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Rojas Cruz C, Hakenberg O, Dräger DL. [Use of implants to treat male urinary incontinence]. Aktuelle Urol 2023; 54:449-456. [PMID: 37748511 DOI: 10.1055/a-2108-7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Treatments for benign and malignant pathologies of the prostate can compromise urine control. Urinary incontinence (UI) affects the quality of life of patients and limits their ability to carry out usual activities. The degree of impact of UI is variable and the associated discomforts make patients seek treatment for it. At the center of the management of urinary incontinence in men are surgical interventions that seek to replace the affected sphincter function through implants. The artificial urinary sphincter since its development in the 1970s has been considered the standard of treatment for UI in men. More recently artificial sphincter and slings have been shown to be effective in a selected group of incontinent men. The goals of surgical treatment of incontinence include the preservation of bladder function, the ability to improve the strength of the urinary sphincter, and to reduce or eliminate urine leakage, and thereby improve the quality of life. The aim of the article is to present various implants for the correction of male urinary incontinence.
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Wang M, Liao Y, Liu Y, Zhou W, Yu H. Development and future prospects of the artificial urinary sphincter. Artif Organs 2023; 47:1688-1699. [PMID: 37424277 DOI: 10.1111/aor.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Urinary incontinence is a urinary disorder in which urine leaks out involuntarily. This disorder seriously affects the quality of life of patients. For patients with mild incontinence, conservative treatment and medication may be the ideal treatment modality, but for patients with severe incontinence, an artificial urinary sphincter is currently a better treatment option. METHODS In order to design an ideal artificial urinary sphincter, this article first searched and collected literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses searched strategy by selecting specific subject terms and reviewed the artificial urinary sphincters that are currently in the research stage based on different activation methods. RESULTS In response to the deficiencies of the existing artificial urinary sphincter, this article discusses the future optimization of the artificial urinary sphincter from three aspects: individual improvement of the artificial urinary sphincter, engineering design elements, and optimization of the artificial urinary sphincter manufacturing process. CONCLUSIONS The manufacture of an idealized artificial urinary sphincter capable of meeting clinical needs is of great importance to improve the quality of life of patients. However, this approach is a reasonable option to explore and should not be overestimated until further evidence is available.
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Affiliation(s)
- Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Chew L, Chang C, Simhan J. Climacturia: what treatment options do we offer to those with and without concomitant erectile dysfunction? Int J Impot Res 2023; 35:634-638. [PMID: 37161059 DOI: 10.1038/s41443-023-00714-4] [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: 11/30/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023]
Abstract
Radical prostatectomy for prostate cancer carries many sequelae, including climacturia, which is not commonly discussed and often under-recognized. To better understand treatment options for incontinence and climacturia, as well as those at time of penile implantation surgery, we completed a comprehensive literature review to identify nonoperative and operative treatments for patients with climacturia alone and those with concomitant climacturia and erectile dysfunction. Nonoperative interventions include behavioral modifications, physical therapy, and tension loops. Operative interventions include the artificial urinary sphincter, male urethral slings, Mini-Jupette sling, and a periurethral prosthesis. We also explore options that can be offered to patients who are also in need of penile prosthesis for concomitant erectile dysfunction. Contemporary work suggests that synchronous implantation of certain devices to treat both climacturia and erectile dysfunction can be done with proven safety and efficacy.
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Affiliation(s)
- Lauren Chew
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chrystal Chang
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Smith WJ, VanDyke ME, Venishetty N, Langford BT, Franzen BP, Morey AF. Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success. Res Rep Urol 2023; 15:217-232. [PMID: 37366389 PMCID: PMC10290851 DOI: 10.2147/rru.s395359] [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: 02/01/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. Methods A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Results Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Conclusion Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.
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Affiliation(s)
- Wesley J Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikit Venishetty
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian T Langford
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce P Franzen
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Liao Y, Wang M, Liu Y, Zhou W, Liu J, Yu H. Magnetically controlled artificial urinary sphincter: An overview from existing devices to future developments. Artif Organs 2023. [PMID: 37114754 DOI: 10.1111/aor.14535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Urinary incontinence is a common clinical problem in the world today. Artificial urinary sphincter is a good treatment approach for severe urinary incontinence, which is designed to mimic the action of the human urinary sphincter and assist patients to regain urinary function. METHODS There are many control methods based on artificial urinary sphincter, such as hydraulic control, electromechanical control, magnetic control, and shape memory alloy control. In this paper, the literature was first searched and documented based on PRISMA search strategy for selected specific subject terms. Then, a comparison of artificial urethral sphincters based on different control methods was conducted, and the research progress of magnetically controlled artificial urethral sphincters was reviewed, and their advantages and disadvantages were summarized. Finally, the design factors for the clinical application of magnetically controlled artificial urinary sphincter are discussed. RESULTS As magnetic control allows for non-contact force transfer and does not generate heat, it is proposed that magnetic control may be one of the more promising control methods. The design of future magnetically controlled artificial urinary sphincters will need a variety of considerations, including the structural design of the device, manufacturing materials, manufacturing costs, and convenience. In addition, validation of the safety and effectiveness of the device and device management are equally important. CONCLUSIONS The design of an ideal magnetically controlled artificial urinary sphincter is of great importance to enhance patient treatment outcomes. However, there are still great challenges to be faced for the clinical application of such devices.
