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Kowalski C, Sibert NT, Hammerer P, Wesselmann S, Feick G, Carl EG, Klotz T, Apel H, Dieng S, Nyarangi-Dix J, Knoll T, Reike MJ, Duwe G, Bartolf E, Steiner T, Borowitz R, Lümmen G, Seitz AK, Pfitzenmaier J, Aziz A, Brock M, Berger FP, Kaftan BT, Grube C, Häfner T, Hamza A, Schmelz H, Haas J, Lenart S, Lafita A, Sippel C, Winter A, Kedia G, Hadaschik B, Varga Z, Buse S, Richter M, Distler F, Simon J, Wiegel T, Baltes S, Janitzky A, Sommer JP, Hijazi S, Fülkell P, Harke NN, Bolenz C, Khalil C, Breidenbach C, Tennstedt P, Burchardt M. [Urinary incontinence after radical prostatectomy for prostate cancer-data from 17,149 patients from 125 certified centers]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:67-74. [PMID: 37747493 DOI: 10.1007/s00120-023-02197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence from routine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients. OBJECTIVE The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care. MATERIALS AND METHODS Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported. RESULTS The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two or more. The proportion of patients using pads differs by age and risk classification. CONCLUSION The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.
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Affiliation(s)
- Christoph Kowalski
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland.
| | - Nora Tabea Sibert
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
| | - Peter Hammerer
- Städtisches Klinikum Braunschweig, Braunschweig, Deutschland
| | - Simone Wesselmann
- Deutsche Krebsgesellschaft, Berlin, Kuno-Fischer-Str. 8, 14057, Berlin, Deutschland
| | - Günter Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Deutschland
| | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Deutschland
| | | | - Gregor Duwe
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | | | | | | | - Gerd Lümmen
- GFO Kliniken Troisdorf, Troisdorf, Deutschland
| | - Anna Katharina Seitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jesco Pfitzenmaier
- Ev. Klinikum Bethel, Universitätsklinikum OWL d, Universität Bielefeld, Bielefeld, Deutschland
| | | | - Marko Brock
- Stiftungsklinikum PROSELIS Recklinghausen, Recklinghausen, Deutschland
| | | | | | | | - Tim Häfner
- Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Amir Hamza
- Klinikum St. Georg Leipzig, Leipzig, Deutschland
| | - Hans Schmelz
- BundeswehrZentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - Jürgen Haas
- Klinikum am Steinenberg, Reutlingen, Deutschland
| | | | | | | | - Alexander Winter
- Universitätsklinik für Urologie, Klinikum Oldenburg, Department für Humanmedizin, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - George Kedia
- DIAKOVERE Friederikenstift, Hannover, Deutschland
| | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Deutschland
| | | | - Matthias Richter
- Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Deutschland
| | - Florian Distler
- Universitätsklinik der Paracelsus, Privatuniversität am Klinikum Nürnberg, Nürnberg, Deutschland
| | - Jörg Simon
- Ortenau-Klinikum Offenburg, Offenburg, Deutschland
| | | | | | | | | | | | | | - Nina N Harke
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | | | | | - Pierre Tennstedt
- Martini Klinik am Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
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Li Y, Li X, Yang Q. Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review. PLoS One 2023; 18:e0290949. [PMID: 37656677 PMCID: PMC10473540 DOI: 10.1371/journal.pone.0290949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. METHODS Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. RESULTS The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. CONCLUSION Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.
