Sourial Michael W, Richard Patrick O, Morisset Julie, Jundi Mazen, Tu Le Mai
Division of Urology, Department of Surgery, Faculté de Médecine et Science de la Santé, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC; Canada.
Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC; Canada.
Can Urol Assoc J. 2017 Jul;11(7):E271-E276. doi: 10.5489/cuaj.4381. Epub 2017 Jul 11.
We aimed to compare the efficacy of two different sling tensioning approaches, and to report our experience, including safety and impact on quality of life (QoL) of the Virtue male sling for the treatment of postprostatectomy incontinence (PPI).
From our prospectively maintained database, we retrospectively identified all men treated with the Virtue male sling for PPI between March 2009 and February 2014 by two urologists in two institutions. Baseline demographic data and the sling tensioning method were abstracted from the database. Likewise, the Patient Global Impression of Improvement (PGI-I) scale, severity of incontinence, and clinical outcomes were also abstracted.
48 patients were treated with the Virtue quadratic male sling. Sling tensioning was done using cystoscopy in the first 18 patients (Group 1), while per-operative retrograde leak point pressure (RLPP) measurement was done in the last 30 patients (Group 2). The median (interquartile range [IQR]) followup from the day of surgery was 22 (15-41) months. At the last followup visit, 7 (39%) patients in Group 1 were cured or improved of their PPI, compared to 21 (70%) patients in Group 2 (p=0.03). The final median (IQR) RLPP in these patients was 41 (37-48) cm HO. Transient pain was the most common adverse event, occurring in 23 (48%) of patients. Twenty-one (70%) patients in Group 2 were "much better" or "very much better" with their device, compared to 7 (39%) in Group 1 (p=0.0008).
The Virtue male sling is a valuable treatment option for PPI. Per-operative RLPP measurement significantly improves cure and satisfaction rates.
我们旨在比较两种不同吊带张紧方法的疗效，并报告我们的经验，包括美德男性吊带治疗前列腺切除术后尿失禁（PPI）的安全性和对生活质量（QoL）的影响。
从我们前瞻性维护的数据库中，我们回顾性识别了2009年3月至2014年2月期间在两个机构由两位泌尿科医生使用美德男性吊带治疗PPI的所有男性。基线人口统计学数据和吊带张紧方法从数据库中提取。同样，患者总体改善印象（PGI-I）量表、尿失禁严重程度和临床结果也被提取。
48例患者接受了美德方形男性吊带治疗。前18例患者（第1组）使用膀胱镜进行吊带张紧，而后30例患者（第2组）进行术中逆行漏点压力（RLPP）测量。从手术当天起的中位（四分位间距[IQR]）随访时间为22（15 - 41）个月。在最后一次随访时，第1组7例（39%）患者的PPI得到治愈或改善，而第2组为21例（70%）患者（p = 0.03）。这些患者的最终中位（IQR）RLPP为41（37 - 48）cm H₂O。短暂疼痛是最常见的不良事件，发生在23例（48%）患者中。第2组21例（占70%）患者对该装置的评价为“好多了”或“非常好多了”，而第1组为7例（39%）患者（p = 0.0008）。
美德男性吊带是治疗PPI的一种有价值的选择。术中RLPP测量显著提高了治愈率和满意度。
