Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings
DOI:
https://doi.org/10.5489/cuaj.595Abstract
Objective: Our objective was to establish the feasibility of combining
2 minimally invasive procedures in patients with failed primary
treatment (male sling) in post-prostatectomy incontinence
(PPI) patients.
Methods: From January 2007 to July 2008, 40 men with PPI were
implanted with a suburethral tape (2 patients with Seratim, 3 with
I-Stop and 35 with Advance). The median preoperative pad count
was 4 (range 2-10). Prior to sling placement, 6 patients had undergone
ProACT implantation. Of these, 4 patients required explantation
due to balloon migration and 2 patients had their balloons
kept in situ, with the balloons deflated.
Results: Twenty-five patients were socially continent at this time.
Fifteen patients (37.5%) did not improve or their improvement
was not significant. These patients had a preoperative pad count
between 7 and 10. Two of these patients had prostate adjustable
continence therapy (ProACT) systems still in place. By gradually
filling the balloons to 3 mL, both of these patients achieved complete
continence, which was maintained at a mean follow-up of
8.5 months. Three patients with prior pelvic irradiation received
an artificial urinary sphincter and achieved continence at mean
follow-up of 8.3 months. The remaining 10 patients received a
ProACT system in addition to the already implanted sling. After
appropriate healing and filling of the balloons (average balloon
volume 5 mL), all 10 patients reached complete continence; they
were pad-free at a mean follow-up of 6 months (range 3-9).
Conclusions: The combination of ProACT and a suburethral tape
was demonstrated to be a possible treatment option in recurrent
or persistent PPI.
Objectif : Notre objectif était d’établir la faisabilité d’une association
de 2 interventions minimalement invasives chez des patients ayant
subi un échec thérapeutique primaire (bandelettes sous-urétrales)
chez des patients atteints d’incontinence post- prostatectomie.
Méthodologie : De janvier 2007 à juillet 2008, on a placé une bandelette
sous-urétrale chez 40 hommes atteints d’incontinence postprostatectomie
(2 patients ont reçu le dispositif de marque Seratim,
3 patients, de marque I-Stop et 35, de marque Advance). Le nombre
médian de protections absorbantes avant l’opération était de 4 (2 à
10). Avant la mise en place de la bandelette, 6 patients avaient subi
une implantation d’un système ProACT. De ce nombre, 4 patients
ont dû se faire retirer les ballonnets en raison de leur déplacement;
chez 2 patients, les ballonnets sont restés en place mais se sont
dégonflés.
Résultats : Vingt-cinq patients présentaient une continence sociale
à ce moment. Quinze patients (37,5 %) n’ont présenté aucune
amélioration, ou une amélioration non significative. Ces patients
utilisaient de 7 à 10 protections absorbantes avant l’opération. Deux
de ces patients étaient toujours porteurs d’un système ProACT. En
remplissant graduellement les ballonnets de 3 mL, ces deux patients
ont atteint une continence totale, maintenue après un suivi moyen
de 8,5 mois. Trois patients ayant reçu antérieurement un traitement
pelvien par rayonnement ont reçu un sphincter urinaire artificiel
et ont atteint la continence après un suivi moyen de 8,3 mois.
Chez les 10 derniers patients, on a implanté un système ProACT
en plus de la bandelette déjà en place. Après un temps suffisant de
guérison et le remplissage des ballonnets (volume moyen : 5 mL),
les 10 patients ont atteint une continence complète. Ils n’avaient
plus besoin de protection absorbante après un suivi moyen de
6 mois (entre 3 et 9 mois).
Conclusions : L’association d’un système ProACT et d’une bandelette
sous-urétrale s’est révélée une option thérapeutique possible
en présence d’incontinence post-prostatectomie récurrente
ou persistante.
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