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Queissert F, Bruecher B, Schrader AJ. A New Proximal Adjustable Sling ATOMS SSP ® Implantation Technique with Focus on the Urethral Bulb: Lessons Learned from Revision Surgery. J Clin Med 2023; 12:4409. [PMID: 37445443 DOI: 10.3390/jcm12134409] [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: 06/01/2023] [Revised: 06/18/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Adjustable sling ATOMS-SSP results in ventral compression of the urethra with favorable results in the treatment of men with mild to moderate stress incontinence. However, with transobturator tunneling and mesh fixation, the surgeon has a range of options, which leads to different results and sometimes unfavorable positioning of the silicone cushion. Using retrograde urethrography (RUG), we identified ATOMS patients with considerable misplacement. We then modified the implantation technique when we performed the revision, and now present here our first experiences with this new surgical technique. METHODS Patients after ATOMS-SSP implantation at our clinic were systematically subjected to a RUG if incontinence persisted after adjustments. In case of unfavorable positioning, a revision was performed with the aim of achieving an idealized urethroproximal position of the silicone pad. During follow-up, a repeat RUG was performed, and both subjective and objective outcome parameters were recorded. RESULTS Four men met the above criteria and underwent revision with reimplantation using our new technique. All patients postoperatively experienced significantly improved continence. RUGs demonstrated an ideal ATOMS position immediately below the proximal bulbar urethra. CONCLUSIONS Our proximal implantation technique, presented here for the first time, allows optimal positioning of the ATOMS SSP, which is reflected in the objective parameters and RUG. Its use in primary implantation should also be considered and an expansion to the indication of severe stress incontinence seems possible, but this should only be done in studies.
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Affiliation(s)
- Fabian Queissert
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Benedict Bruecher
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
| | - Andres J Schrader
- Clinic for Urology and Pediatric Urology, University Hospital Muenster, 48149 Münster, Germany
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Mazur-Bialy A, Tim S, Kołomańska-Bogucka D, Burzyński B, Jurys T, Pławiak N. Physiotherapy as an Effective Method to Support the Treatment of Male Urinary Incontinence: A Systematic Review. J Clin Med 2023; 12:jcm12072536. [PMID: 37048619 PMCID: PMC10095040 DOI: 10.3390/jcm12072536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Urinary incontinence (UI) is a serious health issue that affects both women and men. The risk of UI increases in men with age and after treatment for prostate cancer and affects up to 32% of men. Furthermore, UI may affect up to 69% of men after prostatectomy. Considering such a high incidence, it is critical to search for effective methods to mitigate this issue. Hence, the present review aims to provide an overview of physiotherapeutic methods and evaluate their effectiveness in treating UI in men. This systematic review was performed using articles included in PubMed, Embase, WoS, and PEDro databases. A total of 6965 relevant articles were found. However, after a risk of bias assessment, 39 studies met the inclusion criteria and were included in the review. The research showed that the available physiotherapeutic methods for treating men with UI, including those after prostatectomy, involve pelvic floor muscle training (PFMT) alone or in combination with biofeedback (BF) and/or electrostimulation (ES), vibrations, and traditional activity. In conclusion, PFMT is the gold standard of UI therapy, but it may be complemented by other techniques to provide a personalized treatment plan for patients. The effectiveness of the physiotherapeutic methods varies from study to study, and large methodological differences make it difficult to accurately compare individual results and draw unequivocal conclusions.
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Affiliation(s)
- Agnieszka Mazur-Bialy
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
- Correspondence: ; Tel.: +48-012-421-9351
| | - Sabina Tim
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
| | - Daria Kołomańska-Bogucka
- Department of Biomechanics and Kinesiology, Faculty of Health Science, Jagiellonian University Medical College, Skawińska 8, 31-066 Krakow, Poland
| | - Bartłomiej Burzyński
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Tomasz Jurys
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Natalia Pławiak
- University Hospital in Krakow, Jakubowskiego 2, 30-688 Krakow, Poland
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Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions. Ther Clin Risk Manag 2023; 19:43-56. [PMID: 36686217 PMCID: PMC9851058 DOI: 10.2147/tcrm.s283305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Urinary incontinence is a common and debilitating problem in patients undergoing radical prostatectomy. Current methods developed to treat urinary incontinence include conservative treatments, such as lifestyle education, pelvic muscle floor training, pharmacotherapy, and surgical treatments, such as bulking agents use, artificial urinary sphincter implants, retrourethral transobturator slings, and adjustable male sling system. Pelvic floor muscle exercise is the most common management to improve the strength of striated muscles of the pelvic floor to try to recover the sphincter weakness. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and a-adrenergic drugs have been proposed as medical treatments for urinary incontinence after radical prostatectomy. Development of new surgical techniques, new surgical tools and materials, such as male slings, has provided an improvement of outcomes after UI surgery. Such improvement is still ongoing, and the uptake of new devices might lead to even better outcomes after UI surgery.
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Affiliation(s)
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy,Correspondence: Simone Ferretti, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy, Tel +393278733805, Fax +390871357756, Email
| | - Giulio Litterio
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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Hernandez-Reynoso AG, Rahman FS, Hedden B, Castelán F, Martínez-Gómez M, Zimmern P, Romero-Ortega MI. Secondary urethral sphincter function of the rabbit pelvic and perineal muscles. Front Neurosci 2023; 17:1111884. [PMID: 36875671 PMCID: PMC9978527 DOI: 10.3389/fnins.2023.1111884] [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: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (P ura ) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average P ura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in P ura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average P ura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average P ura (0.26 ± 0.04 mmHg), with a 2-fold increase in average P ura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average P ura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40-60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.
