Sacco Emilio, Gandi Carlo, Vaccarella Luigi, Recupero Salvatore, Racioppi Marco, Pinto Francesco, Totaro Angelo, Foschi Nazario, Palermo Giuseppe, Pierconti Francesco, Bassi Pierfrancesco
Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy.
Department of Urology, "Agostino Gemelli" Academic Hospital Foundation, IRCCS, Catholic University School of Medicine, Rome, Italy.
Urology. 2018 May;115:144-150. doi: 10.1016/j.urology.2018.02.022. Epub 2018 Mar 1.
To evaluate prospectively midterm outcomes of a new titanium-coated fixed polypropylene sling for male stress urinary incontinence.
From January 2013 to June 2016, 44 consecutive patients with incontinence caused by radical prostatectomy (39) or transurethral resection of prostate (5) underwent transobturator 2-arm titanium-coated sling (TiLOOP Male) implantation with an inside-out, single-incision technique, leaving the bulbourethral muscle in place. Patients have been assessed postoperatively with uroflowmetry, pad count, International Prostate Symptom Score-Short Form, Incontinence Impact Quetionnaire-7, Patient's Global Impression of Improvement, Overactive Bladder questionnaire, International Prostate Symptom Score, and satisfaction (yes or no). Successful outcome included cure (no pad use or 1 dry "security" pad) or improvement (reduction of at least 50% of the pad count).
Evaluated patients had mild (11 of 44, 25%), moderate (26 of 44, 59%), or severe (7 of 44, 16%) incontinence. After a median follow-up of 25 months (range 12-55, minimum 12 months), 24 (54.6%) patients were cured and 10 (22.7%) were improved, which was a global success rate of 77.3%. There were 10 (22.7%) failures in the first 6 months. Zero pad rate was 50%. Subjective success (Patient's Global Impression of Improvement very much or much improved) was achieved in 33 (75%) patients. Mean scores of ICIQ-SF, ICIQ-QoL, and IIQ-7 improved to a statistically significant extent. Satisfaction was reported by 33 (75%) patients. Uroflowmetry parameters were unchanged postoperatively, and most of the complications were Clavien-Dindo grade I. Body mass index ≥30 and previous irradiation or high-intensity focused ultrasound were independent predictors of failure.
TiLOOP Male provided favorable and stable midterm continence outcomes. The inside-out approach was safe, and the tolerability of the sling and the single-incision technique was satisfactory. Patients with obesity and previous irradiation or high-intensity focused ultrasound should be aware of their higher risk of failure.
前瞻性评估一种新型钛涂层固定聚丙烯吊带治疗男性压力性尿失禁的中期疗效。
2013年1月至2016年6月，44例因根治性前列腺切除术（39例）或经尿道前列腺切除术（5例）导致尿失禁的患者采用经闭孔双臂钛涂层吊带（TiLOOP Male），通过由内向外单切口技术植入，保留球尿道肌。术后对患者进行尿流率测定、尿垫计数、国际前列腺症状评分简表、尿失禁影响问卷-7、患者总体改善印象、膀胱过度活动症问卷、国际前列腺症状评分及满意度（是或否）评估。成功结局包括治愈（无需使用尿垫或仅使用1片干燥的“安全”尿垫）或改善（尿垫计数至少减少50%）。
评估的患者存在轻度（44例中的11例，25%）、中度（44例中的26例，59%）或重度（44例中的7例，16%）尿失禁。中位随访25个月（范围12 - 55个月，最短12个月）后，24例（54.6%）患者治愈，10例（22.7%）患者改善，总体成功率为77.3%。前6个月有10例（22.7%）失败。零尿垫率为50%。33例（75%）患者取得主观成功（患者总体改善印象为非常改善或大有改善）。ICIQ - SF、ICIQ - QoL和IIQ - 7的平均评分有统计学意义的改善。33例（75%）患者报告满意。术后尿流率参数未改变，大多数并发症为Clavien - Dindo I级。体重指数≥30以及既往接受过放疗或高强度聚焦超声治疗是失败的独立预测因素。
TiLOOP Male提供了良好且稳定的中期控尿效果。由内向外的方法安全，吊带及单切口技术的耐受性良好。肥胖以及既往接受过放疗或高强度聚焦超声治疗的患者应意识到其失败风险较高。