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Affiliation(s)
- Yue Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Xiao Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Qin Yang
- College of Nursing Dali University, Dali City, Yunnan province, China
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Kataoka M, Meguro S, Tanji R, Onagi A, Matsuoka K, Honda-Takinami R, Hoshi S, Hata J, Sato Y, Akaihata H, Ogawa S, Uemura M, Kojima Y. Role of puboperinealis and rectourethralis muscles as a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy. Sci Rep 2023; 13:14126. [PMID: 37644075 PMCID: PMC10465550 DOI: 10.1038/s41598-023-41083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
The present study investigated the role of a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy (RARP), with a focus on pelvic floor muscles, such as the puboperinealis muscle (PPM) and rectourethralis muscle (RUM). Finally, 323 patients who underwent RARP were analyzed in this study. All patients performed a one-hour pad test 1, 3, 6, 9, and 12 months after RARP to assess urinary incontinence and MRI before and 9 months after RARP to evaluate the pelvic anatomical structure. The preoperative cross-sectional area of PPM (2.21 ± 0.69 cm2) was significantly reduced by 19% after RARP (1.79 ± 0.60 cm2; p < 0.01). Positive correlations were observed between the amount of urinary leakage according to the 1-h pad test 1, 3, 6, 9, and 12 months after RARP and the change in the cross-sectional area of PPM by RARP (p < 0.01, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). A positive correlation was also noted between the amount of urinary leakage 6 and 12 months after RARP and the preoperative RUM diameter (p < 0.05). The amount of urinary leakage 1, 3, 6, 9, and 12 months after RARP negatively correlated with the change in the antero-posterior diameter of the membranous urethra (MU diameter) from the static to dynamic phases during the Valsalva maneuver by cine MRI. Furthermore, the change in the MU diameter negatively correlated with the change in the cross-sectional area of PPM (p < 0.05). PPM and RUM play significant roles as a supportive mechanism to maintain urinary continence by functioning as a urethral support.
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Affiliation(s)
- Masao Kataoka
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Satoru Meguro
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ryo Tanji
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akifumi Onagi
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kanako Matsuoka
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ruriko Honda-Takinami
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Hoshi
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Junya Hata
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuichi Sato
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidenori Akaihata
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Soichiro Ogawa
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Motohide Uemura
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yoshiyuki Kojima
- Departments of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
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Tricard T, Song QX, Munier P, Li JY, Leng J, Saussine C, Pan JH, Xue W. Adjustable continence therapy (proACT) for the treatment of male stress urinary incontinence post-prostatectomy: a systematic review and meta-analysis (2023 update). World J Urol 2023; 41:1793-1802. [PMID: 37311990 DOI: 10.1007/s00345-023-04452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) is a key factor for post-prostatectomy (RP) quality of life. Current international guidelines struggle to find the adequate place for each kind of surgeries. The aim of this systematic review and meta-analysis considering updated evidence is to assess the efficacy and safety of proACT in treating male patients with post-RP SUI. METHODS A review of the literature was performed by searching the PubMed database. We narrowed included studies with adult male patients with SUI; outcomes included pads or pad weight per day and quality of life (QOL) questionnaires, as well as safety outcomes. RESULTS 18 studies involving 1570 patients mean age of 68.8 (EC 2.1) were included. The mean follow-up reported was 34.7 months (EC 17.7; median 38.5; range 1-128 months). An average of 60.7% (EC 27) and 40.4% of patients suffered from mild-to-moderate and severe incontinence, respectively. The overall dryness rate was 55.1% (EC 19.3) while respecting the definition of 0-1 pads per day, and the mean dryness rate was 53% (EC 0.2). The mean overall complication rate was 31.2% (EC 18.3%), including an explantation rate of 26.5% (EC 15.3) and a reoperation rate of 22.7% (EC 8.7). The methodological quality of the 18 studies was very heterogeneous. CONCLUSION Implantation of proACT adjustable balloons is a minimally invasive technique that provides medium outcomes (53%) with a strict definition of dryness (0-1 PPD) and important complication rate (31.2%). Past of irradiation is a negative predictive factor for incontinence.
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Affiliation(s)
- Thibault Tricard
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France.
