Treatment Of Post-prostatectomy Incontinence Research Articles

MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyCME1 Apr 2023MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE? Pin Chun Liu, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Hsu, and Min-Che Tung Pin Chun LiuPin Chun Liu More articles by this author , Yi-Sheng LinYi-Sheng Lin More articles by this author , Yen-Chuan OuYen-Chuan Ou More articles by this author , Chao-Yu HsuChao-Yu Hsu More articles by this author , and Min-Che TungMin-Che Tung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-prostatectomy incontinence (PPI) is a bothersome complication after receiving radical prostatectomy. Incontinence may significantly interfere with quality of life and increase activity dependency. Functional electrical stimulation (FES) is one of the treatment tools of urinary incontinence. FES is the only conservative management in Taiwan National Health Insurance. The aim of this study was to analyze the effectiveness of FES in PPI treatment. METHODS: Patients who received robotic-assisted radical prostatectomy between 2019 to 2022 with complications of PPI were enrolled. The patient received FES twice every week (one course). Urinary distress inventory, short form (UDI-6), overactive bladder symptom score (OABSS) and Incontinence Impact Questionnaire, Short Form (IIQ-7) were applied for incontinence symptoms assessment and quantification. Measurements were obtained before and after 3 courses of FES treatment. Pre-FES and post-FES scores were collected and analyzed by pair sample T-test. RESULTS: Questionnaire data of 33 patients with PPI were collected in this study. No complication was noted during the whole treatment course of FES. Bothersome questionnaire scores significantly improved at follow up when compared to the baseline. The average score of OABSS (10.8 to 8.48, p=0.00017) and UDI-6 (8.18 to 5.65, p=0.00026) both got significant reductions. But there is no difference between pre and post-FES IIQ-7 score (10.26 to 8.46, p=0.09). CONCLUSIONS: Our study revealed the incontinence symptoms improvement after receiving functional electrical stimulation therapy. Functional electrical stimulation is a safe and effective treatment for post-prostatectomy incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1021 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pin Chun Liu More articles by this author Yi-Sheng Lin More articles by this author Yen-Chuan Ou More articles by this author Chao-Yu Hsu More articles by this author Min-Che Tung More articles by this author Expand All Advertisement PDF downloadLoading ...

Therapeutic Efficacy and Mid-Term Durability of Urethral Sphincter Platelet-Rich Plasma Injections to Treat Postprostatectomy Stress Urinary Incontinence.

Platelet-rich plasma (PRP) is used for tissue repair and regeneration. Herein, we investigated the therapeutic efficacy and mid-term durability of injections of PRP into the urethral sphincter for the management of postprostatectomy incontinence (PPI). Thirty-nine patients with PPI that were refractory to conservative treatments were prospectively enrolled. They received repeated PRP urethral sphincter injections monthly for a total of four months. The primary endpoint was the Global Response Assessment (GRA) score after treatment. The secondary endpoints included changes in the stress urinary incontinence (SUI) visual analog scale (VAS) from baseline to the end of follow-up and urodynamic parameters from baseline to 3 months. The mean follow-up period after the entire treatment course was 21.0 ± 11.3 (range: 1.6–36.3) months. After PRP injections, the median GRA score with quartiles was 2.0 (1.0, 2.0). The SUI VAS and abdominal leak point pressure significantly improved from 6.9 ± 1.8 to 4.4 ± 2.3, p < 0.001, and from 74.8 ± 37.0 to 115.5 ± 57.9 cmH2O, p = 0.004, respectively, after the fourth PRP urethral sphincter injection. Following PRP urethral sphincter injections, the severity of SUI significantly reduced, indicating efficacy and mid-term durability as a novel treatment for PPI.

Acupuncture for prostatectomy incontinence: study protocol for a multicenter single-blind randomized parallel controlled trial

