男性可調節式尿道懸吊帶術對攝護腺根除手術術後應力性尿失禁之治療效果

邱亮維、方仁愷、楊有容、黃志平

中國醫藥大學附設醫院 泌尿部

The efficacy of the re-adjustable male sling system for stress urinary incontinence after radical prostatectomy

Liang-Wei Chiu, Jen-Kai Fang, You-Rong Yang, Chi-Ping Huang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction: The radical prostatectomy is the risk of developing urinary incontinence (UI) in men. The stress urinary incontinence (SUI) following radical prostatectomy may be improved gradually in 6 to 12 months after operation. The overall incidence of SUI varies from 8% to 60% at 1 year after radical prostatectomy.  Surgical treatment can be considered if conservative treatment failed. Gold standard surgical treatment is artificial urinary sphincter. Other surgical options, including urethral bulking agents, fixed male slings, and adjustable male slings, have variable efficacy in patients with mild to moderate SUI. We aimed to report our experience of SUI treatment with re-adjustable male sling with patients who underwent radical prostatectomy.

Materials and Methods: From January 2016 to April 2020, by a single urology team, with at least 12 months follow-up, we recruited 14 men with stress urinary incontinence following robotic-assisted laparoscopic radical prostatectomy (RALRP) who were treated with re-adjustable male sling (NEOMEDIC Contasure Remeex Male Adjustable System). We evaluated the daily small pad using and uroflowmetry (UFM), preoperatively and postoperatively. The times of male sling adjustment and complications were also investigated in this study. The clinical efficacy was evaluated according to the reductions in the number of daily small pad use after male sling implantation. The results was considered a success if the patients wore no pads or used small security pads but remained dry most days, and an improvement if the number of pads needed diminished more than 50%, while a failure when reduction in the number of pads diminished less than 50%. All the statistical analysis was performed with SPSS 25.0.

Results: Among the patients, the mean age was 70.4±5.9 years, and 71.4% of cases was diagnosed of locally advanced prostate cancer. 35.7%, 57.1%, and 7.1% of the patients had continence to mild (≤2pads/day), moderate (3-5pads/day), and severe incontinence (>5pads/day), respectively. The average of daily small pad using after RALRP was 3.0±1.47 pads. After receiving re-adjustable male sling and a median follow-up of 7.5 months (range: 1-65 months) and a median adjustment of 1.2 time (range: 0-6 times), it showed a significant reduction in the number of the daily small pad using (3.0 vs 1.2; p=0.003). Maximal cystometric capacity, maximum flow rates and postvoid residual volumes were similar (p=0.484, p=0.575 and p=0.345, respectively). 8 patients (57.1%) required a second or more sling adjustment under local anesthesia. After that, 9 patients (64.3%) were considered successful; another 2 cases showed important improvement (14.3%); and 3 patients (21.4%) were considered failed. The most common complication was perineal discomfort (71.4%). Two in 14 patients had an episode of urine retention after the operation. Three patients had episode of mesh infection. In two patients, all parts of the device were removed. One had device failure (43months after the first implantation) and received reimplantation of a new re-adjustable male sling with successful outcome. The other one was complicated with infection and bowel injury caused by sling implantation, and we removed the sling immediately. After antibiotic administration and conservative treatment, he recovered smoothly. The incidence of complications graded by the Clavien-Dindo classification is 71.4% (grade I), 21.4% (grade II), 14.3% (grade IIIa) and 7.1% (grade IIIb).

Conclusions: About 71.4% of these cases is diagnosed of locally advanced prostate cancer including pT4 or pN1 stage. Our results show that the re-adjustable male sling system is an efficient surgical treatment option for post-radical prostatectomy non-severe stress urinary incontinence. Even if device failure developed, it may still reveal a satisfactory outcome after reimplantation of a new re-adjustable sling. Severe complication (greater than the Clavien-Dindo classification grade III) is rare, such as bowel injury. The most common complication is perineal discomfort. Overall, the re-adjustable male sling system is an efficient and relatively safe surgical treatment for patients suffering from non-severe stress urinary incontinence following RALRP.