Sahai Arun, Abrams Paul, Dmochowski Roger, Anding Ralf
Department of Urology, Guy's Hospital, Kings College London, London, UK.
Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK.
Neurourol Urodyn. 2017 Apr;36(4):927-934. doi: 10.1002/nau.23264.
Post prostatectomy stress urinary incontinence can significantly impact on quality of life and is bothersome for patients. The artificial urinary sphincter is still considered the gold standard surgical treatment. Male slings are an alternative surgical option and several designs are currently available. This review will focus on efficacy, adverse events, and mechanism of action of male slings. The context of this review was a proposal at the ICI-RS meeting 2015. Following synthesis of the evidence we address the question: does it matter how male slings work?
The proposal lecture was reviewed and a comprehensive review of the literature undertaken utilising the PubMed database.
Male slings can be broadly divided into adjustable retropubic and suburethral transobturator slings. Male slings are efficacious and can improve quality of life. Adjustable retropubic slings appear to be compressive but studies suggest efficacy can be achieved without voiding dysfunction. Transobturator slings work by urethral compression and/or re-locating the urethral bulb. There is a recognized failure rate in all sling types and most studies suggest radiotherapy as a risk factor for failure. Adjustable slings have the ability to be altered to optimize continence or to prevent retention of urine. However, there appears to be a higher explantation rate in some of these systems.
It is important to understand how male slings work and by doing so we are more reliably able to choose the appropriate sling, predict outcomes, and as a result counsel patients. Suggestions for future research are proposed.
前列腺切除术后压力性尿失禁会显著影响生活质量，给患者带来困扰。人工尿道括约肌仍被视为金标准手术治疗方法。男性吊带是一种替代手术选择，目前有多种设计。本综述将聚焦于男性吊带的疗效、不良事件及作用机制。本综述的背景是在2015年国际尿控学会（ICI-RS）会议上提出的一项提议。在综合证据后，我们提出问题：男性吊带的工作方式重要吗？
对提议讲座进行了回顾，并利用PubMed数据库对文献进行了全面综述。
男性吊带大致可分为可调节耻骨后吊带和经闭孔尿道下吊带。男性吊带有效，可改善生活质量。可调节耻骨后吊带似乎具有压迫作用，但研究表明在不出现排尿功能障碍的情况下也可实现疗效。经闭孔吊带通过压迫尿道和/或重新定位尿道球部起作用。所有类型的吊带都存在公认的失败率，大多数研究表明放疗是失败的一个风险因素。可调节吊带能够进行调整以优化控尿或预防尿潴留。然而，其中一些系统的取出率似乎较高。
了解男性吊带的工作方式很重要，这样我们就能更可靠地选择合适的吊带、预测结果，并据此为患者提供咨询。提出了未来研究的建议。