| | - Qi-Xiang Song
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pierre Munier
- Centre d'Urologie UROVAR, Avenue Bizet, 83000, Toulon, France
| | - Jia Yi Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Leng
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Jia Hua Pan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chung E, Liao L, Kim JH, Wang Z, Kitta T, Lin ATL, Lee KS, Ye L, Chu P, Kaiho Y, Takei M, Jiang H, Lee J, Masuda H, Tse V. The Asia-Pacific AMS800 artificial urinary sphincter consensus statement. Int J Urol 2023; 30:128-138. [PMID: 36375037 PMCID: PMC10100264 DOI: 10.1111/iju.15083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
This Asia-Pacific (AP) AMS 800™ artificial urinary sphincter (AUS) consensus statement aims to provide a set of practical recommendations to assist surgeons with the AMS 800 device surgery. The AP consensus committee consisted of key opinion leaders with extensive experience with AMS 800 surgery across several AP countries. The panel reviewed and discussed relevant findings with emphasis on locoregional and specific clinical challenges relevant to the AP region. Recommendations were made in key areas namely (1) patient selection and informed consent process; (2) preoperative assessment; (3) dealing with co-existing urological disorders; (4) surgical principles and intraoperative troubleshooting; (5) postoperative care; (6) special populations; and (7) cost analysis and comparative review. The AMS 800 device should be offered to males with moderate to severe stress urinary incontinence (SUI). Full informed consent should be undertaken, and emphasis is placed on surgical contraindications and high-risk candidates. The presence of a surgical mentor or referral to experts is recommended in complex AUS candidates. Preoperative cystoscopy with or without multichannel urodynamic study is necessary and patients with pre-existing urological disorders should be treated adequately and clinically stable before surgery. Adherence to strict patient selection and safe surgical principles are critical to ensure excellent clinical outcomes and minimize complications. Given that InhibiZone-coated device is not available in many AP countries, the use of prophylactic antibiotics pre-and post-operatively are recommended. The AMS 800 device should be prepared according to the manufacturer's guidelines and remains a cost-effective treatment for male SUI. The AMS 800 device remains the surgical benchmark for male SUI but is associated with certain mechanical limitations and a unique set of complications.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,AndroUrology Centre, Brisbane, Queensland, Australia
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre and Capital Medical University, Beijing, China
| | - Jang Hwan Kim
- Department of Urology and Urological Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Zhong Wang
- Department of Urology and Andrology, Ninth Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Takeya Kitta
- Department of Urology, Hokkaido University, Sapporo, Japan
| | | | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Liefu Ye
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Peggy Chu
- Department of Surgery, Tuen Mun Hospital, Hong Kong SAR, China
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Hai Jiang
- Department of Urology, the First Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Hitoshi Masuda
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Vincent Tse
- Department of Urology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Crowley F, Mihalopoulos M, Gaglani S, Tewari AK, Tsao CK, Djordjevic M, Kyprianou N, Purohit RS, Lundon DJ. Prostate cancer in transgender women: considerations for screening, diagnosis and management. Br J Cancer 2023; 128:177-189. [PMID: 36261584 PMCID: PMC9902518 DOI: 10.1038/s41416-022-01989-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 02/08/2023] Open
Abstract
Transgender individuals represent 0.55% of the US population, equivalent to 1.4 million transgender adults. In transgender women, feminisation can include a number of medical and surgical interventions. The main goal is to deprive the phenotypically masculine body of androgens and simultaneously provide oestrogen therapy for feminisation. In gender-confirming surgery (GCS) for transgender females, the prostate is usually not removed. Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible. Due to the low incidence of prostate cancer identified in transgender women, there is little evidence to drive specific screening recommendations in this patient subpopulation. The treatment of early and locally advanced prostate cancer in these patients warrants an individualised thoughtful approach with input from patients' reconstructive surgeons. Both surgical and radiation treatment for prostate cancer in these patients can profoundly impact the patient's quality of life. In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients.
