Siracusano Salvatore, Visalli Francesco, Toffoli Laura
Department of Urology, Trieste University, Ospedale di Cattinara, Via Strada di Fiume 447, 34100 Trieste, Italy.
Arab J Urol. 2013 Dec;11(4):331-5. doi: 10.1016/j.aju.2013.06.008. Epub 2013 Sep 29.
To provide an analysis of the outcomes in patients who have a suburethral sling placed using the transobturator approach for the treatment of stress urinary incontinence after radical prostatectomy, because data in this specific area remain limited, and recent changes in male sling surgery might improve the efficacy in men with moderate or mild incontinence.
We evaluated the results of transobturator non-adjustable and re-adjustable sling systems after reviewing previous reports identified using the Medline and PubMed databases for original articles, from 2002 to 2012, using the terms 'postoperative male incontinence', 'transobturator' and 'male sling'. Of a total of 31 articles, we reviewed the 22 related to the outcomes of the suburethral sling with positioning by the transobturator approach.
Currently the only results of the transobturator approach are those relating to the AdVance™ device (American Medical Systems, Minnetonka, MN, USA), for which the cure rate is ≈ 60% at 20 months. The remaining devices, although innovative, were assessed in studies for which the follow-up was too short to make a judgement.
It would be advisable to reserve the transobturator approach for patients with mild and moderate incontinence, and refer those with severe incontinence, with or without adjuvant radiotherapy after radical prostatectomy, for treatment with an artificial urinary sphincter. More results and a long-term follow-up are needed to evaluate the effectiveness of these devices.
对采用经闭孔途径放置尿道下吊带治疗前列腺癌根治术后压力性尿失禁患者的治疗结果进行分析，因为该特定领域的数据仍然有限，且男性吊带手术最近的改进可能会提高中轻度尿失禁男性患者的疗效。
我们通过检索2002年至2012年期间使用Medline和PubMed数据库以“术后男性尿失禁”、“经闭孔”和“男性吊带”为关键词识别出的原始文章，回顾了经闭孔不可调节和可重新调节吊带系统的结果。在总共31篇文章中，我们回顾了22篇与经闭孔途径定位的尿道下吊带治疗结果相关的文章。
目前经闭孔途径的唯一结果是与AdVance™ 装置（美国美敦力公司，明尼通卡，明尼苏达州，美国）相关的结果，该装置在20个月时的治愈率约为60%。其余装置虽然具有创新性，但在随访时间过短无法做出判断的研究中进行了评估。
对于中轻度尿失禁患者，采用经闭孔途径较为合适；而对于前列腺癌根治术后严重尿失禁患者，无论是否接受辅助放疗，均应采用人工尿道括约肌进行治疗。需要更多的结果和长期随访来评估这些装置的有效性。
