Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the "gold standard" for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.
Humans ; Prostatectomy/adverse effects* ; Prosthesis Design ; Urinary Incontinence, Urge/surgery* ; Urinary Sphincter, Artificial

BACKGROUNDInside out transobturator vaginal tape (TVT-O) and tension-free vaginal tape (TVT) are predominant surgical treatments for female stress urinary incontinence. This meta-analysis evaluated the complications and cure rates of TVT-O versus TVT.

METHODSA comprehensive literature search was conducted according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials with no language restriction. Two authors independently assessed papers for eligibility and methodological quality. Estimates were measured by relative risk with 95% confidence intervals. Outcome measures were objective cure, subjective cure and complications. Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

RESULTSTwenty randomized controlled trials met the inclusion criteria, and a pooled estimate of effectiveness and complications was made. Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were: 0.20 (0.09 - 0.45), for bladder injury, 0.37 (0.16 - 0.86) for hematoma, and 2.35 (1.57 - 3.51) for postoperative pain, suggesting an 80% risk reduction of bladder injury, 63% risk reduction of hematoma, and a 1.35% risk elevation for postoperative pain with TVT-O. There was no significant difference between complications of urinary tract infection 1.14 (0.78 - 1.65), lower urinary tract symptoms 1.60 (0.67 - 3.79), recatheterization 0.93 (0.59 - 1.44), and tape erosion 0.90 (0.48 - 1.67), total objective cure rate 1.06 (0.39 - 2.84) and for the subjective cure rate 0.98 (0.93 - 1.04). The quality rating for each outcome and recommendations was high for objective cure, bladder injury, hematoma, lower urinary tract symptoms, and tape erosion and moderate for subjective cure, pain, and urinary tract infection.

CONCLUSIONSTVT-O is associated with a reduced risk of bladder injury and hematoma and an elevated risk of postoperative pain. Other complications, including tape erosion, urinary tract infection, lower urinary tract symptoms, and recatheterization, are similar to those of TVT.

Female ; Humans ; Randomized Controlled Trials as Topic ; Suburethral Slings ; Treatment Outcome ; Urinary Incontinence, Stress ; surgery ; Vagina ; surgery

Aged ; China ; Humans ; Ileum ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Urinary Bladder Neoplasms ; surgery ; Urinary Diversion ; adverse effects ; Urinary Incontinence ; diagnosis ; drug therapy ; surgery ; therapy ; Urinary Reservoirs, Continent

OBJECTIVES: To investigate the effect of progressive pre-disconnection of urethral mucosal flap during transurethral plasmakinetic enucleation of prostate (TUPEP) on early recovery of urinary continence. METHODS: Clinical data of patients with benign prostatic hyperplasia (BPH) admitted in Zhujiang Hospital of Southern Medical University during February and May 2022 were collected. All the patients underwent TUPEP, and the progressive pre-disconnection of urethral mucosal flap was performed in the procedure. The total operation time, enucleation time, postoperative bladder irrigation time and catheter indwelling time were recorded. Urinary continence was evaluated 24 h, 1 week, and 1, 3, 6 months after the removal of urinary catheter. RESULTS: All surgeries were successfully completed at one time with less intraoperative bleeding, and there were no complications such as rectal injury, bladder injury or perforation of prostate capsule. The total operation time was (62.2±6.5) min, the enucleation time was (42.8±5.2) min, the postoperative hemoglobin decrease by (9.5±4.5) g/L, the postoperative bladder irrigation time was (7.9±1.4) h, and the postoperative catheter indwelling time was 10.0 (9.2, 11.4) h. Only 2 patients (3.6%) had transient urinary incontinence within 24 h after catheter removal. No urinary incontinence occurred at 1 week, and 1, 3, 6 months after operation, and no safety pad was needed. The Qmax at 1 month after operation was 22.3 (20.6, 24.4) mL/s, international prostate symptom scores were 8.0 (7.0, 9.0), 5.0 (4.0, 6.0) and 4.0 (3.0, 4.0) at 1, 3 and 6 months after surgery, and quality of life scores at 1, 3 and 6 months after surgery were 3.0 (2.0, 3.0), 2.0 (1.0, 2.0) and 1.0 (1.0, 2.0), all of these indicators were better than those before surgery (all P<0.01). CONCLUSIONS In the treatment of BPH, the application of progressive pre-disconnection of urethral mucosal flap in TUPEP can completely remove the hyperplastic glands and promote early recovery of postoperative urinary continence with less perioperative bleeding and decreased surgical complications.
Male ; Humans ; Prostate ; Prostatic Hyperplasia/surgery* ; Transurethral Resection of Prostate/methods* ; Quality of Life ; Urinary Bladder ; Urinary Incontinence/surgery* ; Treatment Outcome

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some "high-risk" populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
Erectile Dysfunction/surgery* ; Female ; Humans ; Male ; Penile Implantation ; Prosthesis Implantation/methods* ; Reoperation ; Spinal Cord Injuries/complications* ; Urinary Bladder, Neurogenic/surgery* ; Urinary Incontinence, Stress/surgery* ; Urinary Sphincter, Artificial

OBJECTIVETo investigate the clinical efficacy, surgical indications and postoperative complications of mid urethral sling procedures in treatment of female stress urinary incontinence.