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Affiliation(s)
- Ana G Hernandez-Reynoso
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Farial S Rahman
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
| | - Brian Hedden
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Francisco Castelán
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Margarita Martínez-Gómez
- Departamento de Biología Celular y Fisiología, Unidad Foránea Tlaxcala, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Tlaxcala, Tlaxcala, Mexico.,Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala City, Mexico
| | - Philippe Zimmern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mario I Romero-Ortega
- Department of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, United States
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Chung E, Wang J. The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence. Sex Med 2022; 10:100529. [PMID: 35653877 PMCID: PMC9386625 DOI: 10.1016/j.esxm.2022.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction. Aim To evaluate the sexual function impact of AdVance male sling (MS) on erectile and orgasmic domains. Methods A review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for postprostatectomy stress urinary incontinence between 2012 and 2018. Outcomes Patient demographics, clinical outcomes, and validated questionnaires such as the Brief Male Sexual Function Inventory (BMSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 24 months. Results Of the total of 65 men who received AdVance sling, an increase in IIEF-5 score ≥5 points were reported in 10 (15%) patients with no patients complained of deteriorating erectile function at 24 months. The improvement in orgasmic function (Question 10 on IIEF-15) was reported in 22 (34%) patients while 3 (5%) patients reported lower orgasmic scores. The sexual domains scores in BMSFI were higher in 40 (62%) patients, especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). No patient reports pelvic or urethral pain. The reported improvement in erectile and orgasm scores remained similar throughout the 24-months follow-up period. All 20 patients with preoperative climacturia reported resolution of their symptoms during sexual activity. The overall PGI-I was 1.4 (1–3) and men with a higher continence rate were more likely to report better male sexual function (P = .044). Clinical implications AdVance MS appears to improve erectile and orgasmic domains, and there is a positive correlation between urinary continence and male sexual function. Strengths and limitations Strengths of this study include the prospective large patient population analyzed regarding the impact of MS on male sexual function with the use of validated instruments for erectile, orgasmic, and urinary domains. Limitations include single-centre data, relatively short-term follow-up study and lack of a comparative arm. Conclusion Despite the reported adverse effect of sexual dysfunction following pelvic mesh in the female population, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains. Chung E, Wang J. The AdVance Sling and Male Sexual Function: A Prospective Analysis on the Impact of Pelvic Mesh on Erectile and Orgasmic Domains in Sexually Active Men With Postprostatectomy Stress Urinary Incontinence. Sex Med 2022;10:100529.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD, Australia; University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
| | - Juan Wang
- AndroUrology Centre, Brisbane, QLD, Australia
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6
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Mao Q, Lin Y, Xia D, Wang S, Jiang H. Modified female mid-urethral sling for the treatment of incontinence after prostate treatment: One-center experience. Prostate 2022; 82:598-604. [PMID: 35099843 DOI: 10.1002/pros.24306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The male sling has emerged as a minimally invasive option for incontinence after prostate treatment (IPT) in recent years, but it has not yet been introduced into China. This study retrospectively evaluated the clinical outcomes of the modified female mid-urethral sling in the treatment of IPT and explored potential preoperative factors to better predict surgical outcomes. METHODS From May 2014 to January 2021, a total of 70 patients with IPT who underwent transobturator male sling procedure using the modified female mid-urethral sling were retrospectively reviewed. All surgeries were performed by a single surgeon. Functional outcomes were evaluated by daily pad usage, and the severity of incontinence was classified as mild (≤2 pads), moderate (3-4 pads), or severe (≥5 pads). Success was defined as no pad usage or 1 pad for safety (cure), or a reduction in daily pad use by >50% (improved). Patients were followed up at 3, 6 months, and yearly thereafter. RESULTS At a final follow-up of 6-80 months, 35 (50.0%) patients were cured, 12 (17.1%) were improved, and 23 (32.9%) were still incontinent. There was a slight trend of declining continence over time, and the majority of patients remained improved. During follow-up, 25 patients had perineal or scrotal pain, five patients had voiding difficulty and two had de novo urgency, one developed infection and underwent sling explantation. Early urinary retention was the only significant factor linked to better surgical outcomes. CONCLUSION The modified female mid-urethral sling represents a viable option for the treatment of IPT. Improved efficacy is seen in patients with a history of early postoperative urinary retention.
