Department of Urology, Tenon Hospital, Groupe Hospitalo-Universitaire EST, Assistance Publique-Hôpitaux de Paris, University Paris VI, Paris, France.
BJU Int. 2011 Jul;108(2):236-40. doi: 10.1111/j.1464-410X.2010.09765.x. Epub 2010 Oct 18.
• To assess clinical outcomes at mid-term follow-up and determine preoperative factors associated with the failure of the Advance(TM) male sling for post-prostatectomy incontinence (PPI).
• A prospective evaluation was conducted of 136 consecutive patients implanted with the Advance(TM) male sling for mild to moderate stress urinary incontinence after prostatectomy. • Patients were preoperatively evaluated using medical history, ASA score, urodynamics, 24-h pad test and pad usage. • The clinical outcome was evaluated according to pad use and the Patient Global Impression of Improvement scale and by assessment of side effects. 'Cure' was defined as no pad usage and 'improvement' as a decrease in pad use by >50%. • Factors related to functional outcome were studied by univariate and multivariate analysis.
• After a mean ± SD (range) follow-up of 21 ± 6 (12-36) months, 62% of patients were cured, 16% improved and 22% not improved. • Failure (no cure or improvement) was associated with previous urethral stricture surgery (P= 0.013) and a 24-h pad-test >200 g/day (P= 0.026), and there was a trend for an association with previous radiation therapy (P= 0.053). • Age, learning curve and type of prostatectomy did not affect the results. • Immediate postoperative complications were limited to two cases of dysuria, one case of perineal haematoma and two cases of perineal paresthesia. During follow-up, 10% of patients had perineal pain and 14% of patients had mild dysuria. None required surgical management.
• The results of the present study, with a follow-up of up to 3 years, confirm that the Advance(TM) male sling is an efficient treatment for PPI. However, particular attention should be given to the preoperative data associated with failure.
评估中期随访时的临床结果，并确定与前列腺切除术后尿失禁（PPI）相关的男性 Advance(TM)吊带失败的术前因素。
对 136 例连续接受前列腺切除术后轻度至中度压力性尿失禁的 Advance(TM)男性吊带植入患者进行前瞻性评估。患者术前进行病史、ASA 评分、尿动力学、24 小时垫试验和垫使用评估。临床结果根据垫使用和患者总体改善印象量表进行评估，并评估副作用。“治愈”定义为无垫使用，“改善”定义为垫使用减少>50%。通过单变量和多变量分析研究与功能结果相关的因素。
在平均随访 21±6（12-36）个月后，62%的患者治愈，16%改善，22%无改善。失败（无治愈或改善）与既往尿道狭窄手术（P=0.013）和 24 小时垫试验>200 g/天（P=0.026）相关，且与既往放疗有趋势相关（P=0.053）。年龄、学习曲线和前列腺切除术类型不影响结果。术后早期并发症仅限于 2 例排尿困难、1 例会阴部血肿和 2 例会阴部感觉异常。随访期间，10%的患者有会阴部疼痛，14%的患者有轻度排尿困难。均无需手术治疗。
本研究随访时间长达 3 年，结果证实 Advance(TM)男性吊带是治疗 PPI 的有效方法。然而，应特别注意与失败相关的术前数据。
