尿道下吊帶手術治療男性神經性及非神經性應力性尿失禁的療效

黃子修、張天霖、楊家誠、劉民慶、江元宏、張嘉峰、郭漢崇

花蓮慈濟醫院 泌尿部

Therapeutic Efficacy of Suburethral Sling in Treatment of Neurogenic and Non-neurogenic Stress Urinary Incontinence in Men

Tsu-Hsiu Huang, Tien-Lin Jhang, Chia-Cheng Yang, Min-Ching Liu, Yuan-Hong Jiang, Jia-Fong Jhang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

Purpose: Stress urinary incontinence (SUI) in men is usually secondary to prostatectomy or neurological lesions. We present our experiences of male suburethral sling in treatment of male SUI.

Materials and Methods: We retrospectively included patients with post-prostatectomy incontinence (PPI, n=) and neurogenic lesion causing urethral sphincter insufficiency (NSUI, n=26) who were treated with a suburethral sling procedure using a polypropylene mesh with cardiovascular patch reinforcement from Dec 2005 to Aug 2023. In PPI patients, retrograde leak point pressure (RLPP) was set at 50-60 cmH2O depending on baseline voiding detrusor pressure. (Figure 1) In NSUI patients, the RLPP was adjusted to no urine leakage without interfering catheterization. Treatment outcome was defined as successful if the patient was free of SUI or very mild SUI (< 1 pad/day). Patients with mild to severe SUI were considered failure. The revision rate and the infection rate were also evaluated.

Results: A total 44 patients with PPI (33 prostate cancer [CaP] and 11 post-TURP) and 26 NSUI patients (12 SCI, 8 MMC, 6 post radical pelvic surgery) were enrolled. A overall success rate was noted in 37 (52.9%) patients, mild SUI in 17 (24.3%), and failure in 16 (22.9%). Success rate was 56.8% in patients with PPI (51.5% in CaP and 72.7% in TURP) and 46.2% in NSUI (p=0.461). Between patients with successful and failed treatment outcome, a higher abdominal LPP at baseline was associated with successful outcome compared with failure outcome (88.2±36.3 vs 65.3±37.7 cmH2O, P=0.048) in PPI patients. However, there was no difference in urodynamics parameters between successful and failure subgroup in NSUI patients. (Table 1)

Conclusions: The suburethral sling procedure using a polypropylene mesh with a cardiovascular patch is safe and efficacious for male SUI. The success rate was higher in patients with TURP and less favorable for NSUI, although it did not reach a statistical significance. Among pre-operative urodynamic parameters, a higher ALPP is associated with a successful outcome.

Figure 1. The male suburethral sling. (A) Dissecting bulbous urethra to identify pubic rami and isolate the urethra from central tendon. (B) Suture a double layer polypropylene mesh tightly to inferior pubic rami and inserting several layers of cardiovascular patch to enhance the compression to the bulbous urethra. (C) Check the external urethral sphincter with a flexible cystoscope and adjust the layers of cardiovascular patch to reach a 50-60 cmH2O of retrograde leak point pressure without compromising urethral catheterization.

1.                 (B)                         (C)

Table 1. The urodynamic parameters between successful and failure subgroups in patients with post-prostatectomy incontinence (PPI) and neurogenic stress urinary incontinence (NSUI)

CBC: cystometric bladder capacity, cQmax: contracted maximal flow, VE: voiding efficiency, BOOI: bladder outlet obstruction index, BCI: bladder contractility index, ALPP: abdominal leak point pressure