQUISITION In August 2010, a review of the literature was performed using the Medline database. EVIDENCE SYNTHESIS All articles concerning noninvasive and invasive treatment for postprostatectomy incontinence were included. CONCLUSIONS No randomised controlled trials exist to compare currently used noninvasive and invasive treatments for postprostatectomy incontinence. Pelvic floor muscle training is recommended for the initial treatment of stress urinary incontinence (SUI). Additionally, antimuscarinic therapy should be applied for urgency or urge incontinence. For decades, the artificial urinary sphincter was the reference standard for persistent SUI. Nowadays, male slings are an alternative for men with mild to moderate postprostatectomy SUI.
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Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilian-University, Munich, Germany.
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