ABSTRACT
Objective:
To evaluate the long-term
efficacy of AdVance sling bulbar urethral
suspension and artificial
urethral sphincter (AUS) implantation in the
treatment of moderate to severe
male stress
urinary incontinence.
Methods:
The clinical data of 12
male patients with
urinary incontinence who underwent surgical
treatment in
Peking University People's
Hospital from June 2011 to June 2017 were retrospectively analyzed. The median age was 75(64-80) years. There were 9 cases after radical
prostatectomy and 3 cases after
transurethral prostatectomy.
Patients had a median
history of
urinary incontinence of 3(1-9) years, and needed an average of 8(5-10) pads per day. Among them, 5
patients had moderate
urinary incontinence and 7
patients had severe
urinary incontinence. All
patients underwent
urinary incontinence surgery for the first
time. Among the 12
patients, 6 received AdVance sling ball urethral
suspension (AdVance group), and 6 received AUS implantation (AUS group). The median age of the AdVance group was 72 (64-73) years. The median number of pads used daily was 6 (5-8)
tablets.
Urinary incontinence Quality of Life questionnaire (I-QOL) score was (15.0±5.4). Five
patients had moderate
urinary incontinence and one
patient had severe
urinary incontinence. In the AUS group, the median age was 78(76-80) years old, the median daily pad use was 8(6-10)
tablets, and the I-QOL score was (16.7±5.1), all of which were severe
urinary incontinence. The daily pad usage, I-QOL and
postoperative complications were recorded at 1 and 5 years after operation.
Results:
All
patients completed the operation successfully. The postoperative follow-up was 5-7 years (mean 5.5 years). In AdVance group, 1
patient with severe
urinary incontinence had no significant improvement in postoperative symptoms at 1 year after operation. The other 5
patients showed significant improvement in
urinary incontinence symptoms. In the AdVance group, the median number of pads used per day was 2.5 (1-10), and the I-QOL score was (75.0±28.1), which were all significantly improved compared with that before operation ( P<0.05). The median number of pads used per day in the AdVance group 5 years after operation was 2.5(1-10), and the I-QOL score was (78.3±29.3), which were significantly improved compared with those before operation (all P<0.01). In the AUS group, no pad was needed at 1 year after operation, which was significantly improved compared with that before operation ( P<0.01). Urethral
erosion occurred in 2 cases 3 years after operation, and the AUS was removed.
Urinary incontinence recurred and returned to the preoperative
state without
reoperation. The other 4 cases did not need to use the pad 5 years after operation. In AdVance group, 3
patients had perineal
pain within 3 months after operation, which was related to activity and relieved spontaneously. No
wound infection, urethral
erosion and other
complications occurred. Urethral
erosion occurred in 3 cases in AUS group.
Conclusions:
AdVance sling ball urethral
suspension is effective for
patients with moderate stress
urinary incontinence and has fewer
complications. AUS implantation is effective for
patients with severe
male stress
urinary incontinence. However, the long-term
complications of this operation may
affect the postoperative
efficacy.