In a nutshell
This study examined the safety and effectiveness of surgical treatments for stress urinary incontinence (SUI) after prostate surgery. Authors reported that artificial urinary sphincters were associated with the highest overall effectiveness as well as the highest rate of complications. The authors advised that more high-quality evidence is needed.
Some background
Urinary incontinence is common among men undergoing prostate surgery. It has been estimated that 4 to 40% of men experience SUI after prostate surgery. SUI can significantly affect quality of life and treatment with surgery is often required.
Artificial urinary sphincters (AUS) can help restore urinary continence among those who suffered damaged bladder muscles during prostate surgery. Sling procedures are another common surgical treatment for SUI. Sling procedures involve the placement of a small sling to lift the urethra to its normal position. Approved male slings include Invance Sling, Advance Sling, TOMS, and Inside Out. ProAct is another type of surgical treatment involving the implant of two adjustable balloons (one on each side of the urethra) to help reduce SUI.
Methods & findings
The aim of this study was to analyze the effects of AUS and male slings in treating SUI after prostate surgery.
51 separate studies were analyzed. The studies included a total of 4,022 men with SUI after prostate surgery. All men were treated with either AUS, ProAct, or a male sling. Patients were followed for at least 12 months.
AUS was associated with the highest number of continent patients (based on daily incontinence pad use). 20 to 89% of men achieved continence after AUS placement. Treatment with a male sling was overall associated with a lower success rate. Continence was achieved in 13 to 66% for Invance Sling, 9 to 73% for Advance Sling, and 30 to 79% for other slings. ProAct had the most stable results with 62 to 68% of patients reporting continence. However, men required an average of 2.5 adjustments of the implanted balloons to achieve continence.
The highest rate of complications was observed with AUS (19.4%), followed by ProAct (12.3%). The most common complications with AUS and ProAct were erosion and malfunction. 3 to 15% of men treated with Invance Sling experienced an infection. Advance Sling was commonly associated with urinary retention (a temporary inability to pass urine that requires treatment), observed in 2.7 to 15.1% of cases.
The bottom line
The authors concluded that the quality of the evidence was low and it was therefore impossible to establish clinical differences between surgical treatments for SUI. Overall, AUS was associated with both the highest effectiveness and the highest rate of complications.
The fine print
Larger randomized trials are needed to test the effectiveness of surgical treatments for male SUI.
Published By :
Neurourology and urodynamics
Date :
Oct 24, 2016