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Affiliation(s)
- Qiqi Mao
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yiwei Lin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Dan Xia
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shuo Wang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Hai Jiang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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ATOMS (Adjustable Transobturator Male System) Is an Effective and Safe Second-Line Treatment Option for Recurrent Urinary Incontinence after Implantation of an AdVance/AdVance XP Fixed Male Sling? A Multicenter Cohort Analysis. J Clin Med 2021; 11:jcm11010081. [PMID: 35011821 PMCID: PMC8745557 DOI: 10.3390/jcm11010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study examined outcomes of second-line ATOMS implantation after failure of the fixed male sling (FMS) AdVance/AdVance XP. (2) Methods: A retrospective multicenter cohort analysis was carried out in men implanted with an ATOMS between 2011 and 2020 after failure of an AdVance/AdVance XP. Success was assessed on the basis of objective (dryness, 0-1 pad/24 h or >20 g/24 h pad test) and subjective results (PGI-I). We performed the Wilcoxon rank sum test, Fisher's exact test, logistic regression, and multivariate analysis. (3) Results: The study included 88 patients from 9 centers with a mean age of 71.3 years. No Clavien-Dindo > II complications occurred within the first 3 months after ATOMS implantation. A total of 10 cases (9%) required revision in the ensuing clinical course. After a mean follow-up of 42.5 months, 76.1% achieved social continence, and 56.8% used no pads at all. Mean urine leakage/24 h dropped from 422 g (3.9 pads) to 38 g (0.69 pads) and the mean ICIQ-SF decreased from 16.25 to 5.3 (p < 0.0001). PROMs (patient-reported outcome measures) showed improvement in 98.9% of cases, and 63.6% gave a "very much better" PGI-I rating. Multivariate analysis identified a lower probability of achieving maximum satisfaction for the following factors: the AdVance XP as first-line therapy (OR 0.35), a lower ICIQ-SF question 1 (OR 0.26), status post-irradiation (OR 0.14), and more severe pain prior to ATOMS implantation (OR 0.51). (4) Conclusions: Implantation of an ATOMS is an effective and safe second-line treatment option for recurrent urinary incontinence after implantation of an AdVance/AdVance XP sling. High patient satisfaction was demonstrated in a long-term follow-up.
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Bole R, Hebert KJ, Gottlich HC, Bearrick E, Kohler TS, Viers BR. Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications. Transl Androl Urol 2021; 10:2682-2694. [PMID: 34295753 PMCID: PMC8261433 DOI: 10.21037/tau-20-1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Male stress urinary incontinence (SUI) following prostate treatment is a devastating complaint for many patients. While the artificial urinary sphincter is the gold standard treatment for male SUI, the urethral sling is also popular due to ease of placement, lack of mechanical complexity, and absence of manual dexterity requirement. A literature review was performed of male urethral sling articles spanning the last zz20 years using the PubMed search engine. Clinical practice guidelines were also reviewed for comparison. Four categories of male urethral sling were evaluated: the transobturator AdVance and AdVance XP, the bone-anchored InVance, the quadratic Virtue, and the adjustable sling series. Well selected patients with mild to moderate urinary incontinence and no prior history of radiation experienced the highest success rates at long-term follow up. Patients with post-prostatectomy climacturia also reported improvement in leakage after sling. Concurrent penile prosthesis and sling techniques were reviewed, with favorable short-term outcomes demonstrated. Male urethral sling is a user-friendly surgical procedure with durable long-term outcomes in carefully selected men with mild stress urinary incontinence. Multiple sling types are available with varying degrees of efficacy and complication rates. Longer follow-up and larger cohort sizes are needed for treatment of newer indications such as climacturia as well as techniques involving dual placement of sling and penile prosthesis.
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Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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9
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[Alloplastic material in the treatment of urinary incontinence]. Urologe A 2021; 60:706-713. [PMID: 33942152 DOI: 10.1007/s00120-021-01530-8] [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: 04/08/2021] [Indexed: 10/21/2022]
Abstract
Surgery for urinary incontinence is indicated after failure of conservative treatment with pelvic floor therapy. Different sling systems are the established treatment option for urinary incontinence for female and male patients. Tension-free vaginal tapes represent the standard of care in the surgical treatment of female stress urinary incontinence. In male patients with mild or moderate stress urinary incontinence, fixed repositioning slings or adjustable compressive slings represent minimally invasive alternatives to the artificial urinary sphincter. The use of surgical mesh material has been widely discussed within the last years. The current US Food and Drug Administration warning was focused on the use of transvaginal mesh implants in female patients with pelvic organ prolapse. Within the current debate, surgery for stress urinary incontinence and surgery for pelvic organ prolapse have often not been differentiated. With this ongoing discussion about the use of foreign material in reconstructive surgery, laparoscopic colposuspension might be performed more often in the near future.
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10
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Babar M, Katz A, Ciatto M. Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review. J Med Imaging Radiat Oncol 2021; 65:384-397. [PMID: 33855816 DOI: 10.1111/1754-9485.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022]
Abstract
SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate cancer radiation therapy. The objective of this systematic review was to evaluate controlled studies on the dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer. Eight studies were included in the review. All of the studies showed SpaceOAR to reduce the radiation dose volume to the rectum over numerous dosimetry levels. Of the four studies that assessed toxicity, one reported SpaceOAR to significantly decrease acute Grade 1 diarrhoea and two reported SpaceOAR to significantly decrease late Grade 1 and Grade ≥2 rectal toxicities. Two studies assessed cumulative incidence of toxicity at 3 years in which one reported SpaceOAR to significantly decrease urinary incontinence and Grade ≥1 and Grade ≥2 rectal toxicities, and the other reported SpaceOAR to significantly decrease Grade 1 diarrhoea and Grade 2 proctitis. Moreover, one study reported that fewer SpaceOAR patients experienced 10-point declines in bowel quality of life at 3 years, but another study reported no significant difference in 10-point declines in bowel quality of life between the SpaceOAR and control groups at 5 years. With the current research available, SpaceOAR may be beneficial to those who did not meet the standard rectal dose-volume criteria, have higher risk factors of developing rectal toxicities post-radiation, or wish to decrease the length and costs of radiotherapy by increasing the dose of radiation per fraction.
