OBJECTIVES: To compare the efficacy of two surgical treatments for male urinary stress incontinence: adjustable continence therapy (ProACT) and bone anchored male sling (BAMS). METHODS: Eighty-four consecutive post radical prostatectomy incontinent patients received ProACT (n = 46) or BAMS (n = 38) implantation by two different operators in two different centres. Eighty of them had a complete follow up. Both groups were prospectively assessed by number of pads per day and a validated questionnaire (UCLA/RAND). Complications rate and mean operating times were compared. All comparisons were analyzed using the t test, Fischer's exact test and chi(2) analysis (significance P < 0.05). RESULTS: At a mean follow up of 19 and 33 months respectively, 30/44 (68%) patients treated with ProACT were dry (0/1 safety pad) in comparison with 23/36 (64%) patients treated with BAMS (P > 0.05). Stratifying the results, ProACT had 33/39 (85%) dry patients in severe (more than three pads/day) preoperative incontinence, in comparison with 21/26 (81%) for BAMS (P > 0.05). The UCLA/RAND questionnaire showed an average increase of 11.7 points (from 10.2 to 21.9) for ProACT and of 10 points (from 11.9 to 21.9) for BAMS (P > 0.05). Complications included removal of ProACT and BAMS in 6/44 (14%) and 2/36 (6%), respectively. Mean operating time was 18 min and 45 min (P < 0.05) for ProACT and BAMS, respectively. CONCLUSIONS: ProACT and BAMS are both associated with a satisfactory rate of success. ProACT results seem to be better for severe incontinence and BAMS for mild incontinence. The operation time of ProACT is shorter.
Adjustable continence therapy (ProACT) and bone anchored male sling: Comparison of two new treatments of post prostatectomy incontinence.
FREA, Bruno;
2008-01-01
Abstract
OBJECTIVES: To compare the efficacy of two surgical treatments for male urinary stress incontinence: adjustable continence therapy (ProACT) and bone anchored male sling (BAMS). METHODS: Eighty-four consecutive post radical prostatectomy incontinent patients received ProACT (n = 46) or BAMS (n = 38) implantation by two different operators in two different centres. Eighty of them had a complete follow up. Both groups were prospectively assessed by number of pads per day and a validated questionnaire (UCLA/RAND). Complications rate and mean operating times were compared. All comparisons were analyzed using the t test, Fischer's exact test and chi(2) analysis (significance P < 0.05). RESULTS: At a mean follow up of 19 and 33 months respectively, 30/44 (68%) patients treated with ProACT were dry (0/1 safety pad) in comparison with 23/36 (64%) patients treated with BAMS (P > 0.05). Stratifying the results, ProACT had 33/39 (85%) dry patients in severe (more than three pads/day) preoperative incontinence, in comparison with 21/26 (81%) for BAMS (P > 0.05). The UCLA/RAND questionnaire showed an average increase of 11.7 points (from 10.2 to 21.9) for ProACT and of 10 points (from 11.9 to 21.9) for BAMS (P > 0.05). Complications included removal of ProACT and BAMS in 6/44 (14%) and 2/36 (6%), respectively. Mean operating time was 18 min and 45 min (P < 0.05) for ProACT and BAMS, respectively. CONCLUSIONS: ProACT and BAMS are both associated with a satisfactory rate of success. ProACT results seem to be better for severe incontinence and BAMS for mild incontinence. The operation time of ProACT is shorter.
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