Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis

Male sling versus artificial urinary sphincter for the treatment of incontinence after prostate surgery: a systematic review with meta-analysis

Background

Urinary incontinence following prostate treatment (IPT) represents a significant complication that detrimentally impacts the quality of life for patients who have undergone prostate surgery. Presently, there is a scarcity of evidence regarding the preferred surgical techniques for IPT. We conducted a meta-analysis to compare the outcomes of the male sling and artificial urinary sphincter (AUS) in the treatment of IPT.

Methods

Data were extracted through electronic literature searches on PubMed, Web of Science, and Embase databases until September 2023. Eligible studies included patients who underwent AUS or male sling procedures for IPT and had a follow-up duration exceeding 12 months. The primary end point was the success rate, with the secondary outcome focusing on complication rates. A fixed-effects or random-effects models were used to calculate the pooled estimate and its 95% confidence interval (CI). The publication bias was assessed using funnel plots and Egger's regression test.

Results

The meta-analysis included nine studies, involving a total of 1,350 participants. No statistically significant difference in success rates was found between AUS and male sling [odds ratio (OR): 0.96, 95% CI: 0.91-1.01]. In terms of the complication rate, there was no significant disparity between the two procedures (OR: 0.87, 95% CI: 0.86-1.12).

Conclusions

The findings from this study indicated that male sling surgery yielded success and complication rates comparable to those of AUS. This suggests that male sling could serve as a viable alternative surgical option in the treatment of IPT.

European Association of Urology Guidelines on Male Urinary Incontinence

CONTEXT

Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems.

OBJECTIVE

To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI.

EVIDENCE ACQUISITION

A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned.

EVIDENCE SYNTHESIS

UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion.

CONCLUSIONS

This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI.

PATIENT SUMMARY

Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.

Artificial Urinary Sphincter Is Better Than Slings for Moderate Male Stress Urinary Incontinence With Acceptable Complication Rate: A Systematic Review and Meta-Analysis

Background

This meta-analysis aimed to compare the efficacy of artificial urinary sphincter (AUS) and slings for the treatment of moderate male stress urinary incontinence (SUI) based on existing data.

Methods

The study was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched the widely acknowledged database including PubMed, Embase (Ovid version), Medline (Ovid version), and Cochrane Central Register of Controlled Trials (till February 2021). Male patients with moderate SUI who underwent AUS or slings procedure over 18 years old and had been monitored with a mean follow-up time of at least 12 months were included. The primary outcome was success rate defined as daily pad use with 0–1 pad/d postoperatively. Articles with congruent outcomes were suitable for inclusion. The secondary outcome included complication rate of infection, erosion, acute urinary retention, and surgical revision.

Results

Five studies with a total of 509 patients (295 for slings and 214 for AUS) were recruited. The success rate was higher in AUS with an odds ratio (OR) = 0.57 (95% CI: 0.36–0.90). As for the overall complication rate, no significant difference was discovered between slings and AUS groups (OR = 1.06, 95% CI: 0.58–1.92, P = 0.86).

Conclusion

To conclude, AUS was better than slings for moderate male SUI treatment according to daily pad use with an acceptable complication rate. The slings also had clinical value and were options when aging male patients were AUS naive and refused inserted mechanical devices. High-quality pieces of evidence are needed to confirm the efficacy of AUS and slings in moderate male SUI.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=271203, identifier: CRD42021271203.