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Affiliation(s)
- Yucheng Liao
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Minghui Wang
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Yunlong Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Wei Zhou
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Ji Liu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Intelligent Rehabilitation Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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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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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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Abdunnur R, Kaufmann A. [Künstliche Harnsphincter zur Behandlung von Stress-Harninkontinenz - eine oft nicht ausgelastete Behandlungsoption in Deutschland]. Urologe A 2021; 60:696-705. [PMID: 34097109 DOI: 10.1007/s00120-021-01544-2] [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: 04/21/2021] [Indexed: 10/21/2022]
Abstract
ABSTRAKT Harninkontinenz ist in Deutschland weit verbreitet und betrifft Millionen von Frauen und Männern. Vor allem Männer, die postoperativ dauerhaft inkontinent sind, werden hierzulande trotz der ausreichenden Verfügbarkeit chirurgischer Optionen unterbehandelt. Der künstliche Schließmuskel wird seit Jahrzehnten erfolgreich zur Behandlung angeborener und erworbener Stress-Harninkontinenz bei Männern und Frauen sowie neurogener Harninkontinenz eingesetzt und wird in Form neuer Modelle weiterentwickelt. Aufgrund der guten Ergebnisse, Es gilt jetzt als Standardtherapie für Männer mit anhaltender, mittelschwerer bis schwerer Harninkontinenz. Die operationstechnische Technik ist anspruchsvoll, kann aber erlernt werden. Die meisten Komplikationen können in erfahrenen Händen deutlich reduziert werden. Patientenzufriedenheit mit künstlichen Harnsphinctern (AUS) ist hoch und korreliert mit der Kontinenzrate und nicht mit der relativ hohen Revisionsrate, weshalb diese Behandlungsoption in Deutschland zunehmend mehr Patienten mit mittelschwerer bis schwerer Harninkontinenz angeboten werden sollte. Urologen in der allgemeinen Praxis spielen in diesem Zusammenhang eine zentrale Rolle.
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Affiliation(s)
- R Abdunnur
- Klinik für Urologie und Kinderurologie, Helios-Klinikum Schwelm, Dr. Moeller-Str. 15, 58332, Schwelm, Deutschland.
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Straße 450, 41063, Mönchengladbach, Deutschland.
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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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Ostrowski I, Śledź E, Wilamowski J, Józefczak M, Dyś W, Ciechan J, Drewa T, Chłosta PL. Patients' quality of life after implantation of ZSI 375 artificial urinary sphincter due to stress urinary incontinence. Cent European J Urol 2020; 73:178-186. [PMID: 32782838 PMCID: PMC7407780 DOI: 10.5173/ceju.2020.0088] [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: 05/20/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction The study aimed to evaluate the outcomes of artificial urinary sphincter ZSI 375 implantation for stress urinary incontinence, focusing on quality of life assessment (QoL). Material and methods The study had a prospective and non-randomized design. It was conducted in two urological centres in Poland. Between July 2013 and June 2019, artificial urinary sphincter ZSI 375 was implanted in 86 consecutive men with stress urinary incontinence. The follow up was completed in December 2019. The assessment of functional results was based on number of pads used and declared to have been used by patients. The quality of life was assessed on the basis of the ICIQ-SF questionnaire (International Consultation on Incontinence Questionnaire-Short Form), SF-36 questionnaire (Short Form 36 Health Survey Questionnaire) and the severity of pain by means of the NRS (numerical rating scale of pain intensity). Results The operations were performed in 86 patients aged 28 to 80 (median 69). With the median (SD; range) follow-up of 21 (20.2; 1–68) months, daily pad usage decreased significantly from ≥4 to 1.1 (±0.97 pads) per day. Seven (8.1%) patients achieved total continence, 60 (69.8%) social continence, 14 (16.3%) improvement and 5 (5.8%) failures (≥4 pads per day). 15 patients (17.5%) experienced complications after surgery. The study showed a significant improvement of QoL evaluated by ICIQ-UI SF and SF-36. Conclusions Therapy with the use of ZSI 375 device is successfully applied in surgical management of moderate to severe male stress urinary incontinence. The life quality of patients assessed using questionnaires is at a high level.
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Affiliation(s)
- Ireneusz Ostrowski
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Emil Śledź
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Jacek Wilamowski
- Collegium Medicum of Nicolaus Copernicus University, Clinic of General and Oncological Urology, Bydgoszcz, Poland
| | - Mateusz Józefczak
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Wojciech Dyś
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Janusz Ciechan
- Department of Urology and Urological Oncology, Regional Specialistic Hospital, Puławy, Poland
| | - Tomasz Drewa
- Collegium Medicum of Nicolaus Copernicus University, Clinic of General and Oncological Urology, Bydgoszcz, Poland
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