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Affiliation(s)
| | - Alan Katz
- St. Francis Hospital, Roslyn, NY, USA
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11
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Li Marzi V, Morselli S, Fusco F, Baldesi R, Campi R, Liaci A, Gemma L, Morelli G, Serni S. Advance Xp® Male Sling can be an Effective and Safe Treatment for Post-Prostatectomy Stress Urinary Incontinence Also in Patients with Prior History of External Beam Radiation Therapy: A Multicentric Experience. Surg Innov 2021; 28:723-730. [PMID: 33599558 DOI: 10.1177/1553350621995042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Post-prostatectomy stress urinary incontinence (PPSUI) is one of the major complaints after radical prostatectomy. Transoburator male sling (TMS) placement is indicated in persistent mild to moderate PPSUI. External beam radiation therapy (EBRT) might be a negative prognostic factor for TMS outcomes. Study objective was to analyze EBRT impact on TMS outcome. Methods. We retrospectively investigated patients submitted to TMS for PPSUI, with or without previous EBRT, in two tertiary referral centers since 2010. Objective outcome was measured through ICIQ-SF, 1-hour pad test, and pad per die and subjective improvement through PGI-I. Patients were divided according to EBRT to make in-group and between-group comparisons. Results. Patients were 56, 18 (32.1%) had previous EBRT. Median follow-up was 43.0 months (IQR: 22.3-64.0). TMS was placed at mean 18.8 months (SD 4.6) after EBRT. TMS determined a statistically significant reduction of pads, 1-hour pad test, and ICIQ-SF score (P<.05). Improvement diminished during long-term follow-up. At last follow-up, 12 patients (21.4%) used 1 safety pad, while 15 (26.8%) used 0 pads. Median PGI-I was 2 (IQR 2-3). Recorded complications were 9 (16.1%) and none exceeded Clavien-Dindo grade 2. There were no differences in outcomes, failures, and complications between groups. TMS failures were 6 (10.7%), 2 of whom in the EBRT group. Four of them (7.1%) subsequently placed an artificial urinary sphincter (AUS). Conclusion. Advance XP© placement seems effective and safe in well-selected patients complaining with PPSUI, even after EBRT. Surgical outcomes slightly deteriorate over time. Further studies are needed in these patients to assess TMS efficacy.
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Affiliation(s)
- Vincenzo Li Marzi
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Simone Morselli
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Ferdinando Fusco
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica. Università della Campania "Luigi Vanvitelli", Italy
| | | | - Riccardo Campi
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Andrea Liaci
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | - Luca Gemma
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
| | | | - Sergio Serni
- Chirurgia Urologica Robotica Mininvasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Università di Firenze, Italy
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13
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Mumm JN, Klehr B, Rodler S, Kretschmer A, Vilsmaier T, Westhofen T, Chaloupka M, Schulz GB, Gozzi C, Rehder P, May F, Homberg R, Stief CG, Grabbert M, Bauer RM. Five-Year Results of a Prospective Multicenter Trial: AdVance XP for Postprostatectomy-Incontinence in Patients with Favorable Prognostic Factors. Urol Int 2021; 105:421-427. [PMID: 33517334 DOI: 10.1159/000512881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the security, value, and efficacy of the second-generation AdVance male sling XP (Boston Scientific®), after implementation in 2010 with advantageous modifications in the sling structure and needle shape, in a prospective multicenter long-term follow-up study. METHODS In total, 115 patients were included. Exclusion criteria were earlier incontinence (UI) surgery, nocturnal UI, former radiotherapy, or night-time incontinence. We also excluded patients with a functional urethra <1 cm in a preoperatively performed repositioning test. A consistent 24-h pad test, International Quality of Life (IQOL) score, visual analog pain scale (VAS), International Consultation-Incontinence Questionnaire (ICIQ-UI SF), International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and Patient Global Impression of Improvement (PGI-I) scores were requested postoperatively. RESULTS The 24-month follow-up (114 patients) revealed 64.0% cured and 28.8% improved patients. Mean urine loss was reduced significantly to 19.0 g (p < 0.001). A mean PGI score of 1.5 and a mean VAS score of 0.2 were obtained. The 60-month follow-up (59 patients) revealed 57.6% cured and 25.4% improved patients. Mean urine loss was reduced significantly to 18.3 g (p < 0.001). A mean PGI score of 1.6 and a mean VAS score of 0.2 were obtained. CONCLUSIONS The AdVance XP displays excellent continence results and secure effectiveness over a 5-year period. Moreover, these data are demonstrating low complication rates and improved quality of life in the long-term use of AdVance XP.
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Affiliation(s)
- Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany,
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Theresa Vilsmaier
- Department of Gynecology, University of Munich (LMU), Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Florian May
- Department of Urology, Klinikum Dachau, Dachau, Germany
| | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
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14
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Grabbert M, Gratzke C, Khoder WY, Katzenwadel A, Bauer RM. [Incontinence surgery-quality criteria and structured follow-up]. Urologe A 2021; 60:178-185. [PMID: 33443722 DOI: 10.1007/s00120-020-01436-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Abstract
The following article summarizes the current evidence including postoperative success rates and complications for various surgical options in the treatment of urinary incontinence. Due to different inclusion criteria and inconsistent definitions of study endpoints, the analysis of available studies is difficult. Thus, comparative studies with new devices for established treatment options should be planned. Structured processes used in certified continence centers improve the quality of care. Furthermore by documenting relevant complications, comparisons of treatment results thus become possible and provide evidence for the use of different surgical options in the treatment of urinary incontinence.
