Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis

ABSTRACT Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: “prostatectomy” [Mesh], “urinary incontinence” [Mesh] and “suburethral slings” [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).

摘要 前列腺切除术后尿失禁会对患者的生活质量造成显著负面影响。手术治疗方案涵盖多种男性尿道悬吊术式，其中包括可调式尿道悬吊术（adjustable slings）。本研究旨在评估可调式尿道悬吊术治疗前列腺切除术后尿失禁的有效性与安全性。本研究为系统性文献综述，截至2018年1月，我们检索了PubMed®、Embase、CENTRAL及LILACS等电子数据库。检索策略使用的关键词为：「前列腺切除术」[医学主题词（MeSH）]、「尿失禁」[医学主题词（MeSH）]及「尿道下吊带术」[医学主题词（MeSH）]。纳入研究类型包括随机临床试验与观察性研究，无论是否设置对照组，且随访时长需超过12个月。最终仅纳入1项偏倚风险较高的随机对照研究，该研究得出结论：可调式与不可调式尿道悬吊术的疗效相当。其余所有研究均为病例系列研究，纳入患者的尿失禁严重程度不一，且部分患者存在盆腔放疗史与既往手术史。针对24小时内无需使用尿垫的疗效评估，荟萃分析结果显示有效率为53%；针对24小时内使用0~1片尿垫的疗效评估，荟萃分析结果显示有效率为69%。手术失败的危险因素包括既往盆腔放疗史、前列腺切除术后尿失禁严重程度，以及既往手术史。针对尿道悬吊物脱出率的荟萃分析结果为9.8%，最常见的不良反应为疼痛与局部感染。低等级证据表明，可调式尿道悬吊术可有效治疗前列腺切除术后尿失禁，其不良反应发生率与被视为金标准的手术方案——人工尿道括约肌植入术（artificial urinary sphincter implant）——相当。