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Affiliation(s)
- Fionnuala Crowley
- Internal Medicine, Mount Sinai Morningside West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meredith Mihalopoulos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simita Gaglani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Che-Kai Tsao
- Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miroslav Djordjevic
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology & Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajveer S Purohit
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Dara J Lundon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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8
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Greenberg SA, Cowan JE, Lonergan PE, Washington SL, Nguyen HG, Zagoria RJ, Carroll PR. The effect of preoperative membranous urethral length on likelihood of postoperative urinary incontinence after robot-assisted radical prostatectomy. Prostate Cancer Prostatic Dis 2022; 25:344-350. [DOI: 10.1038/s41391-022-00527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/01/2022] [Accepted: 03/03/2022] [Indexed: 11/09/2022]
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9
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Lin L, Sun W, Guo X, Zhou L. Artificial Urinary Sphincter Is Better Than Slings for Moderate Male Stress Urinary Incontinence With Acceptable Complication Rate: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:841555. [PMID: 35223981 PMCID: PMC8863861 DOI: 10.3389/fsurg.2022.841555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Lede Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Wenjin Sun
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaotong Guo
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Liang Zhou
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10
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Zhang Y, Guo S, Wang C, Liu X, Liu Y, Shang H, Yang P, Wang L, Zhai J, Li X, Jia Y. Acupuncture for prostatectomy incontinence: study protocol for a multicenter single-blind randomized parallel controlled trial. Trials 2022; 23:9. [PMID: 34983588 PMCID: PMC8725553 DOI: 10.1186/s13063-021-05805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/06/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Urinary incontinence is a common complication post radical prostatectomy. Acupuncture is considered an effective treatment for post-prostatectomy incontinence (PPI), but the evidence is still limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial. METHODS Twenty hospitals will recruit 340 participants with urinary incontinence after radical prostatectomy in China from April 2021 to April 2022. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The study plan consists of 1-week baseline, 6-week treatment, and 18-week follow-up. Eighteen 30-min sessions of acupuncture or sham acupuncture treatment will be provided between weeks 1 and 6. The primary outcome is the change in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score at the week 6 from the baseline. Secondary outcomes include the change in volume of urine leakage at weeks 4 and 6 from a baseline measured using the 1-h pad test; 72-h incontinence episode frequency based on a 72-h voiding diary; change in the Expanded prostate cancer Index Composite scale (EPIC-26); change in the Self-Rating Anxiety Scale; weekly consumption of pads; and the severity of urinary incontinence based on a 72-h bladder diary and self-assessment of the therapeutic effect. The safety of acupuncture will also be assessed. DISCUSSION This trial will help to identify whether acupuncture is effective for PPI, and, if so, whether it exerts a therapeutic rather than a placebo effect. TRIAL REGISTRATION www.Chictr.org.cn ChiCTR2100042500 . Retrospectively registered on 22 January 2021.
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Affiliation(s)
- Yao Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shanqi Guo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chaoran Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaodi Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peiying Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Liang Wang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Jingbo Zhai
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaojiang Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yingjie Jia
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Sayedahmed K, Rosenhammer B, Burger M, Goßler C. Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success. Urol Int 2021; 106:261-268. [PMID: 34289484 DOI: 10.1159/000517386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION After implantation of an artificial urinary sphincter (AUS) due to stress urinary incontinence, in some cases revision procedures may be necessary. This is mostly due to device infection or cuff erosion in the long term. The aim of this study was to evaluate the impact of early revision procedures (prior to or immediately after AUS activation) on the long-term outcome. METHODS We retrospectively evaluated patients who underwent primary AUS implantation between 2006 and 2019. Patients with previous radiotherapy, urethroplasty, urethral stent placement, or repeat AUS implantation were excluded. Early revision was defined as prior to or immediately after AUS activation and comprised pump repositioning or cuff size adaptation due to difficulties in using the pump, persistent urinary incontinence, or urinary retention. Patients were compared with regard to complication rates, functional outcome, and patient satisfaction. Univariable and multivariable logistic regression analyses were performed to analyze risk factors for early AUS revision. Kaplan-Meier analysis evaluated explantation-free survival. RESULTS A total of 250 patients were included. Twenty patients (8%) required early revision (pump repositioning in 15 cases [75%], cuff downsizing in 3 cases [15%], and cuff upsizing in 2 cases [10%]). Mean follow-up was 78.6 months. 96.4% of all patients were objectively continent at the time of last follow-up without differences between both groups, and patient satisfaction was high in both groups. No differences with regard to mechanical implant failure, tissue atrophy, and AUS explantation due to cuff erosion or implant infection were observed. Explantation-free survival was comparable in both groups. On univariable logistic regression analysis, coronary artery disease and transcorporal cuff placement were associated with early AUS revision. CONCLUSION Early revision after AUS implantation can be performed without negative impact on the long-term outcome.