METHODSA multicenter clinical trial was conducted from April 2002 to April 2008 in five hospitals, 304 cases of genuine stress urinary incontinence and 8 cases of mixed incontinence were included. TVT procedures were carried out in 134 patients, TVTO procedures in 167 patients, Monarc procedures in 11 patients. Perioperative evaluations included: operating time, bleeding volume, and perioperative complications. Operative efficacy was classified into three categories: cure, improved and failure and evaluated before discharge, 3 months after surgery and then every year.

RESULTSTVT group had longer operating time [(18.5 + or - 9.6) min] and more bleeding volume [(32.2 + or - 12.6) ml] than those in TVTO group [(11.5 + or - 3.1) min, (12.8 + or - 8.5) ml] and in Monarc group [(11.1 + or - 2.6) min, (12.3 + or - 3.5) ml] with P < 0.05. Monarc and TVTO procedures had higher cure rates and improve rates comparing with TVT, but the differences were of no significance. The cure rate (95.7%) in patients with genuine stress incontinence were significantly higher than that in patients with mixed incontinence (37.5%). No significant differences of total intra- and postoperative complications were noted for all of the three procedures. However, bladder injury tended to occur in TVT group and obturator nerve injury and vaginal injury tended to occur in TVTO group. Transient voiding dysfunction and urinary retention were the most common complications.

CONCLUSIONSMid urethral sling procedures have excellent clinical outcomes in the treatment of female stress urinary incontinence.

Female ; Follow-Up Studies ; Humans ; Middle Aged ; Suburethral Slings ; Treatment Outcome ; Urinary Incontinence, Stress ; surgery

OBJECTIVETo investigate the value of urodynamic test in the diagnosis of postoperative incontinence after transurethral resection of the prostate(TURP).

METHODSThirty-seven patients with urinary incontinence after TURP received urodynamic tests, including cystometry(CMG), pressure-flow study, rest urethral pressure profilometry(RUPP) and stress leak-point pressure (SLPP) measurement. Urethrocystography was taken when necessary.

RESULTSOf the 37 cases, 16 were diagnosed as motor urge urinary incontinence, 2 as sensory urge urinary incontinence, 17 as stress urinary incontinence and 2 as overflow urinary incontinence.

CONCLUSIONDifferent types of urinary incontinence after TURP can be clearly distinguished by urodynamic tests, which provides objective basis for the choice of adequate treatment.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Transurethral Resection of Prostate ; Urinary Incontinence ; physiopathology ; surgery ; Urodynamics

BACKGROUNDAs the third-generation tension-free tape for female stress urinary incontinence (SUI), tension-free vaginal tape (TVT)-Secur has decreased the common complications associated with TVT and tension-free vaginal tape-transobturator (TVT-O), such as bladder perforation and obstruction of the bladder outlet; but its efficacy and persistence were still controversial. The aim of this study was to prospectively evaluate and compare the postoperative efficacy and complication at different follow-up time.

METHODSPatients with SUI, who underwent TVT-Secur treatment in two hospitals from October 2008 to October 2009, were selected. By analyzing preoperative and intraoperative data and postoperative complications, the therapeutic effect and satisfaction at different follow-up stages were evaluated.

RESULTSA total of 30 female patients participated in this study. Patients were scheduled for follow-up at the 1st month, 3rd month, 6th month and 12th month, while the cure rate was 83.3% (25 patients), 66.7% (20 patients), 63.3% (19 patients) and 60.0% (18 patients) respectively and the overactive bladder (OAB) symptoms appeared in 11 patients (36.7%), 10 patients (33.3%), 6 patients (20%) and 7 patients (23.3%) respectively.

CONCLUSIONWith the follow-up time becoming longer, TVT-Secur has a high recurrence rate of SUI, the therapeutic effect from the 3rd month to the 12th month is relatively persistent.

