Prise en charge d’une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 – 3/5) : place des ballons périurétraux et des bandelettes sous uréthrales

Abstract

The treatment of incontinence is changing. Perineal rehabilitation still plays an essential role, but new modalities are now available with promising results, particularly periurethral balloon and suburethral tape, which may be indicated after failure of well-conducted perineal rehabilitation and before artificial sphincter. Periurethral balloons consist of two silicone balloons filled with a mixture of saline and radiopaque agent inserted transperineally on either side of the urethra as close as possible to the bladder neck. Titanium ports connected to each balloon allow adjustment of the volume contained in the balloon at any time after surgery. This technique appears to be promising but further studies are required to clearly define many unresolved issues, including results based on longer follow-up and patient selection according to the severity of incontinence or their treatment history (radiotherapy). Suburethral tape is used to exert permanent static compression of the urethra and was still under development in 2006. Fairly heterogeneous materials are used and no consensus on this issue has yet been reached. Follow-up is still relatively short and few studies have addressed the problem of patient selection. Some authors consider that the best indication is mild-to-moderate incontinence, which has not yet been clearly defined.