Kathrin Meisterhofer1, Sereina Herzog2, Karin A Strini1, Luca Sebastianelli3, Ricarda Bauer4, Orietta Dalpiaz5. 1. Department of Urology, Medical University of Graz, Graz, Austria. 2. Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria. 3. Department of Neurorehabilitation, Research Unit for Neurorehabilitation South Tyrol, Hospital of Vipiteno, Vipiteno, Italy. 4. Department of Urology, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany. 5. Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: orietta.dalpiaz@gmail.com.
Abstract
CONTEXT: Male slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model. OBJECTIVE: To evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence. EVIDENCE ACQUISITION: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords "incontinence," "prostatectomy," and "male sling/system" was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients' quality of life. EVIDENCE SYNTHESIS: The literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45-0.56, I2=82%). Subjective cure was achieved in 33-94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51-0.71, I2=88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings. CONCLUSIONS: Both fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed. PATIENT SUMMARY: Fixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
CONTEXT: Male slings are recommended by the European Association of Urology guideline for the treatment of mild to moderate postprostatectomy incontinence. However, none of them has been proved to be superior to the others, and there are no defined guidelines to preference of a given sling model. OBJECTIVE: To evaluate and compare the efficacy and safety of the different types of male slings in the treatment of postprostatectomy incontinence. EVIDENCE ACQUISITION: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A systematic literature search in the databases of PubMed, Embase, and Cochrane using the keywords "incontinence," "prostatectomy," and "male sling/system" was conducted in June 2018. Studies in English with at least 15 patients and a minimum follow-up of 12 mo were included. As the primary endpoint, we assessed the cure rate of the different sling types. As secondary endpoints, we assessed the improvement rate, subjective cure rate, overall complication rate, explantation rate, risk factors for failure, and effect on patients' quality of life. EVIDENCE SYNTHESIS: The literature search identified 833 articles. A total of 64 studies with 72 patient cohorts were eligible for inclusion. Fixed slings were implanted in 55 (76.4%) of the patient cohorts. The objective cure rate varies between 8.3% and 87% (pooled estimate 0.50, 95% confidence interval [CI] 0.45-0.56, I2=82%). Subjective cure was achieved in 33-94.4%. Adjustable slings showed objective cure rates between 17% and 92% (pooled estimate 0.61, 95% CI 0.51-0.71, I2=88%). The subjective cure rate varies between 28% and 100%. In both types of slings, pain was the most common complication, but chronic painful conditions were really rare (1.3% in fixed slings and 1.5% in adjustable slings). The most common complication after pain was urinary retention in fixed slings, and infection and consequential explantation in adjustable slings. CONCLUSIONS: Both fixed and adjustable slings are beneficial for the treatment of postprostatectomy incontinence. Although adjustable slings might lead to higher objective cure rates, they might be associated with higher complication and explantation rates. However, at present, due to significant heterogeneity of the data, this cannot be said with certainty. More randomized controlled trials with long-term follow-up and the same definition for continence are needed. PATIENT SUMMARY: Fixed and adjustable slings are effective treatment options in mild to moderate postprostatectomy incontinence.
Authors: Javier C Angulo; Sonia Ruiz; Martín Lozano; Ignacio Arance; Miguel Virseda; David Lora Journal: World J Urol Date: 2020-06-11 Impact factor: 4.226
Authors: Hanson Zhao; Colby P Souders; Paige K Kuhlmann; Kai Dallas; Karyn Eilber; Jennifer T Anger Journal: Int Neurourol J Date: 2021-05-05 Impact factor: 2.835
Authors: Fabian Queissert; Keith Rourke; Sandra Schönburg; Alessandro Giammò; Andreas Gonsior; Carmen González-Enguita; Antonio Romero; Andres J Schrader; Francisco Cruz; Francisco E Martins; Juan F Dorado; Javier C Angulo Journal: J Clin Med Date: 2021-12-24 Impact factor: 4.241
Authors: Emily M Yura; Christopher J Staniorski; Jason E Cohen; Liqi Chen; Ashima Singal; Francisco E Martins; Matthias D Hofer Journal: J Clin Med Date: 2021-12-13 Impact factor: 4.241