Female ; Humans ; Middle Aged ; Postoperative Complications ; Suburethral Slings ; adverse effects ; Treatment Outcome ; Urinary Incontinence, Stress ; surgery

OBJECTIVE: To assess the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and prostatic volume (PV) and intravesical prostatic protrusion length (IPPL) on preoperative magnetic resonance imaging (MRI). METHODS: 88 patients with pathologic confirmed prostate carcinoma who were underwent LRP were included in this study. MRI examination was performed in 1 week before the biopsy. The patients were divided into two groups according to PV (<50 mL, ≥50 mL) on preoperative MRI. The patients were divided into two groups according to IPPL (<5 mm, ≥5 mm), IPPL was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. After surgery we recorded and analyzed recovery of urinary continence of the patients for one year. RESULTS: All the 88 patients received extra-peritoneal LRP successfully. The average operation time was (155±67) min, and the estimated blood volume was (145±159) mL. There was a significant difference between group PV<50 mL and ≥50 mL in the operation time (P=0.045). All the patients who underwent MRI preoperatively showed that their mean PV was (44.54±26.58) mL and mean IPPL was (5.2±5.7) mm. The continence rate for all the patients after LRP was 53.4%, 84.1% and 94.3% in their follow-up of 3, 6 and 12 months. Three months after LRP, the continence rate for group PV<50 mL and ≥50 mL were 61.5% and 30.4%, which were completely continent (P=0.010). Six or twelve months after surgery, the continence rate was 87.7% and 73.9% (P=0.120), 96.9% and 87.0% (P=0.076) for group PV<50 mL and ≥50 mL separately. Three months after LRP, the continence rate for group IPPL<5 mm and ≥5 mm were 66.1% and 31.3%, which were completely continent (P=0.002). Six months after surgery, the continence rate was 92.6% and 68.8% (P=0.003), and one year after surgery, the continence rate was 98.2% and 87.5% for group IPPL<5 mm and ≥5 mm separately (P=0.037). There was a significant difference between group PV<50 mL and ≥50 mL in the urinary continence curve (P=0.017), and the same significant difference between group IPPL<5 mm and ≥5 mm (P=0.001). CONCLUSION The PV and IPPL on preoperative MRI were associated with significantly slower return of urinary continence, especially for early recovery (3 months) of continence after LRP.
Humans ; Laparoscopy ; Male ; Prostatectomy/adverse effects* ; Prostatic Neoplasms/surgery* ; Recovery of Function ; Urinary Incontinence

OBJECTIVE: To evaluate urinary continence recovery time and risk factors of urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RARP). METHODS: From January 2019 to January 2021, a consecutive series of patients with localized prostate cancer (cT1-T3, cN0, cM0) were prospectively collected. RARP with total anatomical reconstruction was performed in all the cases by an experienced surgeon. Lymph node dissection was performed if the patient was in high-risk group according to the D'Amico risk classification. The primary endpoint was urinary continence recovery time after catheter removal. Postoperative and pathological variables were analyzed. Continence was rigo-rously analyzed 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal. Continence was evaluated by recording diaper pads used per day, and all the patients were instructed to perform the 24-hour pad weight test until full recovery of urinary continence. The patient was defined as continent if no more than one safety pad were needed per day, or no more than 20-gram urine leakage on the 24-hour pad weight test. Time from catheter removal to full recovery of urinary continence was recorded, and risk factors influencing continence recovery time evaluated. RESULTS: In total, 166 patients were analyzed. The mean age of the enrolled patients was 66.2 years, and the median prostate specific antigen (PSA) was 8.51 μg/L. A total of 59 patients (35.5%) had bilateral lymphatic dissection, and 28 (16.9%) underwent neurovascular bundle (NVB) preservation surgery. Postoperative pathology results showed that stage pT1 in 1 case (0.6%), stage pT2 in 77 cases (46.4%), stage pT3 in 86 cases (51.8%), and positive margins in 28 patients (16.9%). Among patients who underwent lymph node dissection, lymph node metastasis was found in 7 cases (11.9%). Median continence recovery time was one week. The number of the continent patients at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 65 (39.2%), 32 (19.3%), 34 (20.5%), 24 (14.5%), and 9 (5.4%). Two patients remained incontinent 24 weeks after catheter removal. The continence rates after catheter removal at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 39.2%, 58.4%, 78.9%, 93.4%, and 98.8%, respectively. Univariate COX analysis revealed that diabetes appeared to influence continence recovery time (OR=1.589, 95%CI: 1.025-2.462, P=0.038). At the end of 48 hours, 4 weeks, 12 weeks, and 24 weeks after catheter removal, the mean OABSS score of the continent group was significantly lower than that of the incontinent group. CONCLUSION RARP showed promising results in the recovery of urinary continence. Diabetes was a risk factor influencing continence recovery time. Bladder overactive symptoms play an important role in the recovery of continence after RARP.
Aged ; Humans ; Male ; Prostatectomy ; Prostatic Neoplasms/surgery* ; Recovery of Function ; Robotics ; Treatment Outcome ; Urinary Incontinence/etiology*