INTRODUCTION: With the increasing number of radical prostatectomies (RP) performed, male stress urinary incontinence (SUI) has become common.
The artificial urinary sphincter (AUS) is the gold standard to treat SUI post-RP, but new devices have recently been developed. We review the recent studies on the treatment of SUI post-RP; we also describe the surgical techniques, mechanisms of action and results of these new procedures.
METHODS: We conducted a literature review search in the PubMed/Medline and Embase databases. Our search was restricted to recent articles. We included studies even if the urinary incontinence was due to sphincter deficiency after RP in non-neurologic patients.
RESULTS: We found 8 cohort studies for the surgical procedure: 3 studies concerning slings, 1 involving balloons adjustable implant, and 4 involving new devices. The only randomized controlled trial (RCT) was a pharmacologic clinical trial comparing duloxetine to placebo. The social continence rates were analyzed for 6 studies and were up to 66%.
CONCLUSION: New minimally invasive surgical procedures have emerged as the main alternative to AUS, with social continence rates up to 60% despite just 1 RCT studying the pharmacologic approach. There is an urgent need for well-designed clinical trials to clarify the role of new surgical alternatives in the management of SUI post-RP. New technologies should continue to be evaluated and compared with the AUS, which remains the gold standard.
Written by:
Caremel R, Corcos J. Are you the author?
Department of Urology, Jewish General Hospital, McGill University, Montreal, QC.
Reference: Can Urol Assoc J. 2014 May;8(5-6):202-12.
doi: 10.5489/cuaj.1349
PubMed Abstract
PMID: 25024791
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