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Affiliation(s)
- M Grabbert
- Klinik für Urologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland.
| | - C Gratzke
- Klinik für Urologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
| | - W Y Khoder
- Klinik für Urologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
| | - A Katzenwadel
- Klinik für Urologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
| | - R M Bauer
- Klinik und Poliklinik für Urologie, LMU Klinikum, Campus Großhadern, München, Deutschland
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15
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Kim M, Park M, Pak S, Choi SK, Shim M, Song C, Ahn H. Integrity of the Urethral Sphincter Complex, Nerve-sparing, and Long-term Continence Status after Robotic-assisted Radical Prostatectomy. Eur Urol Focus 2020; 5:823-830. [PMID: 29759661 DOI: 10.1016/j.euf.2018.04.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/07/2018] [Accepted: 04/30/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND The applicability of the sphincter complex integral theory to robotic-assisted radical prostatectomy (RARP) is unclear, with little known about the long-term effect of sphincter complex integrity on continence. OBJECTIVE To determine whether the preoperative anatomical and functional features of the sphincter complex and the degree of nerve-sparing affect long-term continence after RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 529 patients who underwent RARP at a single tertiary center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Anatomical factors, including membranous urethral length (MUL) and pelvic diaphragm length (PDL), were assessed using sagittal views of preoperative magnetic resonance imaging. MUL was defined as the distance from the posterior prostate apex to the urethra level at the penile bulb, and PDL was defined as the length of the urethra that met the planes created by the pelvic floor muscles. Functional parameters including maximum urethral closure pressure (MUCP) and functional urethral length were evaluated using preoperative measurements of the urethral pressure profiles. The degree of nerve-sparing was stratified as bilateral, unilateral, or none. Continence (pad-free status) was assessed according to anatomical and functional factors and nerve-sparing. We used binary logistic regression to assess factors predicting continence return 12 mo after RARP. RESULTS AND LIMITATIONS Continence return rates 1, 3, 6, and 12 mo after RARP were 39.7%, 66.0%, 80.2%, and 87.0%, respectively. Continence return rates at 12 mo differed significantly in patients with MUL ≥11.7mm (91.9%) and <11.7mm (79.9%), PDL ≥9.9mm (96.7%) and <9.9mm (74.5%), and MUCP ≥66 cmH2O (89.7%) and <66 cmH2O (79.4%). The continence return rate was significantly higher in patients with bilateral (93.0%) than in patients with unilateral (78.1%) or no (76.7%) nerve-sparing. Multivariate analysis showed that PDL (odds ratio [OR]=2.187 per mm), MUCP (OR=1.037 per cmH2O), and bilateral nerve-sparing (OR=3.671) were independently associated with continence return 12 mo after RALP. CONCLUSIONS The anatomical length and static pressure of the sphincter complex affected continence after RARP. Bilateral nerve-sparing was independently associated with long-term continence. PATIENT SUMMARY Predisposing length and static pressure of the urinary sphincter affect continence after robotic-assisted radical prostatectomy. Nerve bundle preservation during surgery enhances postoperative return of continence.
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Affiliation(s)
- Myong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myungchan Park
- Department of Urology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sahyun Pak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Kwon Choi
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myungsun Shim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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16
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Oh S, Shitara T. Enucleation of the prostate: An anatomical perspective. Andrologia 2020; 52:e13744. [DOI: 10.1111/and.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Seung‐June Oh
- Department of Urology Seoul National University College of Medicine Seoul National University Hospital Seoul Korea
| | - Toshiya Shitara
- Department of Urology Fuchinobe General Hospital Sagamihara Kanagawa Japan
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17
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Monn MF, Jarvis HV, Gardner TA, Mellon MJ. Impact of obesity on male urethral sling outcomes. Ther Adv Urol 2020; 12:1756287220927997. [PMID: 32565915 PMCID: PMC7285931 DOI: 10.1177/1756287220927997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/27/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min (p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily (p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.
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Affiliation(s)
- M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hannah V Jarvis
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas A Gardner
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, 1801 N Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA
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18
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Mungovan SF, Jaffe WI, Graham PL, Patel MI, Sandhu JS. A novel human cadaver model to investigate a retrourethral transobturator male sling procedure. Investig Clin Urol 2019; 60:367-372. [PMID: 31501799 PMCID: PMC6722399 DOI: 10.4111/icu.2019.60.5.367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/22/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop a cadaver model for the assessment of a male transobturator male sling (retrourethral transobturator sling [RTS], AdVance™; Boston Scientific, USA) to investigate its effect on a simulated abdominal and retrograde leak point pressures (ALPP, RLPP) and the urethral pressure profile (UPP). Materials and Methods Three fresh frozen human male cadaver specimens were obtained. A suprapubic tube was inserted into the bladder and connected to a digital manometer to measure bladder pressure. Manual suprapubic pressure was then applied to generate an increase in intraabdominal pressure and measure a simulated ALPP. Subsequent measurements of RLPP and UPP were recorded. All measurements were undertaken prior to and following insertion of a RTS. Results The placement of the RTS consistently increased the simulated ALPP for all three cadaver specimens when compared to baseline measures. No leaks occurred at simulated ALPP's of 170 cm H2O for specimen 1, 160 cm H2O for specimen 2, and 170 cm H2O for specimen 3. There was minimal or no change in the RLPP's and UPP's following insertion of the RTS when compared to respective baseline. Conclusions A model using fresh unfixed cadavers that incorporates a simulated measurement of ALPP is feasible for male stress urinary incontinence surgical intervention investigations.
