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不成功治療效果之風險因子分析

邱亮維、黃志平

中國醫藥大學附設醫院 泌尿部

Risk factors of unsuccess outcome of the re-adjustable male sling system for stress urinary incontinence following radical prostatectomy

Liang-Wei Chiu, Chi-Ping Huang

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

Purpose: The stress urinary incontinence (SUI) following radical prostatectomy (RP) is a has a negative effect on the quality of life for prostate cancer patients. The rate of SUI after RP ranges from 1 to 40%. After pelvic floor muscle training and medical therapy fail, adjustable male slings might be considered, but they have variable efficacy in patients with mild to moderate SUI. Therefore, we aimed to analyze the risk factors of unsuccess outcome in patients undergoing re-adjustable male sling system for SUI following RP.

Materials and Methods: In this study, 22 patients from a single medical center in Taiwan with SUI at least one year after RP between January 2016 and September 2022, were retrospectively analyzed. They were treated with re-adjustable male slings (NEOMEDIC Con-tasure Remeex Male Adjustable System). The severity of their SUI was defined as either mild (≤ 2pads/day), moderate (3-5 pads/day), or severe (> 5pads/day). At least 7 months after the operation for re-adjustable male sling implantation, we evaluated the clinical efficacy which was defined by a reduction in the number of daily pads used after male sling implantation. The operation was considered a success if the patient wore no pads or used security pads but remained dry most days. The condition was considered improved if the number of daily pads used decreased by > 50%, while the operation was considered un-successful if the number of daily pads used decreased by < 50%. All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25.0

Results: Among the patients, the mean age was 70.4 ± 5.9 years. Mild, moderate, and severe SUI were reported as 4.6%, 5.1%, and 0.5%, respectively. The average daily pad use after RP was 3.2 pads before the first sling procedure. The average time after the RP until the sling operation was performed was 21.6 ± 11.8 months (ranged from 12 to 50 months). Re-adjustable male sling implantation was reported as successful in 15 patients (68.2%); 1 other case had improvement (4.5%); while 6 patients (27.3%) were considered unsuccessful. Surgery without neurovascular bundle-sparing (p=0.017), and prostate specimen weight more than 65gm (p=0.018) increased the risks of an unsuccess outcome in patients undergoing re-adjustable male sling system for SUI following RP. Notably, the severity of SUI following RP did not increased the risks of unsuccess outcome. In the severe incontinence subgroup (4 patients), three (75%) had improvement or success. No statistically significant correlation was found with other variables, such as age, BMI, diabetes mellitus, operation history of TURP, clinical T stage or pathologic T stage.