RESUMEN

BACKGROUND: The male sling has emerged as a minimally invasive option for incontinence after prostate treatment (IPT) in recent years, but it has not yet been introduced into China. This study retrospectively evaluated the clinical outcomes of the modified female mid-urethral sling in the treatment of IPT and explored potential preoperative factors to better predict surgical outcomes. METHODS: From May 2014 to January 2021, a total of 70 patients with IPT who underwent transobturator male sling procedure using the modified female mid-urethral sling were retrospectively reviewed. All surgeries were performed by a single surgeon. Functional outcomes were evaluated by daily pad usage, and the severity of incontinence was classified as mild (≤2 pads), moderate (3-4 pads), or severe (≥5 pads). Success was defined as no pad usage or 1 pad for safety (cure), or a reduction in daily pad use by >50% (improved). Patients were followed up at 3, 6 months, and yearly thereafter. RESULTS: At a final follow-up of 6-80 months, 35 (50.0%) patients were cured, 12 (17.1%) were improved, and 23 (32.9%) were still incontinent. There was a slight trend of declining continence over time, and the majority of patients remained improved. During follow-up, 25 patients had perineal or scrotal pain, five patients had voiding difficulty and two had de novo urgency, one developed infection and underwent sling explantation. Early urinary retention was the only significant factor linked to better surgical outcomes. CONCLUSION: The modified female mid-urethral sling represents a viable option for the treatment of IPT. Improved efficacy is seen in patients with a history of early postoperative urinary retention.

Asunto(s)

Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo , Incontinencia Urinaria , Retención Urinaria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Próstata , Prostatectomía/métodos , Estudios Retrospectivos , Cabestrillo Suburetral/efectos adversos , Resultado del Tratamiento , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugía , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Esfuerzo/cirugía , Retención Urinaria/etiología , Retención Urinaria/cirugía

RESUMEN

OBJECTIVE: To observe the clinical significance of modified sling in the treatment of moderate stress urinary incontinence (SUI). METHODS: From January 2016 to January 2019, eighty patients with moderate urinary incontinence who were hospitalized in our hospital were randomly divided into two groups. 40 patients in the experimental group underwent modified sling transvaginal tension-free mid-urethral suspension. Modification method of the sling: cut the sling to a remaining length of about 6~7cm, properly connect the barbed sutures (V-LOCK) on both sides of the sling, and insert the urinary incontinence sling from the urethra to the obturator membrane, from the obturator membrane to the thigh. The inner skin area is replaced by the V-LOCK line. The 40 patients in the control group were unmodified ordinary slings. The operation time, the local pain of the inner thigh after the operation, and the improvement of postoperative urinary incontinence symptoms were compared and analyzed between the two groups. RESULTS: Both groups of patients were successfully operated. The operation time was 16.36 minutes in the experimental group and 27.18 minutes in the control group. The difference in operation time between the two groups was statistically significant (p=0.00); the catheter was pulled out on the third day after the operation. One patient in the group had urinary effort, four patients still had urinary incontinence symptoms, the remaining 35 patients had good urinary control (effective rate 87.5%), five patients in the control group still had urinary incontinence, two patients had urinary effort, and the remaining 33 patients had urinary control Good, (effective rate 87.5%), there was no significant difference in surgical effectiveness between the two groups (p=0.53); follow-up for 12 to 36 months, no significant long-term complications occurred, the pain score of the inner thigh of the experimental group was significantly lower than that of the control group ,statistically significant (p=0.04). CONCLUSION: The efficacy of the modified sling in the treatment of moderate SUI is the same as that of the traditional sling, but the operation time is shorter, the operation is simpler, and the local pain is significantly reduced.