BackgroundUrinary incontinence is a common complication post radical prostatectomy. Acupuncture is considered an effective treatment for post-prostatectomy incontinence (PPI), but the evidence is still limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial.MethodsTwenty hospitals will recruit 340 participants with urinary incontinence after radical prostatectomy in China from April 2021 to April 2022. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The study plan consists of 1-week baseline, 6-week treatment, and 18-week follow-up. Eighteen 30-min sessions of acupuncture or sham acupuncture treatment will be provided between weeks 1 and 6. The primary outcome is the change in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score at the week 6 from the baseline. Secondary outcomes include the change in volume of urine leakage at weeks 4 and 6 from a baseline measured using the 1-h pad test; 72-h incontinence episode frequency based on a 72-h voiding diary; change in the Expanded prostate cancer Index Composite scale (EPIC-26); change in the Self-Rating Anxiety Scale; weekly consumption of pads; and the severity of urinary incontinence based on a 72-h bladder diary and self-assessment of the therapeutic effect. The safety of acupuncture will also be assessed.DiscussionThis trial will help to identify whether acupuncture is effective for PPI, and, if so, whether it exerts a therapeutic rather than a placebo effect.Trial Registrationwww.Chictr.org.cnChiCTR2100042500. Retrospectively registered on 22 January 2021.

Bulkamid® injection in men: Cadaver study of operative technique and putative mechanism of action

Objective: Post-prostatectomy incontinence (PPI) is relatively common and of variable degree. Treatment of small-volume persistent PPI with a male sling or an artificial urinary sphincter is overly invasive, and the concept of intraurethral injection is very appealing in this situation. Bulkamid® is a nanoparticulate polyacrylamide and water polymer gel which is being used successfully in female stress urinary incontinence. We assessed the feasibility and effects of a four-point intraurethral technique on maximum urethral pressure (MUP) in male cadavers. Methods: Urethral pressure profile (UPP) was measured twice on two male fresh-frozen cadaver models before and after a four-point injection of 2 mL of Bulkamid® intraurethrally at the level of the sphincter in 0.5 mL aliquots using a 21Ch cystoscope with a 12° telescope and a 23G needle. Results: A clear UPP trace was recordable in both cadavers. The mean MUP at baseline was 38 cm H2O, and the mean MUP following Bulkamid® intraurethral injection increased to 55 cm H2O. Conclusions: Bulkamid® intraurethral injection in male cadavers is a simple technique that increases MUP. This increase in MUP may allow for treatment of low-volume PPI in men following prostate cancer treatment and warrants further study in the clinical situation. Level of evidence: Level 4.

Factors effecting the outcomes of artificial urinary sphincter placement: a single-center study

Objectives: To evaluate the patients who underwent artificial urinary sphincter (AUS) placement and report outcomes of the procedure.Methods: From March 2008 to February 2017, the data of patients who have undergone AUS placement were evaluated retrospectively. Age, body-mass index (BMI), comorbidities, education level, previous radiotherapy (RT) history of the patients were recorded. Cognitive status was examined using the Mini Mental Status Examination test (MMSE). International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) was completed pre- and post-operatively. Quality of life and satisfaction of patients were evaluated using Patient Global Impression of Improvement (PGI-I) scale. To analyze factors effecting success and revision rates, patients were grouped according to age, BMI, comorbidities, smoking habbit, previous RT history and etiology of incontinence. Treatment success was defined as requirement of ≤ 1/day.Results: A total of 61 patients were included in the study and each were cognitive intact (MMSE &amp;gt; 25). ICIQ-SF significantly improved in postoperative period (p &amp;lt; 0.001). PGI-I median score was 1 (1-4) in postoperative period. Success rate was 96.7% (n = 59) and 47 (77%) patients were complete dry. Revision requirement occured in 10 (16.4%) patients. When patient groups were compared according to the success and revision rates; presence of BMI &amp;gt; 25 kg/m2 was the only significant factor associated with revision requirement and there was no significant factor associated with success status.Conclusion: AUS placement is a safe and effective method in the treatment of post-prostatectomy incontinence (PPI). Success and revision rates are similar regardless the etiology of PPI. Cognitive functions of patients may be crucial in the postoperative satisfaction status.

264 - Treatment of Post-Prostatectomy Incontinence (PPI) with non-obstructive Slings (n-oS). Results from a real life cohort of ideal and comorbid patients

264 - Treatment of Post-Prostatectomy Incontinence (PPI) with non-obstructive Slings (n-oS). Results from a real life cohort of ideal and comorbid patients

