No continence benefit with sling after prostate surgery _ medpage today
The adjusted Expanded Prostate Cancer Index Composite-Urinary Inventory (EPIC-UIN) score as well as the I-PSS (International Prostate Symptom Score) score changed at 1, 3 and 6 months after catheter removal but didn’t differ between the groups, they wrote online in the Journal of Urology.
“We failed to determine that early return of complete continence was independently associated with adding a retropubic urethral sling during RARP,” they explained, pointing out that these results are similar to those recently reported from a smaller study using a sling made of porcine small intestinal submucosa.
The current study showed that after adjusting for clinical, urinary, and surgical factors, the likelihood of both complete (odds ratio 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92) at 6 months rose with every 5-year drop in patient age at diagnosis ( P<0.01 for both).
“Follow-up is ongoing to determine the long-term impact of sling placement on return of continence,” the researchers noted.
New innovations in the world “Surgical innovation, like most medical technology, should be subjected to rigorous testing before undergoing widespread adoption.”
The researchers said they developed the vas deferens sling technique in response to limitations seen with synthetic slings, namely cost and erosion, as well as the costs associated with absorbable slings of porcine small intestinal submucosa. New innovations in it They also wanted to avoid the separate incision required for harvesting the anterior rectus fascia.
Although earlier experience with the technique indicated that it did improve continence when compared with historical controls, the researchers said they wanted to “better test the hypothesis that placement of an autologous sling at RARP would improve early return of urinary continence.”
For the study, patient accrual took place from May 2013 through July 2014. New world innovations Patients were divided into two groups (ages <65 and ?65) prior to randomization to sling placement or no sling placement.
The mean preoperative EPIC-UIN score was 79.3 in the sling group and 81.2 in the non-sling group ( P=0.53). New innovations in science and technology Mean baseline I-PSS was 9.3 in patients with a sling and 8.9 in patients without a sling ( P=0.71).
Median prostate volume was 31 gm in the sling group and 35 gm in the non-sling group and the median baseline score on the Sexual Health Inventory for Men (SHIM) was 21 and 18, respectively ( P=0.76). New ideas of innovation In the sling group, 55% of patients had complete nerve sparing compared with 67% in the non-sling group, the researchers said.
In an accompanying editorial comment, Derya Tilki, MD, of the University Hospital Hamburg-Eppendorf in Germany, pointed out that the four surgeons “may have in?uenced the results as there is heterogeneity in functional outcomes among surgeons.”
To account for variation in surgical approaches and tension on the sling, Nguyen’s group also analyzed a subgroup of 150 patients who underwent surgery with one surgeon. New innovations in medicine The change in EPIC-UIN and I-PSS scores after catheter removal were assessed using adjusted mixed models.
The study had some limitations including the fact that the time to continence reported by patients may have been imprecise because of recall bias. New innovations in car technology Also, continence outcomes were missing in 27 men who did not provide an interview 6 months after catheter removal, and longer term outcomes have not been assessed.
This study was “rigorously conducted, optimizing the internal validity of the findings,” said Matthew J. New innovations downstate Resnick, MD, MPH, MMHC, of Vanderbilt University Medical Center in Nashville, said in an email.
Urinary incontinence remains a relatively common functional deficit following radical prostatectomy, and attempts to modify surgical technique have been met with mixed results, noted Resnick, who was not involved with the study.
Optimizing urinary outcomes following radical prostatectomy requires proper patient selection and ongoing surgical innovation, he explained. New innovations vanderbilt By identifying groups of men at risk for urinary incontinence, this study facilitates pre-treatment counselling that can “best align” patient expectations with outcomes.
“Additionally, and importantly, optimizing functional outcomes following radical prostatectomy will require both development and rigorous evaluation of novel surgical techniques to maximize oncologic control and minimize functional deficits after treatment,” he said.