Silva Laercio Antonio da, Simonetti Rogério, Silva Edina Mariko Koga da
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2019 Sep 23;17(4):eRW4508. doi: 10.31744/einstein_journal/2019RW4508. eCollection 2019.
Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).
前列腺切除术后尿失禁对患者的生活质量有显著负面影响。手术治疗包括多种男性吊带模型，如可调节吊带。本研究的目的是评估可调节吊带治疗前列腺切除术后尿失禁的有效性和安全性。这是一项文献系统综述。检索了以下电子数据库直至2018年1月：医学期刊数据库（PubMed®）、荷兰医学文摘数据库（Embase）、考克兰系统评价数据库（CENTRAL）和拉丁美洲及加勒比地区卫生科学数据库（LILACS）。检索策略中使用的关键词为：“前列腺切除术”[医学主题词]、“尿失禁”[医学主题词]和“尿道下吊带”[医学主题词]。纳入了随机临床试验和观察性研究，无论有无对照组，且随访时间超过12个月。仅纳入了一项存在高偏倚风险的随机研究，其得出可调节吊带与不可调节吊带在有效性上等效的结论。所有其他研究均为病例系列，患者的尿失禁严重程度不同，且有盆腔放疗史和既往手术史。24小时无尿垫使用的荟萃分析显示有效性为53%。对于24小时0至1个尿垫测试，荟萃分析得出有效性为69%。手术失败的风险因素包括既往放疗、前列腺切除术后尿失禁的严重程度以及既往手术。挤出率的荟萃分析为9.8%，最常报告的不良反应为疼痛和局部感染。低质量证据表明，可调节吊带治疗前列腺切除术后尿失禁有效，不良事件发生率与被视为金标准的手术选择（人工尿道括约肌植入）相似。
