Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol

Abstract

Background: Post-radical prostatectomy urinary incontinence (PPI) is a frequent and feared complication that can affect approximately 25% of patients. Between 1 and 10% of patients suffering from PPI will require surgery. The effectiveness of the available surgical interventions has only been compared in a few randomized controlled trials and the available reviews have important limitations regarding both benefits and harms that make them insufficient to inform decision-making. The aim of the study is to provide systematic summaries of benefits and harms of contemporary surgical treatment options for PPI through systematic review and meta-analysis using GRADE methodology and reporting in accord with the PRISMA-P statement. Methods: Studies pertaining to bulking agents, male synthetic slings, compressive balloon systems (ProACT) or artificial urinary sphincters (AUS) used for the treatment of patients suffering from PPI will be included. A systematic search will be conducted using the OVID and PubMED platforms in MEDLINE, Embase and Cochrane databases, and reference lists of relevant reviews and guidelines. Trained independent reviewers will conduct study selection and data extraction. Outcomes will include the number of pads used per day, the 24-h pad weight test, the Patient Global Impression of Improvement (PGI-I) and the Incontinence Quality of Life (IQOL) as possible benefits and the reoperations, the Clavien-Dindo complications and the other reported adverse events as the harms. When possible, pooled analyses will be completed. Risk of bias will be assessed using the CLARITY tools and a new tool for the before-and-after studies without a control group. Finally, study heterogeneity will be assessed, publication bias will be evaluated with funnel plots and quality of evidence rated for each outcome. Discussion: Our study will address patient-important outcomes and will be useful in clinical decision-making as well as identifying key elements for future research. Study registration: PROSPERO: CRD42018073923 05/12/2018

Patient’s Desire and Real Availability Concerning Supportive Measures Accompanying Radical Prostatectomy: Differences between Certified Prostate Cancer Centers and Non-Certified Centers Based on Patient-Reported Outcomes within the Cross-Sectional Study Improve

“…Thus, shared decision making between the patient and his treating physician is an important perioperative criterion that strongly correlates with patients' long-term acceptance of the surgical procedure. In addition to the intended impact of radical prostatectomy on the oncological outcomes, this procedure clearly has a functional component, resulting in stress urinary incontinence (in varying degrees) and erectile dysfunction in some of the surgically treated patients, leading to a significant impact on the quality of life [22][23][24]. For this reason, perioperative pelvic floor muscle training should be offered to patients by urologic centers, and therapeutic counselling should be offered to patients with postoperative erectile dysfunction problems in an outpatient setting [25][26][27].…”

A narrative review: evaluation and surgical management of persistent and recurrent urinary incontinence after previous surgical treatment

“…A recently published systematic review and metaanalysis by Choiniere et al identified 20 trials of fixed and adjustable male urethral slings including 1,956 patients, which identified an overall cure rate (defined as using <1 pad per day) of 58.6% (24). These results are similar to a review by Meisterhofer et al comparing fixed and adjustable slings, which identified that whilst adjustable slings may yield a higher cure rate, they may be associated with higher rates of complication and explantation (25).…”

Prostatectomy postoperative urinary incontinence: From origin to treatment

“…In contemporary practice, surgical interventions for PPUI encompass four principal methods: bulking agents, male synthetic slings, compressive balloon systems (also known as ProACTTM), and the artificial urinary sphincter (AUS), which stands as the current gold standard. 31 It is crucial to distinguish between bladder instability, prevalent in the early postoperative period, and intrinsic sphincter dysfunction, responsible for persistent stress incontinence. The latter does not respond to physiotherapy and anticholinergic medication.…”