Hammad Muhammed A M, Barham David W, Osmonov Daniar, Hatzichristodoulou Georgios, van Renterghem Koenraad, Andrianne Robert, Park Sung Hun, Kohler Tobias S, Hellstrom Wayne J G, Jenkins Lawrence, Yafi Faysal A
University of California-Irvine, Irvine, CA, USA.
University Hospital Schleswig-Holstein, Kiel, Germany.
Transl Androl Urol. 2023 May 31;12(5):859-865. doi: 10.21037/tau-22-661. Epub 2023 Mar 14.
In 2017, a prospective multicenter, multinational, investigational pilot study was conducted examining outcomes using a novel surgical technique, the Mini-Jupette sling, for the management of erectile dysfunction (ED) patients with climacturia and/or minimal stress urinary incontinence (SUI) after prostate procedures. Climacturia has been reported in up to 64% of patients following radical prostatectomy (RP). We sought to report the 5-year outcomes from this original cohort to assess long-term safety and effectivity of the mini-jupette sling in the treatment of ED and concomitant mild SUI and/or climacturia.
This is a single-arm, multicenter, retrospective, observational study. We identified patients who were enrolled in the previous multicenter study with post-RP ED and climacturia and/or mild SUI- 2 PADS PER DAY (PPD) and underwent inflatable penile prosthesis (IPP) insertion with simultaneous placement of a mini-jupette sling. Data were collected including current PPD, subjective improvement in climacturia/SUI, complications, need for revision of IPP or additional urinary incontinence surgery, and date of most recent follow-up. SPSS was used for statistical analysis.
Of the original 38 patients, 5 have since died and 10 were lost to follow-up with 23/38 (61%) patients available for evaluation of long-term outcomes. The average follow-up time was 59 months (SD =8.8) with a mean age of 69 years (SD =6.8). Most patients (n=21, 91%) had subjective improvement of SUI and climacturia. One patient with persistent bothersome incontinence underwent artificial urinary sphincter (AUS) placement in 2018 with no complications, while the other is still considering a repeat procedure due to minor but persistent SUI. The mean PPD decreased from 1.4 preoperatively to 0.4 at a mean of 5 years of follow-up. Most patients reported satisfaction in their urinary symptoms with 91% and 73% reporting improvement in SUI and climacturia respectively, compared to 86% and 93% respectively in the original series. One (4.3%) patient had an IPP revision for pump malfunction. There were no device infections reported.
The mini-jupette sling appears to be a safe and effective procedure with durable improvements in SUI and climacturia at 5 years of follow-up.
2017年，开展了一项前瞻性多中心、跨国性的试验性研究，采用一种新型手术技术——Mini-Jupette吊带，来治疗前列腺手术后出现更年期尿频和/或轻度压力性尿失禁（SUI）的勃起功能障碍（ED）患者。据报道，高达64%的前列腺癌根治术（RP）患者会出现更年期尿频。我们试图报告该初始队列的5年随访结果，以评估Mini-Jupette吊带治疗ED及伴发的轻度SUI和/或更年期尿频的长期安全性和有效性。
这是一项单臂、多中心、回顾性观察研究。我们确定了之前多中心研究中纳入的RP术后ED且伴有更年期尿频和/或轻度SUI（每天2片尿垫）并接受了可膨胀阴茎假体（IPP）植入同时放置Mini-Jupette吊带的患者。收集的数据包括当前每天使用尿垫数、更年期尿频/SUI的主观改善情况、并发症、IPP翻修或额外尿失禁手术的需求以及最近一次随访日期。使用SPSS进行统计分析。
在最初的38例患者中，5例已死亡，10例失访，23/38（61%）例患者可用于评估长期结果。平均随访时间为59个月（标准差=8.8），平均年龄为69岁（标准差=6.8）。大多数患者（n=21，91%）的SUI和更年期尿频有主观改善。1例持续性烦人的尿失禁患者于2018年接受了人工尿道括约肌（AUS）植入，无并发症，而另1例患者因轻微但持续的SUI仍在考虑再次手术。平均每天使用尿垫数从术前的1.4片降至平均随访5年时的0.4片。大多数患者对其泌尿系统症状表示满意，分别有91%和73%的患者报告SUI和更年期尿频有所改善，而在最初的系列研究中这一比例分别为86%和93%。1例（4.3%）患者因泵故障对IPP进行了翻修。未报告器械感染情况。
Mini-Jupette吊带似乎是一种安全有效的手术方法，在5年随访中SUI和更年期尿频有持久改善。
