Transopturatorna AdVance® suspenzija u liječenju postoprostatektomijske stresne inkontinencije mokraće

Autor: Goran, Štimac, Borislav, Spajić, Alek, Popović, Danijel, Justinić, Igor, Grubišić, Šoip, Šoipi, Ivan, Svaguša, Matea, Pirša, Boris, Ružić
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: Acta Clinica Croatica, Vol 57., Iss Supplement 1, Pp 77-84 (2018)
Acta clinica Croatica
Volume 57.
Issue Supplement 1
ISSN: 1333-9451
0353-9466
Popis: Stress urinary incontinence (SUI) continues to present a major complication after radical prostatectomy. Suburethral slings represent one of the less invasive options for postprostatectomy SUI, and a more recent addition is a transobturator sling, the AdVance®. We report our results with the AdVance® sling for the management of postoperative SUI. The evaluation was conducted on 47 patients with AdVance® implant for SUI in our institution (November 2010 - June 2017). Measurements included age, etiology of SUI, duration of SUI, follow-up and pad use per day (PPD) pre- and postoperatively. Patients were classified as cured if they used no pads or 1 PPD for security reasons, or as improved if 1-2 PPDs were used and if there was a 50% reduction in pad use per day postoperatively. In our series we observed a reduction of mean PPD of 5.1 (2-8) to 1.7 (0-4) postoperatively. After follow-up and according to our criteria, the cure rate was 51.1% (24/47) and the improvement rate 27.5% (13/47). The overall success rate was 78.6% (37/47). No improvement was observed in 21.4% (10/47) of patients. Failure rates after sling placement for patients with additional treatments following prostatectomy were much higher (60% (3/10) for radiation therapy and 66.7% (4/10) for urethral stricture disease). Our results show favourable cure and improvement rates and are comparable to results from larger series. The most appropriate candidates for the AdVance® sling are patients with mild to moderate postprostatectomy SUI. The results may be even better in patients without additional treatment following prostatectomy, such as radiation therapy or surgery for stricture disease.
Unatoč napretku u liječenju lokaliziranog raka prostate radikalnom prostatektomijom, i dalje je prisutan dio bolesnika kod kojih perzistira stresna urinarna inkontinencija (SUI). Suburetralni, a odnedavno i transopturatorni „slingovi“ zbog neinvazivnosti postaju metodom izbora u liječenju ovih bolesnika. U članku prikazujemo kiruršku tehniku i naše rezultate liječenja postoperativne SUI metodom AdVance®. Od studenog 2010. do lipnja 2017. metodom AdVance® na Klinici je operirano 47 bolesnika. Zabilježena je dob, etiologija i trajanje SUI te dnevni broj uložaka preoperativno i postoperativno. Izlječenje je definirano kao potpuna kontinencija ili korištenje jednog sigurnosnog uloška / dan. Poboljšanje je definirano kao korištenje 1-2 uloška / dan te smanjenje u dnevnom broju uložaka veće od 50%. U ispitivanom razdoblju kod operiranih bilježimo značajan pad prosječnog broja uložaka / dan s 5.1 (2-8) na postoperativno 1.7 (0-4). Prema našim kriterijima, postoperativno je kontinentno 51.1% (24/47), a poboljšanje kontinencije nalazimo kod 27.5% (13/47) operiranih. Kod 78.6% (37/47) operiranih broj dnevno korištenih uložaka smanjio se za više od 50% i/ili je kontinentno. Stope neuspjeha znatno su veće kod bolesnika koji su nakon prostatektomije tretirani radioterapijom (60% (3/10)) ili uretrotomijom (66.7% (4/10)). Rezultati liječenja postoperativne SUI suspenzijom AdVance® u našoj ustanovi usporedivi su s rezultatima do sada objavljenih studija. Suspenzija AdVance® indicirana je kod bolesnika s blagom do umjerenom postoperativnom SUI te očuvanom ostatnom funkcijom sfinktera potvrđenom uretrocistoskopijom. Očekivano, a zbog periuretralne fibroze, uspješnost metode upitna je kod bolesnika koji su nakon prostatektomije tretirani radioterapijom ili endourološkim zahvatima.
Databáze: OpenAIRE
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