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对患者的生活质量存在显著负面影响。外科治疗方案涵盖多款男性尿道吊带术式，可调节式吊带即为其中一类。本研究旨在评估可调节式吊带治疗前列腺切除术后尿失禁的有效性与安全性，属于系统性文献综述。本研究检索了截至2018年1月的电子数据库，包括PubMed®、Embase、CENTRAL及LILACS，检索策略采用的关键词为："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）]。纳入研究的标准为：随机对照试验与观察性研究（无论是否设置对照组），且随访时长超过12个月。本研究仅纳入1项偏倚风险较高的随机对照试验，该试验得出可调节式吊带与不可调节式吊带疗效等效的结论；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，部分患者存在盆腔放射治疗史与既往手术史。针对24小时内无需使用尿垫的患者的荟萃分析显示，治疗有效率为53%；针对24小时内使用0~1片尿垫的患者的荟萃分析显示，治疗有效率为69%。手术失败的危险因素包括既往放射治疗史、前列腺切除术后尿失禁的严重程度以及既往手术史。针对吊带脱出率的荟萃分析显示，脱出率为9.8%；最常见的不良反应为疼痛与局部感染。现有低等级证据表明，可调节式吊带可有效治疗前列腺切除术后尿失禁，其不良反应发生率与公认金标准术式（人工尿道括约肌植入术）相当。