What if artificial urinary sphincter is not possible? Feasibility and effectiveness of ProACT for patients with persistent stress urinary incontinence after radical prostatectomy treated by sling

Autor: Pierre Costa, Stéphane Droupy, Christian Saussine, T. Tricard, Pierre Munier, Marc Nicolas
Přispěvatelé: Les Hôpitaux Universitaires de Strasbourg (HUS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Urethral injury
Male
medicine.medical_treatment
Urinary Incontinence
Stress
030232 urology & nephrology
Urinary incontinence
[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
MESH: Suburethral Slings
Artificial urinary sphincter
0302 clinical medicine
Postoperative Complications
MESH: Aged
80 and over
Adjustable continence therapy
Clinical endpoint
Medicine
ProACT
MESH: Postoperative Complications / therapy
MESH: Treatment Outcome
Aged
80 and over
education.field_of_study
030219 obstetrics & reproductive medicine
Prostatectomy
MESH: Urinary Incontinence
Stress / etiology
Middle Aged
MESH: Urinary Sphincter
Artificial
Radical prostatectomy
3. Good health
Treatment Outcome
MESH: Balloon Occlusion
Urinary Sphincter
Artificial
Female
medicine.symptom
medicine.medical_specialty
Urology
Population
Male sling
MESH: Urinary Incontinence
Stress / therapy
Sling (weapon)
03 medical and health sciences
Urethra
Humans
education
Aged
Suburethral Slings
Stress urinary incontinence
business.industry
MESH: Quality of Life
Retrospective cohort study
Balloon Occlusion
MESH: Urinary Incontinence
Stress / psychology
Surgery
MESH: Prostatectomy / adverse effects
Urinary Incontinence
Quality of Life
Feasibility Studies
Neurology (clinical)
MESH: Urethra / physiopathology
business
MESH: Feasibility Studies
Zdroj: Neurourology and Urodynamics
Neurourology and Urodynamics, Wiley, 2020, 39 (5), pp.1417-1422. ⟨10.1002/nau.24355⟩
ISSN: 0733-2467
1520-6777
DOI: 10.1002/nau.24355⟩
Popis: International audience; Background: Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable.Aims: This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings.Materials & methods: This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported.Results: Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement.Conclusion: The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.
Databáze: OpenAIRE
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