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Neurourol Urodyn. 2018 Aug;37(6):1978-1987. doi: 10.1002/nau.23543. Epub 2018 Mar 5.

Factors contributing to treatment outcomes of post-prostatectomy incontinence surgery for the selection of the proper surgical procedure for individual patients: A single-center experience.

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1
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Abstract

OBJECTIVES:

To investigate the clinical and urodynamic parameters affecting the treatment outcomes of post-prostatectomy incontinence (PPI) surgery.

PATIENTS AND METHODS:

We reviewed the patients with PPI who received an artificial urinary sphincter (AUS) or adjustable male sling (MS) from 2001 to 2016.

RESULTS:

A total of 103 patients (AUS, 53; adjustable MS, 50) with a mean age of 69.9 (±5.6, standard deviation) years were analyzed. The mean number of pads used daily was 4.8 (±3.4). The mean symptom duration and follow-up duration were 46.9 (±31.1) and 31.0 (±21.4) months, respectively. The overall rate of treatment success (≤1 pad per day at last follow-up) at 12 months postoperatively was 81.6%. Based on univariate analysis, previous pelvic irradiation (P = 0.013), prior PPI surgery (P = 0.017), and degree of incontinence (P = 0.010) were inversely associated with the success of PPI surgery. In patients who received AUS, history of neurologic disease (P = 0.038) was inversely associated with treatment success. However, in patients with an adjustable MS, previous pelvic irradiation (P = 0.001), prior PPI surgery (P = 0.022), and degree of incontinence (P = 0.008) were inversely associated with treatment success.

CONCLUSIONS:

Adjustable MS should be avoided in patients with previous pelvic irradiation, prior PPI surgery, or severe symptoms. Physicians should be aware that the treatment outcome of AUS might be compromised in patients with neurologic disease.

KEYWORDS:

artificial urethral sphincter; incontinence; post-prostatectomy incontinence; predictive model; sling surgery; treatment outcome

PMID:
29504655
DOI:
10.1002/nau.23543

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