Podium 01
攝護腺切除術後尿失禁病人使用男性吊帶手術與人工括約肌手術之治療結果比較
徐震翰1、林志杰1、林登龍1、范玉華1、顧明軒1、黃逸修1、
台北榮民總醫院泌尿部1
Comparative Outcomes of Male Sling and Artificial Urinary Sphincter for Post-Prostatectomy Incontinence
Chen-Han Hsu1, Chih-Chieh Lin1, Alex T.L. Lin1, Yu-Hua Fan1,
Ming-Hsuan Ku1, Eric Yi-Hsiu Huang1
Department of Urology, Taipei Veterans General Hospital1,
Introduction:
Post-prostatectomy incontinence (PPI) remains a challenging complication after radical prostatectomy. Both male sling and artificial urinary sphincter (AUS) are established surgical options, but comparative data on efficacy and safety remain limited. This study aimed to compare functional outcomes and complications between male sling and AUS procedures, and to explore predictive factors associated with surgical success.
Materials and Methods:
We retrospectively reviewed 27 male patients with post-prostatectomy incontinence who underwent adjustable sling (n=12) or AUS implantation (n=15) between 2015 and 2024 at a single institution. Baseline characteristics, urodynamic variables and clinical data (radiotherapy history, preoperative pad/day) were analyzed. Surgical success was defined as ≥50% reduction in pad/day at follow-up. Comparisons between groups were performed using Fisher’s exact test, t-test, or Mann–Whitney U test as appropriate. Logistic regression and interaction models were applied to identify predictors and potential differential benefit between sling and AUS.
Results:
Success rates were 50.0% for sling and 60.0% for AUS (p=0.707). Average preoperative and postoperative pad use significantly decreased in both groups (sling: 3.3→1.8 pads/day; AUS: 4.3→2.1 pads/day), with no significant difference in the magnitude of improvement between groups (p=0.198). However, complications were more frequent with AUS: 53.3% vs 8.3% for sling (p=0.019). On univariate and multivariate logistic regression, no single urodynamic parameter (VLPP, MBC, PdetQmax, Qmax, PVR, FD, or DU) independently predicted success (all p>0.1).
Conclusions:
Both AUS and male sling achieved meaningful improvement in post-prostatectomy incontinence, with similar overall success rates. AUS tended to yield slightly higher continence rates but was associated with a substantially higher complication rate. Although no specific clinical or urodynamic characteristic could predict surgical success between the two procedures, this may be related to the relatively small sample size. These findings highlight the crucial balance between efficacy and safety that should guide individualized surgical decision-making in managing post-prostatectomy incontinence.