PD37-04 BLADDER ELEVATION IN PELVIC FLOOR MUSCLE TRAINING EVALUATED BY CINE MRI (MAGNETIC RESONANCE IMAGING) IS ASSOCIATED WITH EARLY RECOVERY OF CONTINENCE AFTER RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVE: Postprostatectomy incontinence (PPI) is a major complication of prostatectomy. MRI (magnetic resonance imaging) is a good tool to evaluate the risk factors of PPI such as membranous urethral length (MUL). Pelvic floor muscle training (PFMT) is a good treatment of PPI, and ultrasound-based training of the muscle as physical therapy has been effective. However, there is no evidence of how muscle movement affects recover of continence. In the present study, we evaluated some dynamic factors of prostatectomy patients with cine MRI, and identified the risk factors of PPI. METHODS: A total of 128 male prostate cancer patients were enrolled in the present study. The all prostatectomy were robot assisted laparoscopic surgery. Cine MRI was performed preoperatively and at 6 months after surgery. Continence was defined as pad free or safety pad. We defined bladder neck elevation length in PFMT as “bladder elevation length (BEL)”. Other undynamic or dynamic parameters were also measured. Patients who got recovery of continence within a month were divided into Continence-group (n=48), and others were into Incontinence- group (n=80). We analyzed the parameters between two groups using Mann-Whitney U test or chi-square test, and between pre-post operations using Wilcoxon signed rank test. Preoperative parameters were also analyzed using multivariable analysis. RESULTS: In the two groups, there was no significant difference in any parameters of patient characteristics, perioperative data, pathological results and with or without nerve-sparing technique. In Continence-group, postoperative BEL was significantly longer than Incontinence- group (p=0.0001). Postoperative BEL of Continence-group also tended to be longer (p=0.0569). Only in postoperative state, posterior urethrovesical angle of Continence-group was significantly smaller than Incontinence- group at both resting and voiding phase (p=0.0046, p=0.0264). Postoperative MUL of Continence-group was significantly longer (p=0.004). Multivariable analysis showed that preoperative BEL and MUL significantly contributed to getting recovery of continence (p=0.0156, p=0.0329). CONCLUSIONS: Cine MRI enables us to evaluate dynamic and highly accurate measurement. From the present study, BEL was strongly related to recovery of early continence. Cine MRI could provide the patients the risk of PPI and better PFMT guidance. Source of Funding: None

Post-Prostatectomy Incontinence: an Update on Current Management

To review the most recent literature on the treatment of post-prostatectomy incontinence. New technology and implementation of surgical devices have resulted in a myriad of treatment options for men suffering post-prostatectomy incontinence. However, many of these have widely varied results. The treatment of post-prostatectomy incontinence is consistent and continues to expand with more devices being introduced in the market. However, optimization of patient outcomes and determination of which devices work best will be required. To date, there are few randomized controlled trials for the treatment of post-prostatectomy incontinence.

The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence

Prostate cancer is a common male malignancy. Radical prostatectomy is a common treatment option in patients with localised disease. Post-prostatectomy incontinence (PPI) is not uncommon, with a significant impact on the quality of life. However, it is often under-reported and undertreated. There are no standard international guidelines specifically for investigation and diagnosis of PPI. The routine use of urodynamic studies (UDS), with an attempt to assess urinary incontinence aetiology and to predict success prior to invasive surgical treatment, has been widely adopted but remains controversial. Literature concerning the pros and cons of pre-operative UDS is reviewed. There are conflicting results on UDS findings post-prostatectomy. Few studies demonstrated that UDS findings are not predictive of outcomes of the artificial urinary sphincter (AUS). Other studies have shown the presence of detrusor overactivity (DO) to be an adverse prognostic factor, especially for PPI patients treated with male sling success. Currently, there is no consensus on the indication for UDS in patients with PPI. Despite conflicting results on the usefulness of UDS prior to PPI surgery, the majority of surgeons still routinely perform UDS pre-operatively. Further prospective and randomised controlled studies would be beneficial in determining if routine UDS is required before surgical treatment for PPI. The authors also gave their perspective on the application of personalised UDS in investigating patients PPI prior to treatment.

Biofeedback Training for the Recovery of Urinary Continence After Prostatectomy: a Systematic Review

0

Long-term results of the implantation of the AMS 800 artificial sphincter for post-prostatectomy incontinence: a single-center experience.

