ProACT versus AdVance procedure for stress urinary incontinence after radical prostatectomy: single center experience.
Radical prostatectomy (RP) represents an effective treatment for prostate cancer.
Nevertheless stress urinary incontinence (SUI) represents a mayor issue for patient undergoing to RP and is a common consequence after radical prostatectomy.
SUI post-prostatectomy rates vary from 5% to 48% (1), with 6–9% of patients ultimately seeking treatments for PPSUI (2).
Conservative approach represents a valuable option in selected patients but surgical procedures can best mange more challenging cases.
Artificial urinary sphincter represents the most effective long-term surgical treatment for SUI post RP. Recently minimal invasive approaches have gained popularity due to economic issue and minimal invasiveness procedure with lower morbidity.
Methods and results:
We evaluated retrospectively the data reported in our prostate cancer database of patients with SUI post RP who underwent to a minimal invasive procedure (AdVance sling and ProACT) for SUI in the period between 2010 and 2013 in our department.
15 patients underwent ProACT device procedure and 19 patients received a retrourethral transobturator sling (AdVance) procedure.
In the ProACT group 13 patients need more refilling interventions. 2 patients received endoscopic uretrotomy for bladder neck stenosis before to ProACT procedure.
In the AdVance group complete continence or reduction of the number of daily pads have been achieved in 70% of the case versus 13,3% in the ProACT group.
In our experience continence rate of AdVance procedure is superior to ProACT procedure. AdVance sling procedure represents a better approach for SUI post RP patients according to the fact that is a one-time single procedure. ProACT required multiple outpatient manipulations to achieve a full continence. Balloons migration and extrusion represent a major issue.
-1 R.M. Bauer, C. Gozzi et al. Contemporary management of post prostatectomy incontinence. Eur Urol. 2011;59:985-996.
-2 S. Herschorn et al. Surgical treatment of stress incontinence in men. Neurourol Urodyn. 2010;29:179-190