Surgical treatment for urinary incontinence after prostatectomy: A meta-analysis and systematic review

Simonetti

2019

Einstein (São Paulo)

Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: “prostatectomy” [Mesh], “urinary incontinence” [Mesh] and “suburethral slings” [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).

Section: Discussionsupporting

confidence: 89%

Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis

Simonetti

2019

Einstein (São Paulo)

Neurourology and Urodynamics

“…It is important to mention that there are many approaches to treat women with MUI, such as electrical stimulation, 30 surgical, 31 and PFMT, 32 which have shown important improvements. PFM strength has been demonstrating to improve quality of life, 33 decrease urinary leaking, and number of incontinences episodes 32 .…”

Section: Discussionmentioning

confidence: 99%

Game therapy a new approach to treat women facing mixed urinary incontinence: A study protocol

Oliveira

Bezerra

Ângelo

et al. 2020

Aims To describe a pelvic floor muscle training (PFMT) isolated and associated with game therapy (PFMT + GT) for women facing mixed urinary incontinence (MUI) during climacteric period. Methods To standardize a randomized controlled clinical trial intervention, a protocol was created, in an attempt to decrease women's symptomatology generated by MUI, through pelvic floor and abdomino‐loin‐pelvic muscles strength, and endurance. This study protocol will be composed of 32 volunteers, divided into two groups of 16. They will perform PFMT isolated or PFMT + GT, twice a week during 8 weeks. Interventions will last 40 minutes and will be divided into warming (5 minutes), training (30 minutes), and 5 minutes will be composed of resting time between exercises (1 minute each). Isolated PFMT sessions will be performed through four modalities of exercises: diaphragmatic, bridge, abdominal (plank), and pelvic mobility. PFMT + GT training will be carried out by using Wii Fit Plus games, such as Lotus Focus, Penguin Slide, Basic Step, and Hula Hoop from Wii equipment. Assessments will occur before, after, and 1 month after interventions. Vaginal manometry, 1‐hour Pad Test, International Consultation on Incontinence Questionnaire—Short Form (ICIQ‐SF), and Patient Global Intervention (PGI) will be used to evaluate the sample. Conclusions It is expected greater increase on pelvic floor muscle (PFM) strength, endurance, vaginal pressure for PFMT + GG. Moreover, it is supposed that PFMT + GT volunteers present better treatment adherence due to games motivational inclusion.

Therapeutic Advances in Urology

“…Success rates vary between 23% and 73% depending on the definition and duration of follow up. 2–5,12,14…”

Section: Discussionmentioning

confidence: 99%

Impact of obesity on male urethral sling outcomes

Monn

Jarvis

Gardner

et al. 2020

Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.