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Affiliation(s)
- Sean F Mungovan
- Westmead Private Physiotherapy Services, Westmead Private Hospital Sydney, Sydney, Australia.,The Clinical Research Institute, Sydney, Australia.,Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - William I Jaffe
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie University, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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19
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Moser DC, D'ancona CAL, Voris BRI, Lahan D, Jani K, Henry GD. Proposal of a new way to evaluate the external sphincter function prior male sling surgey. Int Braz J Urol 2019; 45:354-360. [PMID: 30735337 PMCID: PMC6541136 DOI: 10.1590/s1677-5538.ibju.2018.0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.
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Affiliation(s)
- Daniel Carlos Moser
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | | | | | - Daniel Lahan
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Kavina Jani
- Department of Urology, Ark-La-Tex Urology, Shreveport, Louisiana, USA
| | - Gerard D Henry
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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20
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Grabbert M, Mumm JN, Klehr B, Kretschmer A, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Bauer RM. Extended follow-up of the AdVance XP male sling in the treatment of male urinary stress incontinence after 48 months: Results of a prospective and multicenter study. Neurourol Urodyn 2019; 38:1973-1978. [PMID: 31297894 DOI: 10.1002/nau.24101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the AdVance XP male sling in a midterm follow-up for the treatment of male urinary incontinence in a selected patient cohort. MATERIALS AND METHODS In all, 115 patients with postprostatectomy incontinence were prospectively enrolled. A previous endoscopic evaluation of a sufficient coaptive zone in the repositioning test was mandatory. Patients with urine leakage in supine position or previous incontinence surgery were excluded. Postoperatively a standardized 24-hour pad test and pad usage were evaluated. To compare pre- and postoperative continence status nonparametric t test was used. A P-value of <.05 was seen as statistically significant. RESULTS Median preoperative urine loss in the 24-hour pad test was 272 g (min. 42-max. 1600) and was significantly improved at any point in follow-up. Success was defined as 0 pads per day and a maximum of 5 g in the 24-hour pad test. After a follow-up of 48 months, 71.7% of the patients were cured, whereas 15.0% of patients had an improved continence situation and 13.3% were classified as failed. Mean urine loss decreased significantly to 24.4 g (P ≤ .001). No severe intra- or postoperative complications are to be reported. Median follow-up was 4.2 years. CONCLUSIONS A stable effectiveness in a selected patient cohort can also be demonstrated in an extended follow-up. The complication rates are low and no late postoperative complications occurred, indicating the safety of the procedure.
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Affiliation(s)
- Markus Grabbert
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University of Munich (LMU), Munich, Germany
| | - Benedikt Klehr
- Department of Urology, University of Munich (LMU), Munich, Germany
| | | | - Peter Gebhartl
- Department of Urology, Salzkammergut Klinikum Voecklabruck, Voecklabruck, Austria
| | | | - Roland Homberg
- Department of Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | - Florian May
- Department of Urology, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Rehder
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | | | - Ricarda M Bauer
- Department of Urology, University of Munich (LMU), Munich, Germany
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21
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Collado Serra A, Pelechano Gómez P, Martin I, Dominguez-Escrig J, Alberich-Bayarri Á, Barrios M, Cervera Deval J, Rubio-Briones J. Magnetic resonance imaging as an assessment tool following intervention with an AdVance XP suburethral sling for postprostatectomy urinary incontinence. Neurourol Urodyn 2019; 38:1616-1624. [PMID: 31090095 DOI: 10.1002/nau.24023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/27/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
AIMS The aim of this study was to compare magnetic resonance imaging (MRI) parameters in patients with mild incontinence after radical prostatectomy, who had undergone treatment with a suburethral sling. The objective was to compare patients who had been successfully treated with unsuccessful patients. METHODS This observational cohort study at a single institution evaluated consecutive patients treated with an AdVance XP sling. MRI was performed using a 1.5 Tesla system. Preoperative urodynamic assessment and flexible cystoscopy were performed. The qualitative analysis was based on sling indentation (complete vs incomplete). The quantitative analysis comprised the following three parameters: the sling-pubis distance, the thickness of the proximal urethral bulb, and the sling backward distance (SBD), defined as the distance between the prolongation of a line through the major axis of the pubis (the line-segment joining the vertices of the pubis) and the sling indentation. The primary outcome was pad count at 3 months; cure as zero pads. A logistic univariate regression model was employed to assess the potential predictors of successful outcomes. An adjusted multivariate logistic regression model using the significant univariate factors was developed. RESULTS Of the 83 patients enrolled, the univariate analysis revealed a relationship between failure and adverse urodynamics and between success and sling indentation, thickness of the proximal bulb and SBD. Only the association with SBD persisted in the multivariate analysis. CONCLUSIONS MRI revealed a strong relationship between proper positioning of the sling (small SBD) and continence outcome. These data have important implications for a second surgery following initial sling failure.
