Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation [Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice]
DEWANDRE, Manon; Waltregny, David; de Leval, Jeanet al.
Male sling; Mechanism of action; Post-radical prostatectomy urinary incontinence; Urodynamics
Abstract :
[en] Introduction: The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. Patients and methods: In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). Results: Urodynamic studies were performed after a median time of 9 months (min 4 – max 34) following sling implantation. Postoperatively, a rise of 11 cm H2O in median MUCP (P = 0.09) and an increase of 14 mm in median FUL (P = 0.13) were observed. None of the urodynamic changes was statistically significant. Conclusions: Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. Level of evidence: 4.
Research center :
Service d'Urologie
Disciplines :
Urology & nephrology
Author, co-author :
DEWANDRE, Manon ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service d'urologie
Waltregny, David ; Université de Liège - ULiège > Département des sciences cliniques > Urologie
de Leval, Jean ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
LERUTH, Julie ; Centre Hospitalier Universitaire de Liège - CHU > Département de chirurgie > Service d'urologie
Language :
French
Title :
Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation [Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice]
Alternative titles :
[en] Évaluation urodynamique de patients guéris d’incontinence urinaire d’effort post-prostatectomie radicale après implantation d’une bandelette sous-urétrale transobturatrice
Publication date :
October 2019
Journal title :
Progrès en Urologie
ISSN :
1166-7087
eISSN :
2405-5131
Publisher :
Elsevier Masson SAS
Volume :
29
Pages :
1041-1046
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Introduction. — Le(s) mécanisme(s) responsable(s) de la restauration de la continence par implantation de bandelette sous-urétrale (BSU) pour incontinence urinaire post-prostatectomie radicale sont imparfaitement connus. Le but de cette étude a été d’évaluer les paramètres uro- dynamiques avant et après implantation d’une BSU uniquement chez des patients guéris de leur incontinence.
Patients et méthodes. — Au total, 10 patients continents après implantation d’une BSU transobturatrice, sans antécédent de sténose urétrale ou d’irradiation pelvienne, ont été sélectionnés pour exploration urodynamique de manière aléatoire à partir d’une base de données. Les para- mètres analysés ont inclus la profilométrie urétrale, avec mesure de la pression de clôture urétrale maximale (PCUM) et de la longueur urétrale fonctionnelle (LUF), et ont été comparés à ceux obtenus en préopératoire. Les échantillons appariés ont été comparés grâce au test des rangs signés de Wilcoxon (StatPlus®).Résultats. — Les explorations urodynamiques ont été conduites après un délai médian de 9 mois (min 4 — max 34) suivant l’implantation d’une BSU. En postopératoire, une augmentation de 11cm H2O de la PCUM médiane (p=0,09) et une augmentation de 14mm de la LUF médiane (p=0,13) ont été observées. Aucune des modifications urodynamiques n’a été statistiquement significative.
Conclusions. — Après BSU, des modifications de la profilométrie urétrale sont observées, avec augmentations de la PCUM et de la LUF mais sans que celles-ci ne soient statistiquement signi- ficatives. Les limitations de notre étude incluent les biais inhérents à l’interprétation et la reproductibilité de la profilométrie urétrale, le nombre d’échantillons analysés, et le délai variable entre BSU et évaluation urodynamique postopératoire.
Niveau de preuve.— 4.
Hennessey, D.B., Hoag, N., Gani, J., Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence—a review. Transl Androl Urol 6:S2 (2017), S103–S111.
Heesakkers, J., Farag, F., Bauer, R.M., Sandhu, J., De Ridder, D., Stenzl, A., Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71:6 (2017), 936–944.
Sahai, A., Abrams, P., Dmochowski, R., Anding, R., The role of male slings in post prostatectomy incontinence: ICI-RS 2015. Neurourol Urodyn 36:4 (2017), 927–934.
Doudt, A.D., Zuckerman, J.M., Male slings for post-prostatectomy incontinence. Rev Urol 20:4 (2018), 158–169.
de Leval, J., Waltregny, D., The inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence. Eur Urol 54:5 (2008), 1051–1065.
Leruth, J., Waltregny, D., de Leval, J., The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. Eur Urol 61:3 (2012), 608–615.
Montague, D.K., Male slings: compressive versus repositioning. Eur Urol 56:6 (2009), 934–935.
Rehder, P., Gozzi, C., Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol 52:3 (2007), 860–867.
Davies, T.O., Bepple, J.L., McCammon, K.A., Urodynamic changes and initial results of the advance male sling. Urology 74:2 (2009), 354–357.
Soljanik, I., Becker, A.J., Stief, C.G., Gozzi, C., Bauer, R.M., Urodynamic parameters after retrourethral transobturator male sling and their influence on outcome. Urology 78:3 (2011), 708–712.
Paiva, O.G., Lima, J.P.C., Bezerra, C.A., Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence. Int Braz J Urol 44:3 (2018), 536–542.
Horstmann, M., Fischer, I., Vollmer, C., Horton, K., Kurz, M., Padevit, C., et al. Pre- and postoperative urodynamic findings in patients after a bulbourethral composite suspension with intraoperative urodynamically controlled sling tension adjustment for postprostatectomy incontinence. Urology 79:3 (2012), 702–707.
Soljanik, I., Solyanik, O., Stief, C.G., Bauer, R.M., Becker, A.J., Gozzi, C., et al. The extent of changes in the membranous urethra angle is associated with the outcome of retrourethral transobturator sling procedure. Int Urol Nephrol 47:2 (2015), 249–255.
Kahokehr, A.A., Selph, J.P., Belsante, M.J., Bashir, M., Sofue, K., Tausch, T.J., et al. Mechanism of action of the transobturator sling for post-radical prostatectomy incontinence: a multi-institutional prospective study using dynamic magnetic resonance imaging. Urology 116 (2018), 185–192.
Horstmann, M., John, H., Horton, K., Graf, N., Reischauer, C., Doert, A., et al. Comparison of standardized pre- and postoperative functional pelvic cine-MRI in patients with a bulbourethral composite suspension due to post-prostatectomy incontinence. Int Urol Nephrol 45:4 (2013), 967–973.
Kaufman, J.J., Treatment of post-prostatectomy urinary incontinence using a silicone gel prosthesis. Br J Urol 45:6 (1973), 646–653.
Madjar, S., Jacoby, K., Giberti, C., Wald, M., Halachmi, S., Issaq, E., et al. Bone anchored sling for the treatment of post-prostatectomy incontinence. J Urol 165:1 (2001), 72–76.
