Al-Najar Amr, Kaufmann Sascha, Boy Soenke, Naumann Carsten Maik, Jünemann Peter-Klaus, Van Der Horst Christof
Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Can Urol Assoc J. 2011 Apr;5(2):107-11. doi: 10.5489/cuaj.10092.
Our objective was to establish the feasibility of combining 2 minimally invasive procedures in patients with failed primary treatment (male sling) in post-prostatectomy incontinence (PPI) patients.
From January 2007 to July 2008, 40 men with PPI were implanted with a suburethral tape (2 patients with Seratim, 3 with I-Stop and 35 with Advance). The median preoperative pad count was 4 (range 2-10). Prior to sling placement, 6 patients had undergone ProACT implantation. Of these, 4 patients required explantation due to balloon migration and 2 patients had their balloons kept in situ, with the balloons deflated.
Twenty-five patients were socially continent at this time. Fifteen patients (37.5%) did not improve or their improvement was not significant. These patients had a preoperative pad count between 7 and 10. Two of these patients had prostate adjustable continence therapy (ProACT) systems still in place. By gradually filling the balloons to 3 mL, both of these patients achieved complete continence, which was maintained at a mean follow-up of 8.5 months. Three patients with prior pelvic irradiation received an artificial urinary sphincter and achieved continence at mean follow-up of 8.3 months. The remaining 10 patients received a ProACT system in addition to the already implanted sling. After appropriate healing and filling of the balloons (average balloon volume 5 mL), all 10 patients reached complete continence; they were pad-free at a mean follow-up of 6 months (range 3-9).
The combination of ProACT and a suburethral tape was demonstrated to be a possible treatment option in recurrent or persistent PPI.
我们的目的是确定在前列腺切除术后尿失禁（PPI）患者中，将两种微创手术相结合用于初次治疗（男性吊带）失败患者的可行性。
2007年1月至2008年7月，40例PPI男性患者植入了尿道下胶带（2例使用Seratim，3例使用I-Stop，35例使用Advance）。术前尿垫使用量中位数为4片（范围2 - 10片）。在放置吊带前，6例患者已植入ProACT。其中，4例因球囊移位需要取出，2例患者的球囊保留原位且已放气。
此时25例患者在社交场合能保持干爽。15例患者（37.5%）没有改善或改善不明显。这些患者术前尿垫使用量在7至10片之间。其中2例患者仍保留前列腺可调节控尿治疗（ProACT）系统。通过逐渐将球囊充至3 mL，这2例患者均实现了完全控尿，在平均8.5个月的随访中得以维持。3例曾接受盆腔放疗的患者接受了人工尿道括约肌植入，在平均8.3个月的随访中实现了控尿。其余10例患者在已植入吊带的基础上又接受了ProACT系统。在球囊适当愈合并充盈（平均球囊体积5 mL）后，所有10例患者均达到完全控尿；在平均6个月（范围3 - 9个月）的随访中无需使用尿垫。
ProACT与尿道下胶带相结合被证明是复发性或持续性PPI的一种可能治疗选择。
