Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis

Abstract

Background: The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP). Methods: This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included. Results: Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies. Conclusions: Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.

Artificial Urinary Sphincter Is Better Than Slings for Moderate Male Stress Urinary Incontinence With Acceptable Complication Rate: A Systematic Review and Meta-Analysis

“…It is frustrating that the study only compared the efficacy of both interventions before and after surgery and found that the two procedures contributed to decreased daily pad use and quality of life improvement. Guachetá Bomba PL determined the effectiveness of adjustable slings vs. AUS in patients with severe postprostatectomy SUI, despite the fact that he could only conduct a network meta-analysis to compare the two interventions indirectly ( 16 ). He concluded that both were able to reduce incontinence and improve life quality; however, the difference of effectiveness for adjustable slings vs. AUS was not significant.…”

“…Hence, researches on meta-analysis is urgently needed to integrate the existing evidence to draw a conclusion about the preference of two SUI treatments mentioned above. Nevertheless, it is regrettable that recent systematic reviews merely include network meta-analysis that indirectly compares AUS intervention or adjustable slings procedure with non-intervention group ( 16 ), or includes meta-analysis that compares the pad use per day before and after SUI surgery ( 17 ). Moreover, they did not pay attention to moderate male SUI, whose treatment seems to be a choice between AUS and slings.…”

Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis

“…Treatment for PPUI can be either noninvasive or invasive 24 . Noninvasive approaches include lifestyle management, pelvic floor muscle exercise, and medical treatment.…”

“…Noninvasive approaches include lifestyle management, pelvic floor muscle exercise, and medical treatment. The invasive approaches include surgical treatment such as injection of urethral bulking agents, artificial urethral sphincter (AUS) insertion, and adjustable or nonadjustable sling 24 . The goals of surgical treatment for PPUI are to preserve bladder capacity and compliance, improve urethral strength, and reduce urinary leakage; the choice of treatment depends on the severity, duration, and type of symptoms 24 , 25 .…”

“…For PPUI, a standard strategy for surgical treatment and the choice of surgical procedure have not been established 24 . However, it is generally accepted that when PPUI persists for more than 12 months, surgical treatment may be considered 24 .…”