attached to the silicone cone columns that, after being passed with needles from the perineum to the abdominal wall, are adjusted with silicone washers to regulate and keep the desired tension against the urethra. The pad and washers are radio-opaque, which allows their position to be assessed during followup. The surgical technique was one described previously, with some modifications.
RESULTSAt a mean (range) follow-up of 7.5 (1-17.5) months, 35 (73%) of the 48 patients were dry, five (10%) were improved, and eight (17%) were incontinent, including four (8%) who needed sling adjustment. The mean (range) ICIQ-SF improved from 19.2 (12-21) to 4 (0-21). There were three (6%) urethral perforations during surgery that were resolved by re-passing the needle. The sling was removed in three men (6%) due to erosion and in two (4%) due to infection.Seven (15%) cases of acute urinary retention resolved spontaneously, except for one that needed the sling loosening. No cases of chronic retention were reported. There was perineal discomfort and mild dysuria soon after surgery that resolved spontaneously after a few weeks.
CONCLUSIONThis new adjustable male sling safely and effectively controls sphincter incontinence in men after prostate surgery, with an acceptably low complication rate. The early results are encouraging; the Argus is a valid alternative to the artificial urinary sphincter, the standard therapy for this condition.
Study Type – Therapy (RCT)
Level of Evidence 1b
What's known on the subject? and What does the study add?
Photovaporization of the prostate (PVP) is now challenging TURP as the standard treatment for lower LUTS caused by BPH. The learning curve for PVP is short and the main advantages of this method over TURP are a shorter period of hospitalization, a shorter period of postoperative vesical catheterization, lower levels of retrograde ejaculation, rare development of dilutional hyponatraemia syndrome, the lack of a need for postoperative vesical irrigation as a result of extremely low indices of postoperative haematuria, and the lack of a need to suspend anticoagulant medication for the surgery. Traditionally, comparisons of the effectiveness of TURP vs PVP have involved parameters such as peak flow urinary rate and post‐void residual urine volume measurements, and have employed questionnaires such as the IPSS and the International Index of Erectile Function instruments. However, studies evaluating detailed urodynamic parameters remain scarce and non‐comparative
The present study compared postoperative, medium‐term urodynamic parameters among patients receiving TURP and high‐power PVP. We consider the present study to be distinctive because it involved a double‐blind, detailed functional analysis of the vesical emptying stage over the course of 2 years, and did not simply comprise an evaluation of clinical parameters and uroflowmetrics. We saw a reduction of infravesical obstruction, as shown by the significant reduction of ≥20 cm H2O in the mean micturition pressure for the groups studied, as well as a significant reduction in bladder outlet obstruction index. Thus, the present data show that high‐power PVP can achieve and maintain the same results as TURP over a period of 24 months regarding an aspect that is particularly important for maintaining vesical health (i.e. detrusor pressure during the evacuation of the bladder). Such urodynamic data describing the functional outcome of PVP are currently missing from the literature.
OBJECTIVE
To assess the impact of GreenLight HPSTM 120‐W (American Medical System Incorporation, Minnetonka, MN, USA) laser photovaporization of the prostate (PVP) compared to transurethral resection of the prostate (TURP) on urodynamic results, voiding function and sexual function.
PATIENTS AND METHODS
In total, 20 men with intermediate/severe lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH) were randomly selected and equally divided into two groups: TURP and PVP.
Urodynamic evaluation was performed and International Prostate Symptom Score (IPSS), International Index of Erectile Function‐5 and International Consultation on Incontinence Questionnaire – Short Form questionnaires were completed.
The results were assessed at 2 years.
RESULTS
Mean IPSS scores were reduced in both groups, although they did not differ between the TURP and PVP groups.
There was no significant change in International Index of Erectile Function‐5 scores.
Half of the patients in th...
ARTICLE INFO
______________________________________________________________ ______________________Purpose: To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). . Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.
Argus has demonstrated its efficacy in long- term follow-up. The social continence rate was about 80%. The important complication was erosion or infection.
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