ABSTRACTObjectivesReport the long-term outcomes of the AMS 800 artificial sphincer (AS) for the treatment post-prostatectomy incontinence (PPI) in a single center in Brazil.Materials and MethodsClinical data from patients who underwent the procedure were retrieved from the medical records of individuals with more than 1 year of follow-up from May 2001 to January 2016. Continence status (number of pads that was used), complications (erosion or extrusion, urethral atrophy, and infection), malfunctions, and need for secondary implantation were evaluated. The relationship between complications and prior or subsequent radiation therapy (RT) was also examined.ResultsFrom May 2001 to January 2016, 121 consecutive patients underwent AS implantation for PPI at an oncological referral center in Brazil. At the last visit, the AS remained implanted in 106 patients (87.6%), who reported adequate continence status (maximum of 1 pad/day). Eight-two subjects (67.8%) claimed not to be using pads on a regular basis at the final visit (completely dry). Revision occurred in 24 patients (19.8%). Radiation therapy (RT) for prostate cancer following radical prostatectomy was used in 47 patients before or after AS placement. Twelve patients with a history of RT had urethral erosion compared with 3 men without RT (p=0.004).ConclusionConsidering our outcomes, we conclude that AS implantation yields satisfactory results for the treatment of PPI and should remain the standard procedure for these patients. Radiation therapy is a risk factor for complication.

Pharmacological Treatment of Post-Prostatectomy Incontinence: What is the Evidence?

Urinary incontinence is a common and debilitating problem, and post-prostatectomy incontinence (PPI) is becoming an increasing problem, with a higher risk among elderly men. Current treatment options for PPI include pelvic floor muscle exercises and surgery. Conservative treatment has disputable effects, and surgical treatment is expensive, is not always effective, and may have complications. This article describes the prevalence and causes of PPI and the current treatment methods. We conducted a search of the PUBMED database and reviewed the current literature on novel medical treatments of PPI, with special focus on the aging man. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and α-adrenergic drugs have been proposed as medical treatments for PPI. Most studies were small and used different criteria for quantifying incontinence and assessing treatment results. Thus, there is not enough evidence to recommend the use of these medications as standard treatment of PPI. To determine whether medical therapy is a viable option in the treatment of PPI, randomized, placebo-controlled studies are needed that also assess side effects in the elderly population.

MP87-04 NATIONAL TRENDS IN UTILIZATION OF SURGICAL THERAPIES FOR POST-PROSTATECTOMY STRESS URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2016MP87-04 NATIONAL TRENDS IN UTILIZATION OF SURGICAL THERAPIES FOR POST-PROSTATECTOMY STRESS URINARY INCONTINENCE Yahir Santiago-Lastra, J. Quentin Clemens, and Bahaa S. Malaeb Yahir Santiago-LastraYahir Santiago-Lastra More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and Bahaa S. MalaebBahaa S. Malaeb More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2354AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The adoption of male perineal sling (MPS) procedures has been thought to increase steadily. Our aim was to evaluate the impact of MPS on utilization of the artificial urinary sphincter (AUS) using data from the vendor as well as regional varations. We hypothesize that despite increasing utilization of the MPS, AUS utilization has continued to steadily increase. METHODS We used sales and revenue unit data provided by American Medical Systems (Boston Scientific, Natick, MA) to retrospectively review the number of AUS (AMS 800) and MPS (AdVance Male Sling System, InVance Male Sling System) that were implanted in males with post-prostatectomy incontinence (PPI) nationwide for the years of 2001 to 2013. Sales results for the MPS were reported as growth rates in utilization, by using this formula: {(Present utilization value) minus (Initial year utilization value) / (Initial year utilization value)}. These are represented as percent growth rates by year. Regional standardized MPS utilization rate (per 100 000 persons) were measured using state/region population and urologist density data as obtained from the most recent AUA census. We excluded devices implanted for revision cases. RESULTS We identified 46,939 original AUS units implanted with patient identification forms (PIFs) reported from 2000-2013. A regression model for the effect of different age groups on the rate of utilization demonstrated that increasing age was associated with an increased rate of utilization of the AUS, with robust yearly increase in utilization for both the 60-69 age group and the 70+ age group, with a stable rate of utilization for men under age 59 (Adjusted R square=0.985, p<0.001). For the MPS, there was a peak in utilization in year 2009 that correlates significantly with utilization rates for the AdVance sling. Since 2009, the growth rate in MPS utilization has decreased significantly. Urologist density correlates with MPS utilization rates by state (p<0.002). No significant decline in overall AUS utilization was observed with the introduction of different male sling products. CONCLUSIONS AUS utilization in the treatment of PPI continues to increase despite introduction of various MPS devices, particularly for older men. Areas with a greater urologist density are associated with greater MPS utilization. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1115-e1116 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yahir Santiago-Lastra More articles by this author J. Quentin Clemens More articles by this author Bahaa S. Malaeb More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgimesh M-SLING(®) transobturator and prepubic four-arm urethral sling for post-prostatectomy stress urinary incontinence: clinical prospective assessment at 24 months.

To assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of post-prostatectomy incontinence (PPI) in men. This was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING(®) implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Qmax ) and urinary retention. We also analysed Urinary Symptom Profile (USP(®) ) score, degree of erectile dysfunction, patients' satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was <2 g. Patients whose condition was considered to have improved reduced their daily urinary losses by >50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures. The mean hospitalization period was 1.57 ± 0.70 days. All patients remained catheterized for 1.17 ± 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred. The Surgimesh M-SLING transobturator and prepubic four-arm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes.

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence.

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2–4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter.

The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI. A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day. There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs. 16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006). For mild to moderate PPI there is no difference in continence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

AdVance and AdVance XP slings for the treatment of post-prostatectomy incontinence

To examine the outcomes with the AdVance XP and AdVance slings in the management of post-prostatectomy incontinence (PPI). Eighty patients were treated with the AdVance resp. AdVance XP at one tertiary reference centre. The initial patients were implanted with the AdVance male sling with no associated surgery. Following the introduction of the AdVance XP sling, subsequent patients were implanted with the AdVance XP slings. Measurements included: daily pad usage, 24-h pad weight test, International Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire Short Form and the Patient Global Impression of Improvement. Adverse events were recorded. Follow-up was available for 39 and 41 patients treated with the AdVance and AdVance XP slings, respectively. At a median follow-up of 24.7 months, 69.3 % of patients could be classified as cured or improved in the AdVance group and at a median follow-up of 11.9 months, 90.3 % of AdVance XP-treated patients. At 3-month follow-up, 96.8 and 97.3 % of patients could be classed as cured or improved in the AdVance and AdVance XP groups, respectively (not significant). There were no perioperative complications. Two AdVance and three AdVance XP serious post-operative complications were reported, which were resolved following treatment. QOL was improved in both treatment groups. Both the AdVance and the AdVance XP slings are effective and safe for the treatment of PPI.

Modern operative treatment possibilities in male stress urinary incontinence

Postprostatectomy incontinence (PPI) is one of the most feared complications of radical prostatectomy with major impact on quality of life and social well-being. In recent years due to improved surgical techniques a reduction of the postoperative incontinence rate was achieved. However, due to the increasing number of radical prostatectomies performed for prostate cancer, a substantial and increasing number of patients are suffering from postoperative stress urinary incontinence. If conservative treatment fails, surgical therapy is recommended. For decades, the artificial urinary sphincter was the reference standard for moderate to severe postoperative male stress urinary incontinence. However, patients' demand on minimally invasive treatment options is high. Age or advanced prostate cancer should not be an exclusion criterion for surgical treatment of persistent PPI.

Penile vibratory stimulation in the treatment of post-prostatectomy incontinence: A randomized pilot study

To examine penile vibratory stimulation (PVS) in the treatment of post-prostatectomy urinary incontinence (UI). Patients with post-prostatectomy UI were included in a 12-week trial. A 24-hr pad test and a 72-hr voiding diary were collected at baseline. Participants were randomized to receive PVS for the first 6 weeks (group 1) or for the final 6 weeks (group 2) of the study. The primary outcome was the difference in leakage between groups 1 and 2 at 6 weeks as measured by changes in the pad test. The trial was registered at www.clinicaltrials.org (NCT01540656). Data from 31 men were available for analyses. The difference in the change on the pad test between the groups did not reach statistical significance at 6 weeks (P = 0.13) while the change in incontinence episodes between groups approached statistical significance (P = 0.052). However, there was a median reduction of -33 g (P = 0.021) on the pad test and a median reduction in daily incontinence episodes of -1 (P = 0.023) in group 1 at 6 weeks. At 12 weeks, group 2 had a median decrease on the pad test of -8 g (P = 0.10) and no change in incontinence episodes. A pooled analysis showed a decline on the pad test of -13.5 g (P = 0.004) after PVS. Small improvements were seen in subjective symptom scores and 58% stated to be satisfied with PVS. Self-limiting side effects were experienced by 15% of patients. PVS is feasible in the treatment of post-prostatectomy UI. Larger trials are needed to document the clinical efficacy.

S86 Is transobturator sling procedure the first choice for the treatment of post-prostatectomy incontinence?

S86 Is transobturator sling procedure the first choice for the treatment of post-prostatectomy incontinence?