부산대학교 도서관

IntroductionThe incidence of organ confined prostate cancer has increased in our country and worldwide over the past few decades as a result of the widespread application of PSA testing and [...]
Stress urinary incontinence (SUI) continues to present a major complication after radical prostatectomy. Suburethral slings represent one of the less invasive options for postprostatectomy SUI, and a more recent addition is a transobturator sling, the AdVance[R]. We report our results with the AdVance[R] sling for the management of postoperative SUI. The evaluation was conducted on 47 patients with AdVance[R] implant for SUI in our institution (November 2010 - June 2017). Measurements included age, etiology of SUI, duration of SUI, follow-up and pad use per day (PPD) pre- and postoperatively. Patients were classified as cured if they used no pads or 1 PPD for security reasons, or as improved if 1-2 PPDs were used and if there was a 50% reduction in pad use per day postoperatively. In our series we observed a reduction of mean PPD of 5.1 (2-8) to 1.7 (0-4) postoperatively. After follow-up and according to our criteria, the cure rate was 51.1% (24/47) and the improvement rate 27.5% (13/47). The overall success rate was 78.6% (37/47). No improvement was observed in 21.4% (10/47) of patients. Failure rates after sling placement for patients with additional treatments following prostatectomy were much higher (60% (3/10) for radiation therapy and 66.7% (4/10) for urethral stricture disease). Our results show favourable cure and improvement rates and are comparable to results from larger series. The most appropriate candidates for the AdVance[R] sling are patients with mild to moderate postprostatectomy SUI. The results may be even better in patients without additional treatment following prostatectomy, such as radiation therapy or surgery for stricture disease.Key words: Prostate cancer; Prostatectomy; Urinary incontinence; Postprostatectomy incontinence; Stress urinary incontinence; Suburethral sling; Transobturator sling; Reconstructive surgeryUnatoc napretku u lijecenju lokaliziranog raka prostate radikalnom prostatektomijom, i dalje je prisutan dio bolesnika kod kojih perzistira stresna urinarna inkontinencija (SUI). Suburetralni, a odnedavno i transopturatorni 'slingovi' zbog neinvazivnosti postaju metodom izbora u lijecenju ovih bolesnika. U clanku prikazujemo kirursku tehniku i nase rezultate lijecenja postoperativne SUI metodom AdVance[R]. Od studenog 2010. do lipnja 2017. metodom AdVance[R] na Klinici je operirano 47 bolesnika. Zabiljezena je dob, etiologija i trajanje SUI te dnevni broj ulozaka preoperativno i postoperativno. Izljecenje je definirano kao potpuna kontinencija ili koristenje jednog sigurnosnog uloska / dan. Poboljsanje je definirano kao koristenje 1-2 uloska / dan te smanjenje u dnevnom broju ulozaka vece od 50%. U ispitivanom razdoblju kod operiranih biljezimo znacajan pad prosjecnog broja ulozaka / dan s 5.1 (2-8) na postoperativno 1.7 (0-4). Prema nasim kriterijima, postoperativno je kontinentno 51.1% (24/47), a poboljsanje kontinencije nalazimo kod 27.5% (13/47) operiranih. Kod 78.6% (37/47) operiranih broj dnevno koristenih ulozaka smanjio se za vise od 50% i/ili je kontinentno. Stope neuspjeha znatno su vece kod bolesnika koji su nakon prostatektomije tretirani radioterapijom (60% (3/10)) ili uretrotomijom (66.7% (4/10)). Rezultati lijecenja postoperativne SUI suspenzijom AdVance[R] u nasoj ustanovi usporedivi su s rezultatima do sada objavljenih studija. Suspenzija AdVance[R] indicirana je kod bolesnika s blagom do umjerenom postoperativnom SUI te ocuvanom ostatnom funkcijom sfinktera potvrdenom uretrocistoskopijom. Ocekivano, a zbog periuretralne fibroze, uspjesnost metode upitna je kod bolesnika koji su nakon prostatektomije tretirani radioterapijom ili endouroloskim zahvatima.Kljucne rijeci: Rak prostate; Prostatektomija; Inkontinencija mokrace; Postprostatektomijska inkontinencija; Stresna inkontinecija; Suburetralni slingovi; Transobturatorni sling; Rekonstruktivna kirurgija