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Affiliation(s)
- Khalid Sayedahmed
- Department of Urology, Menoufia University, Shibin Al Kawm, Egypt.,Department of Urology, Rhein-Maas Hospital, Wuerselen, Germany
| | - Bernd Rosenhammer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany
| | - Christopher Goßler
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany,
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12
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Abstract
Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the “gold standard” for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.
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Affiliation(s)
- Culley C Carson
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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13
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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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14
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Angulo JC, Ruiz S, Lozano M, Arance I, Virseda M, Lora D. Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence. World J Urol 2020; 39:1083-1092. [PMID: 32529450 DOI: 10.1007/s00345-020-03300-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence (PPI). MATERIAL AND METHODS A systematic review and meta-analysis on adjustable device ATOMS compared to male REMEEX is presented. Studies on female or neurogenic incontinence were excluded. Primary objectives were evaluation of dryness (the proportion of patients with no-pad or one safety pad/day after device adjustment) and improvement between devices. Secondary objectives were complications and explant rate. They were estimated using a random-effect model. Statistical heterogeneity among studies was assessed using Cochran's Q test, Higgins's I2 statistics and tau2. RESULTS Combined data of 29 observational studies with 1919 patients showed an equivalent proportion of patients treated with radical prostatectomy (p = .125) and previous radiation (p = .126). Dryness rate was 69.3% for ATOMS and 53.4% for male REEMEX (p = .008). Improvement rate was 90.8% for ATOMS and 80.2% for REMEEX (p = .007). Complication rate was 18.9% for ATOMS and 35.8% for REMEEX (p = .096) and explant rate was 5.5% for ATOMS and 13.9% for REMEEX (p = .027). Significant heterogeneity was evidenced, due to absence of randomized studies, variable incontinence severity baseline, difficulties for a common reporting of complications and difference in the follow-up. Differences observed between devices remained statistically significant when only studies with silicone-covered scrotal port (SSP) ATOMS and male REMEEX system II were considered. CONCLUSIONS Despite the absence of direct comparison and the limitations observed ATOMS appears more effective than male REMEEX to treat PPI, and with less explant rate as reported in the literature.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain. .,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain.
| | - Sonia Ruiz
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Martín Lozano
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Ignacio Arance
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - Miguel Virseda
- Departamento Clínico, Universidad Europea de Madrid, Madrid, Spain.,Servicio de Urología, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, 28905, Madrid, Spain
| | - David Lora
- Instituto de Investigación Sanitaria Hospital "12 de Octubre" (i+12), CIBER de Epidemiología y Salud Pública (CIBERESP), Universidad Complutense de Madrid, 28041, Madrid, Spain
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15
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Oliveira MCE, Bezerra LO, Melo Ângelo PH, de Oliveira MC, Silva-Filho E, Ribeiro TS, Pegado R, Micussi MTABC. Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol. Neurourol Urodyn 2020; 39:1592-1600. [PMID: 32243660 DOI: 10.1002/nau.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022]
Abstract
AIMS To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. METHODS To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino-loin-pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1-hour Pad Test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. CONCLUSIONS It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.
