Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy

Abstract

Purpose. To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate. Methods. We distinguished five categories of treatment: A = bulking agents, B = fixed slings, C = adjustable slings, D = circumferential compressor devices (artificial sphincter), and E = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. Evidence synthesis. 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 g to 747.0 g , and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI −0.12–0.78), 0.63 (95% CI 0.55–0.71), 0.65 (95% CI 0.58–0.72), 0.50 (95% CI 0.34–0.66), and 0.53 (95%CI 0.36–0.70), respectively, in groups A, B, C, D, and E (I2 85.87%; Q 249.82— P > 0.01 ) (test of group differences P = 0.22 ). Conclusion. In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.

Post-Prostatectomy Urinary Incontinence

“…According to a recent meta-analysis, which compared the different devices used for treating PPUI, bulking agents are associated with the lowest improvement in continence after treatment. In addition, the more the injections are, the lower the continence rates and improvements are [108].…”

The Effect of Low-Frequency Electrical Stimulation Combined With Anus Lifting Training on Urinary Incontinence After Radical Prostatectomy in a Chinese Cohort

“…There is no relevant research on whether electrical stimulation combined with anus lifting training can improve the recovery of postoperative urinary control. Most of these studies were performed in White patients ( Salciccia et al, 2022 ).…”