Papachristos Alexander, Mann Sarah, Talbot Kay, Moon Daniel
Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Australian Urology Associates, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 Mar;88(3):E178-E182. doi: 10.1111/ans.13890. Epub 2017 Feb 27.
Since 2008, the AdVance male urethral sling has emerged as a minimally invasive option for stress urinary incontinence. We aimed to evaluate the success of the AdVance sling using validated continence outcome measures.
A total of 72 patients treated with the AdVance sling completed validated questionnaires reporting on quality of life and functional outcomes. Incontinence was assessed according to pad weight, pad usage per day (PPD), International Consultation on Incontinence Questionnaire scores and Patient Global Impression of Improvement scores.
At a median 52-month follow-up, 37 (51%) patients were pad free or used a security pad; 18 (25%) used ≥50% fewer PPDs; and the remaining 17 (24%) patients were classified as 'failed'. According to pad weights, 27 (38%) patients were dry; 32 (44%) had mild incontinence (<100 mL/day); and 13 (18%) had moderate (100-400 mL/day) or severe (>400 mL/day) incontinence. Patient satisfaction was high, with 57 (79%) very much or much better, six (8%) somewhat better and only nine (13%) unchanged or worse. There was a trend of declining continence over time, although the majority remained improved. Patients with severe preoperative incontinence performed significantly worse postoperatively (P = 0.02), as did those who had had prior pelvic radiotherapy (P = 0.02).
The AdVance sling offers a high rate of success for the treatment of mild to moderate post-prostatectomy incontinence according to PPD; however, when using objective measures of continence, the success rates are lower. The improvement in urinary control is largely durable over the medium term; however, they may decline beyond 4 years. Reduced efficacy is seen in those with a history of radiotherapy and severe incontinence, although the majority of these men are still improved with surgery.
自2008年以来，AdVance男性尿道悬吊带已成为压力性尿失禁的一种微创治疗选择。我们旨在使用经过验证的控尿结果指标来评估AdVance悬吊带的治疗效果。
共有72例接受AdVance悬吊带治疗的患者完成了关于生活质量和功能结局的经过验证的问卷调查。根据尿垫重量、每日尿垫使用量（PPD）、国际尿失禁咨询问卷评分和患者总体改善印象评分来评估尿失禁情况。
在中位随访52个月时，37例（51%）患者无需使用尿垫或仅使用保护尿垫；18例（25%）患者的PPD使用量减少了≥50%；其余17例（24%）患者被归类为“治疗失败”。根据尿垫重量，27例（38%）患者无尿失禁；32例（44%）患者有轻度尿失禁（<100 mL/天）；13例（18%）患者有中度（100 - 400 mL/天）或重度（>400 mL/天）尿失禁。患者满意度较高，57例（79%）患者感觉非常好或好多了，6例（8%）患者感觉有所改善，只有9例（13%）患者感觉无变化或变差。尽管大多数患者仍有改善，但随着时间推移控尿情况有下降趋势。术前有严重尿失禁的患者术后表现明显较差（P = 0.02），既往接受过盆腔放疗的患者也是如此（P = 0.02）。
根据PPD，AdVance悬吊带治疗轻度至中度前列腺切除术后尿失禁的成功率较高；然而，使用客观的控尿指标时，成功率较低。尿控改善在中期基本持久；然而，4年后可能会下降。有放疗史和严重尿失禁的患者疗效降低，尽管这些患者中的大多数通过手术仍有改善。