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Affiliation(s)
| | - Livia Oliveira Bezerra
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Maiara Costa de Oliveira
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Edson Silva-Filho
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Tatiana Souza Ribeiro
- Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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16
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Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and Adjustable Continence Therapy (ProACT) for male stress incontinence. PLoS One 2019; 14:e0225762. [PMID: 31790490 PMCID: PMC6886794 DOI: 10.1371/journal.pone.0225762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background and purpose Urinary incontinence is one of the most serious complications of prostate cancer treatment. The objective of this study was to assess efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to Adjustable Continence Therapy (proACT) for male stress urinary incotinence according to literature findings. Material and methods A systematic review and meta-analysis on adjustable devices ATOMS and ProACT is presented. Studies on female or neurogenic incontinence were excluded. Differences between ATOMS and proACT in primary objective: dryness status (no-pad or one safety pad/day) after initial device adjustment, and in secondary objectives: improvement, satisfaction, complications and device durability, were estimated using random-effect model. Statistical heterogeneity among studies included in the meta-analysis was assessed using tau2, Higgins´s I2 statistics and Cochran´s Q test. Results Combined data of 41 observational studies with 3059 patients showed higher dryness (68 vs. 55%; p = .01) and improvement (91 vs. 80%; p = .007) rate for ATOMS than ProACT. Mean pad-count (-4 vs. -2.5 pads/day; p = .005) and pad-test decrease (-425.7 vs. -211.4 cc; p < .0001) were also significantly lower. Satisfaction was higher for ATOMS (87 vs. 56%; p = .002) and explant rate was higher for proACT (5 vs. 24%; p < .0001). Complication rate for ProACT was also higher, but not statistically significant (17 vs. 26%; p = .07). Mean follow-up was 25.7 months, lower for ATOMS than ProACT (20.8 vs. 30.6 months; p = .02). The rate of working devices favoured ATOMS at 1-year (92 vs. 76; p < .0001), 2-years (85 vs. 61%; p = .0008) and 3-years (81 vs. 58%; p = .0001). Significant heterogeneity was evidenced, due to variable incontinence severity baseline, difficulties for a common reporting of complications, different number of adjustments and time of follow-up and absence of randomized studies. Conclusions Despite the limitations that studies available are exclusively descriptive and the follow-up is limited, literature findings confirm ATOMS is more efficacious, with higher patient satisfaction and better durability than ProACT to treat male stress incontinence.
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17
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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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18
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Choiniere R, Richard PO, Morin M, Tu LM, Guyatt GH, Violette PD. Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol. F1000Res 2019; 8:1155. [PMID: 33381297 PMCID: PMC7689604 DOI: 10.12688/f1000research.19484.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Post-radical prostatectomy urinary incontinence (PPI) is a frequent and feared complication that can affect approximately 25% of patients. Between 1 and 10% of patients suffering from PPI will require surgery. The effectiveness of the available surgical interventions has only been compared in a few randomized controlled trials and the available reviews have important limitations regarding both benefits and harms that make them insufficient to inform decision-making. The aim of the study is to provide systematic summaries of benefits and harms of contemporary surgical treatment options for PPI through systematic review and meta-analysis using GRADE methodology and reporting in accord with the PRISMA-P statement. Methods: Studies pertaining to bulking agents, male synthetic slings, compressive balloon systems (ProACT) or artificial urinary sphincters (AUS) used for the treatment of patients suffering from PPI will be included. A systematic search will be conducted using the OVID and PubMED platforms in MEDLINE, Embase and Cochrane databases, and reference lists of relevant reviews and guidelines. Trained independent reviewers will conduct study selection and data extraction. Outcomes will include the number of pads used per day, the 24-h pad weight test, the Patient Global Impression of Improvement (PGI-I) and the Incontinence Quality of Life (IQOL) as possible benefits and the reoperations, the Clavien-Dindo complications and the other reported adverse events as the harms. When possible, pooled analyses will be completed. Risk of bias will be assessed using the CLARITY tools and a new tool for the before-and-after studies without a control group. Finally, study heterogeneity will be assessed, publication bias will be evaluated with funnel plots and quality of evidence rated for each outcome. Discussion: Our study will address patient-important outcomes and will be useful in clinical decision-making as well as identifying key elements for future research. Study registration: PROSPERO: CRD42018073923 05/12/2018.
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Affiliation(s)
| | - Patrick O. Richard
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Melanie Morin
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Le-Mai Tu
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Gordon H. Guyatt
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
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19
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Ng ATL, Lam W. The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00526-7] [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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20
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Mühlstädt S, Hüsch T, Bauer RM. [Differentiated surgical treatment of male stress urinary incontinence-between intention and reality?]. Urologe A 2019; 58:640-650. [PMID: 31089755 DOI: 10.1007/s00120-019-0947-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The differentiated surgical treatment of male urinary incontinence is a very interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently a lack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and a constructive attempt to differentiate the indication.
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Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle / Saale, Deutschland.
| | - T Hüsch
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
| | - R M Bauer
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität, Campus Großhadern, München, Deutschland
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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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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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