Department of Urology, Medical University of Graz, Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
Eur Urol Focus. 2020 May 15;6(3):575-592. doi: 10.1016/j.euf.2019.01.008. Epub 2019 Feb 2.
Male slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model.
To evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence.
This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords "incontinence," "prostatectomy," and "male sling/system" was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients' quality of life.
The literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45-0.56, I=82%). Subjective cure was achieved in 33-94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51-0.71, I=88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings.
Both fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed.
Fixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
欧洲泌尿外科学会指南推荐使用男性吊带治疗轻度至中度前列腺切除术后尿失禁。然而，目前还没有一种吊带被证明比其他的更优越，也没有明确的指南来选择特定的吊带模型。
评估和比较不同类型的男性吊带在治疗前列腺切除术后尿失禁方面的疗效和安全性。
本系统评价和荟萃分析按照系统评价和荟萃分析首选报告项目的要求进行。2018 年 6 月，我们在 PubMed、Embase 和 Cochrane 数据库中使用“incontinence”、“prostatectomy”和“male sling/system”等关键词进行了系统的文献检索。纳入至少有 15 名患者且随访时间至少为 12 个月的英文研究。我们将不同吊带类型的治愈率作为主要终点，将改善率、主观治愈率、总并发症率、取出率、失败的危险因素以及对患者生活质量的影响作为次要终点。
文献检索共确定了 833 篇文章。共有 64 项研究的 72 个患者队列符合纳入标准。其中 55 项（76.4%）患者队列植入了固定吊带。客观治愈率在 8.3%至 87%之间（合并估计值 0.50，95%置信区间[CI]0.45-0.56，I=82%）。主观治愈率为 33%-94.4%。可调式吊带的客观治愈率在 17%至 92%之间（合并估计值 0.61，95%CI0.51-0.71，I=88%）。主观治愈率在 28%至 100%之间。在这两种类型的吊带中，疼痛都是最常见的并发症，但慢性疼痛的情况非常罕见（固定吊带为 1.3%，可调式吊带为 1.5%）。固定吊带的最常见并发症是尿潴留，可调式吊带的并发症是感染和随后的取出。
固定吊带和可调式吊带均有益于治疗前列腺切除术后尿失禁。尽管可调式吊带可能会导致更高的客观治愈率，但它们可能与更高的并发症和取出率有关。然而，目前由于数据的高度异质性，还不能确定这一点。需要更多具有长期随访和相同定义的尿失禁的随机对照试验。
固定吊带和可调式吊带是治疗轻度至中度前列腺切除术后尿失禁的有效治疗选择。