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Affiliation(s)
| | | | - Isabel Martin
- Department of Radiology, Fundación IVO, Valencia, Spain
| | | | - Ángel Alberich-Bayarri
- Biomedical Imaging Research Group GIBI 230, La Fe Health Research Institute, Valencia, Spain
| | - María Barrios
- Department of Radiology, Fundación IVO, Valencia, Spain
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MacLachlan L, Mourtzinos A. Current Update on Management of Male Stress Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Ye H, Haab F, de Ridder D, Chauveau P, Becker A, Arano P, Haillot O, Fassi-Fehri H. Effectiveness and Complications of the AMS AdVance™ Male Sling System for the Treatment of Stress Urinary Incontinence: A Prospective Multicenter Study. Urology 2018; 120:197-204. [DOI: 10.1016/j.urology.2018.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 12/23/2022]
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24
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The AdVance and AdVanceXP male sling in urinary incontinence: is there a difference? World J Urol 2018; 36:1657-1662. [PMID: 29728764 DOI: 10.1007/s00345-018-2316-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/27/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To compare the efficacy and perioperative complications of the AdVanceXP with the original AdVance male sling. METHODS We retrospectively enrolled 109 patients with an AdVance and 185 patients with an AdVanceXP male sling. The baseline characteristics and complication rates were analyzed retrospectively. Functional outcome and quality of life were evaluated prospectively by standardized, validated questionnaires. The Chi2-test for categorical and Mann-Whitney U test for continuous variables were performed to identify heterogeneity between the groups. RESULTS Regarding operation time, there was no significant difference between the slings (p = 0.146). The complication rates were comparable in both groups except for postoperative urinary retention. This occurred significantly more often in patients with the AdVanceXP (p = 0.042). During follow-up, no differences could be identified regarding ICIQ-SF, PGI or I-QoL or number of pad usage. CONCLUSIONS The AdVance and AdVanceXP are safe and effective treatment options for male stress urinary incontinence. However, the innovations of the AdVanceXP sling did not demonstrate a superiority over the original AdVance sling regarding functional outcome.
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Shakir NA, Fuchs JS, McKibben MJ, Viers BR, Pagliara TJ, Scott JM, Morey AF. Refined nomogram incorporating standing cough test improves prediction of male transobturator sling success. Neurourol Urodyn 2018; 37:2632-2637. [PMID: 29717511 DOI: 10.1002/nau.23703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/09/2018] [Indexed: 11/10/2022]
Abstract
AIMS To develop a decision aid in predicting sling success, incorporating the Male Stress Incontinence Grading Scale (MSIGS) into existing treatment algorithms. METHODS We reviewed men undergoing first-time transobturator sling for stress urinary incontinence (SUI) from 2007 to 2016 at our institution. Patient demographics, reported pads per day (PPD), and Standing Cough Test (SCT) results graded 0-4, according to MSIGS, were assessed. Treatment failure was defined as subsequent need for >1 PPD or further procedures. Parameters associated with failure were included in multivariable logistic models, compared by area under the receiver-operating characteristic curves. A nomogram was generated from the model with greatest AUC and internally validated. RESULTS Overall 203 men (median age 67 years, IQR 63-72) were evaluated with median follow-up of 45 months (IQR 11-75 months). A total of 185 men (91%) were status-post radical prostatectomy and 29 (14%) had pelvic radiation history. Median PPD and SCT grade were both two. Eighty men (39%) failed treatment (use of ≥1 PPD or subsequent anti-incontinence procedures) at a median of 9 months. History of radiation (P = 0.03), increasing MSIGS (P < 0.0001) and increasing preoperative PPD (P < 0.0001) were associated with failure on univariate analysis. In a multivariable model with AUC 0.81, MSIGS, and PPD remained associated (P = 0.002 and <0.0001 respectively, and radiation history P = 0.06), and was superior to models incorporating PPD and radiation alone (AUC 0.77, P = 0.02), PPD alone (AUC 0.76, P = 0.02), and a cutpoint of >2 PPD alone (AUC 0.71, P = 0.0001). CONCLUSIONS MSIGS adds prognostic value to PPD in assessing success of transobturator sling for treatment of SUI.
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Affiliation(s)
- Nabeel A Shakir
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Joceline S Fuchs
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Maxim J McKibben
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Boyd R Viers
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Travis J Pagliara
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Jeremy M Scott
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Allen F Morey
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Grabbert MT, Kretschmer A, Stief C, Bauer R. [Male urinary incontinence - causes and therapeutic approaches for male stress incontinence]. MMW Fortschr Med 2017; 159:52-56. [PMID: 29124582 DOI: 10.1007/s15006-017-0278-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Markus Tobias Grabbert
- Univ.-Klinikum Köln, Klinik für Urologie, Uro-Onkologie, spezielle und roboter-assistierte Chirurgie, Kerpener Str. 62, D-50634, Köln, Deutschland.
| | - Alexander Kretschmer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
| | - Christian Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
| | - Ricarda Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, München, Deutschland
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Kretschmer A, Nitti V. Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts. Eur Urol Focus 2017; 3:364-376. [DOI: 10.1016/j.euf.2017.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/12/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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Abstract
The AdVance sling (American Medical Systems, Minnetonka, MN, United States of America) is a synthetic transobturator sling, which is a safe and effective minimally invasive treatment for mild to moderate stress urinary incontinence (SUI) in male patients. This article provides a step-by-step description of our technique for placement of the AdVance male sling, including details and nuances gained from surgical experience, advice for avoidance of complications and discussion on management of complications and sling failures. Patient selection is very important, including exclusion and preoperative treatment of urethral stenosis and bladder dysfunction. Previous pelvic radiation is a poor prognostic factor. In brief, the steps of sling placement are: (I) mobilization of the corpus spongiosum (CS); (II) marking and mobilization of the central tendon; (III) passage of the helical trocar needles exiting at the apex of the angle between the CS and inferior pubic ramus; (IV) fixation of the broad part of the sling body to the CS at the previous mark; (V) cystoscopy during sling tensioning; (VI) placement of a Foley urethral catheter; (VII) Subcutaneous tunnelling of the sling arms back toward the midline; (VIII) wound closure. The most common early postoperative complication is urinary retention but long-term retention is extremely rare. Management of sling failures include placement of an artificial urinary sphincter, repeat AdVance sling, urethral bulking agent or ProACT device.
