Centre Hospitalier Universitaire de Sherbrooke, Department of Urology, Québec, Canada.
BJU Int. 2010 Oct;106(7):1012-6. doi: 10.1111/j.1464-410X.2010.09207.x. Epub 2010 Mar 1.
To present a prospective long-term evaluation of the bone-anchored male sling (InVance™, American Medical Systems, Minnetonka, MN, USA) for patients with moderate to severe stress urinary incontinence (SUI) after prostate surgery
Forty-five patients had a male sling implanted for SUI after prostate surgery. The evaluation before and after surgery included a complete history and physical examination, various questionnaires (American Urological Association Symptom Score, University of California Los Angeles/RAND prostate index), cysto-urethroscopy, International Continence Society (ICS) 1-h pad test and a urodynamic study. The follow-up assessments were at 2, 6 and 12 months after surgery, and yearly thereafter. The success rate was defined as the percentage of patients 'dry' and 'improved'.
The median (range) follow-up was 36 (2-64) months. Twelve patients (27%) had previous adjuvant radiotherapy. Eighteen patients (40%) had moderate SUI (two or three pads/day) and 27 (60%) had severe SUI (more than three pads/day). All preoperative ICS 1-h pad tests were positive. The success rate was 76%; 16 patients were dry (36%), 18 were improved (one or two pads/day, 40%) and in 11 the sling was a failure (24%); 76% of ICS 1-h pad tests were negative after surgery. The postoperative urodynamic study showed no signs of bladder outlet obstruction. In all, 72% of patients were satisfied/very satisfied with the surgery and 86% considered themselves cured/almost cured. The success rate was not affected by the presence of previous radiotherapy or the severity of SUI. Ten patients had perineal numbness, but in all it resolved within 1-3 months. There was one mesh infection which required its removal. There was no urethral erosion.
Compared to previous studies, the InVance male sling had a good success rate for moderate and severe SUI, with a median follow-up of 36 months. The results did not differ for moderate or severe SUI or with the presence of previous radiotherapy.
对前列腺手术后中重度压力性尿失禁（SUI）患者行骨锚定男性吊带（InVance™，美国医学系统公司，明尼苏达州明尼阿波利斯）前瞻性长期评估。
45 例前列腺手术后 SUI 患者行男性吊带植入术。术前和术后评估包括完整的病史和体格检查、各种问卷（美国泌尿外科学会症状评分、加利福尼亚大学洛杉矶分校/兰德前列腺指数）、膀胱尿道镜检查、国际尿控协会（ICS）1 小时垫试验和尿动力学研究。术后 2、6 和 12 个月以及此后每年进行随访评估。成功率定义为“干燥”和“改善”的患者百分比。
中位（范围）随访时间为 36（2-64）个月。12 例患者（27%）有辅助放疗史。18 例患者（40%）有中度 SUI（每天 2-3 片尿垫），27 例患者（60%）有重度 SUI（每天超过 3 片尿垫）。所有术前 ICS 1 小时垫试验均为阳性。成功率为 76%；16 例患者干燥（36%），18 例患者改善（每天 1-2 片尿垫，40%），11 例吊带失败（24%）；术后 ICS 1 小时垫试验 76%为阴性。术后尿动力学检查未见膀胱出口梗阻迹象。总的来说，72%的患者对手术满意/非常满意，86%的患者认为自己已治愈/基本治愈。成功率不受既往放疗和 SUI 严重程度的影响。10 例患者出现会阴麻木，但所有患者均在 1-3 个月内缓解。有 1 例网片感染，需要取出。无尿道侵蚀。
与既往研究相比，InVance 男性吊带治疗中重度 SUI 的成功率较高，中位随访时间为 36 个月。对于中重度 SUI 或既往放疗，结果没有差异。
