Hüsch Tanja, Kretschmer Alexander, Obaje Alice, Kirschner-Hermanns Ruth, Anding Ralf, Pottek Tobias, Rose Achim, Olianas Roberto, Friedl Alexander, Homberg Roland, Pfitzenmaier Jesco, Abdunnur Rudi, Queissert Fabian, Naumann Carsten M, Schweiger Josef, Wotzka Carola, Nyarangi-Dix Joanne, Hofmann Torben, Ulm Kurt, Hübner Wilhelm, Bauer Ricarda M, Haferkamp Axel
Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
Promedon GmbH, Clinical Research, Kolbermoor, Germany.
Transl Androl Urol. 2020 Jun;9(3):1099-1107. doi: 10.21037/tau-19-852.
Fixed and adjustable male slings for the treatment of male urinary stress incontinence became increasingly popular during the last decade. Although fixed slings are recommended for the treatment of mild to moderate stress urinary incontinence, there is still a lack of evidence regarding the precise indication for an adjustable male sling. Furthermore, there is still no evidence that one type of male sling is superior to another. However, both, adjustable and fixed slings, are commonly utilized in daily clinical practice. This current investigation aims to evaluate the differences between fixed and adjustable male slings regarding indications, complication rates and functional outcome in the treatment of male stress urinary incontinence in current clinical practice.
A total of 294 patients with a fixed and 176 patients with an adjustable male sling were evaluated in a multicenter single arm cohort trial. Data collection was performed retrospectively according the medical record. Functional outcome was prospectively analyzed by standardized, validated questionnaires. Descriptive statistics was performed to present patient characteristics, complication rates and functional outcome. A chi2-test for categorical and independent t-test for continuous variables was performed to identify heterogeneity between the groups and to correlate preoperative characteristics with the outcome. A P value <0.05 was considered statistically significant.
Patients with higher degree of urinary incontinence (P<0.001) and risk factors such as history of pelvic irradiation (P<0.001) or prior surgery for urethral stricture (P=0.032) were more likely to receive an adjustable MS. Complication rates were comparable except for infection (P=0.009, 0 2.3%) and pain (P=0.001, 1.7% 11.3%) which occurred more frequently in adjustable slings. Functional outcome according validated questionnaires demonstrated no differences between fixed and adjustable male slings.
Adjustable male slings are more frequently utilized in patients with higher degree of incontinence and risk factors compared to fixed slings. No differences could be identified between functional outcome which may imply an advantage for adjustability. However, pain and infection rates were significantly higher in adjustable MS and should be considered in the decision process for sling type.
在过去十年中，用于治疗男性压力性尿失禁的固定和可调节男性吊带越来越受欢迎。虽然固定吊带被推荐用于治疗轻至中度压力性尿失禁，但对于可调节男性吊带的确切适应症仍缺乏证据。此外，尚无证据表明一种类型的男性吊带优于另一种。然而，可调节和固定吊带在日常临床实践中都被普遍使用。本研究旨在评估在当前临床实践中，固定和可调节男性吊带在治疗男性压力性尿失禁的适应症、并发症发生率和功能结局方面的差异。
在一项多中心单臂队列试验中，对总共294例使用固定男性吊带和176例使用可调节男性吊带的患者进行了评估。根据病历进行回顾性数据收集。通过标准化、经过验证的问卷对功能结局进行前瞻性分析。进行描述性统计以呈现患者特征、并发症发生率和功能结局。对分类变量进行卡方检验，对连续变量进行独立t检验，以识别组间异质性并将术前特征与结局相关联。P值<0.05被认为具有统计学意义。
尿失禁程度较高（P<0.001）以及存在盆腔放疗史（P<0.001）或既往尿道狭窄手术史（P=0.032）等危险因素的患者更有可能接受可调节男性吊带。除感染（P=0.009，0 2.3%）和疼痛（P=0.001，1.7% 11.3%）外，并发症发生率相当，感染和疼痛在可调节吊带中更频繁发生。根据经过验证的问卷得出的功能结局显示，固定和可调节男性吊带之间没有差异。
与固定吊带相比，可调节男性吊带在失禁程度较高和有危险因素的患者中使用更为频繁。在功能结局方面未发现差异，这可能意味着可调节性具有优势。然而，可调节男性吊带的疼痛和感染率明显更高，在选择吊带类型的决策过程中应予以考虑。