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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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Kajbafzadeh AM, Abbasioun R, Sabetkish S, Sabetkish N, Rahmani P, Tavakkolitabassi K, Arshadi H. Future Prospects for Human Tissue Engineered Urethra Transplantation: Decellularization and Recellularization-Based Urethra Regeneration. Ann Biomed Eng 2017; 45:1795-1806. [PMID: 28536786 DOI: 10.1007/s10439-017-1857-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/17/2017] [Indexed: 01/03/2023]
Abstract
To evaluate the histological characteristics of decellularized human urethra after transplantation into the rat omentum and compare in vivo cell seeding with perfusion-based and cell sheet urethral regeneration. Eight adult human male urethras accompanied with the surrounding corpus spongiosum were obtained. The tissues were decellularized with detergent-based method. The efficacy of decellularization and extracellular matrix preservation was evaluated by several techniques. Decellularized scaffolds were transplanted into the omentum of 12 male rats and located into the scrotum. Biopsies were taken 1, 3, and 6 months postoperatively to assess the natural recellularization. Mesenchymal stem cells obtained from preputial tissue were seeded with perfusion-based and cell sheet techniques as well. Immunohistochemical staining with α-actin, cytokeratin AE1/AE3, synaptophysin, and CD31 antibodies were performed. Removal of nuclear components and preservation of biomechanical properties was confirmed. In-vivo recellularization revealed promising results in progressive angiogenesis and cell seeding of epithelium-like cells in the lining of the urethra as well as smooth muscle cells in the wall structure. In-vitro urethral regeneration revealed that cell sheet engineering was the technique of choice compared to perfusion-based technique. This study may paw the road for clinical application of acellular urethral matrix with the surrounding corpus spongiosum in urological reconstructive surgery.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran.
| | - Reza Abbasioun
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Parvin Rahmani
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Kamyar Tavakkolitabassi
- Department of Urology and Renal Transplantation, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Arshadi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
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Bauer RM, Grabbert MT, Klehr B, Gebhartl P, Gozzi C, Homberg R, May F, Rehder P, Stief CG, Kretschmer A. 36-month data for the AdVance XP ® male sling: results of a prospective multicentre study. BJU Int 2016; 119:626-630. [PMID: 27862836 DOI: 10.1111/bju.13704] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of the AdVance XP® sling (Boston Scientific, formerly American Medical Systems) in male stress urinary incontinence (SUI) after radical prostatectomy in a prospective multicentre study, as in recent years several studies have shown the effectiveness and safety of the AdVance sling for treating male SUI and in 2010 the second-generation AdVance XP was introduced with several changes in the sling design and a new needle shape. PATIENTS AND METHODS In all, 115 patients were included. Patients with nocturnal UI, previous UI surgery, previous radiotherapy and a coaptive zone of <1 cm in the preoperative repositioning test were excluded. Postoperatively, a standardised 24-h pad test, quality-of-life scores [International Quality of Life score (IQOL) and International Consultation on Incontinence Questionnaire short form (ICIQ-UI SF)], visual analogue scale (VAS) for pain, five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS) and Patient Global Impression of Improvement (PGI-I) score, were performed. All patients with a 0-5 g pad test were defined as cured and improved with a reduction of urine loss of >50%. All others were classified as failures. Significance analysis was performed using the Wilcoxon test. RESULTS The mean (median) preoperative urine loss in the 24-h pad test was 272.0 (272.0) g. After a follow-up of 3 months (114 patients), 64.9% of the patients were cured and 31.6% had an improved continence status. The mean urine loss decreased significantly to 34.9 g (P < 0.001), with a mean VAS score of 0.5, and mean PGI-I of 1.5. After a follow-up of 24 months (80 patients), 68.8% of the patients were cured and 22.5% had improved. The mean urine loss decreased significantly to 19.1 g (P < 0.001), with a mean VAS score of 0.3, and mean PGI-I of 1.5. After a follow-up of 36 months (47 patients), 66.0% of the patients were cured and 23.4% had improved. The mean urine loss decreased significantly to 21.8 g (P < 0.001), with a mean VAS score of 0.0, and mean PGI-I of 1.6. The mean IQOL and ICIQ-UI SF improved significantly (both P < 0.001) after 36 months. There were no significant postoperative changes in IIEF-5 and IPSS. No intraoperative and no long-term complications occurred. No erosion or explanations occurred. CONCLUSION The AdVance XP shows good and stable effectiveness and low complication rates even at a mid-term follow-up of up to 36 months.
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Affiliation(s)
| | | | - Benedikt Klehr
- Ludwig-Maximlians-University Munich (LMU), Munich, Germany
| | | | | | - Roland Homberg
- Department of Urology and Paediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | | | - Peter Rehder
- Department of Urology, University of Innsbruck, Innsbruck, Austria
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