Results of the surgical correction of male urinary incontinence due to prostate cancer treatment with Remeex®

Padilla-Fernández B1, Sanz-Ruiz A2, Sousa-Escandón A3, Perán-Teruel M4, Hernández-Hernández D1, García-Cenador M B5, Castro-Díaz D M1, Lorenzo-Gómez M F6

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 88
Open Discussion ePosters
Scientific Open Discussion ePoster Session 7
Wednesday 29th August 2018
12:10 - 12:15 (ePoster Station 3)
Exhibition Hall
Incontinence Male Surgery New Devices
1. Department of Urology, Hospital Universitario de Canarias, Tenerife, Spain, 2. Department of Urology, Complejo Hospitalario Universitario de León, León, Spain, 3. Department of Urology, Hospital de Monforte de Lemos, Lugo, Spain, 4. Department of Urology, Hospital Arnau de Vilanova, Valencia, Spain, 5. Department of Surgery, University of Salamanca, Salamanca, Spain, 6. Department of Urology, Complejo Hospitalario Universitario de Salamanca, Salamanca, Spain
Presenter
B

Bárbara Padilla-Fernández

Links

Poster

Abstract

Hypothesis / aims of study
Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.1 million diagnoses worldwide in 2012, accounting for 15% of all cancers diagnosed. The incidence of PCa diagnosis varies widely between different geographical areas, having in Western Europe age-standardised rates per 100,000 of 94.9 (1). Post-prostatectomy incontinence is a common problem following surgery for prostate cancer. Recent systematic reviews have reported that the mean continence rates at twelve months were 89-100% for patients treated with robot-assisted laparoscopic prostatectomy and 80-97% for patients treated with open retropubic radical prostatectomy (1). The figures of urinary incontinence after radiation therapy are not well established, and vary according to the treatment modality (3D-CRT, IMRT, brachytherapy).
There is a wide surgical armamentarium for the management of post-prostatectomy incontinence, including artificial urinary sphincter, transobturator male slings, self-anchoring adjustable transobturator male system, and readjustable retropubic male sling with a suprapubic varitensor that makes possible to adjust the tension of the device, externally, under local anesthesia at any moment from device implant (MRS Remeex® system).
We investigate the cure rate of patients with urinary incontinence after different teratment modalities due to prostate cancer who underwent surgery with the MRS Remeex® system.
Study design, materials and methods
Multicentric retrospective study of a sample of 160 patients with urinary incontinence treated with the MRS Remeex® system after prostate cancer treatment. 
Study groups: 
* Group A (n=95): patients with urinary incontinence secondary to radical prostatectomy.
* Group B (n=47): patients with urinary incontinence secondary to radical prostatectomy plus radiation therapy.
* Group C (n=18): patients with urinary incontinence secondary to radiation therapy.
VARIABLES: Age. BMI. PSA. pTNM. Urinary incontinence grade, urodynamic study (UDS). Urinary incontinence surgery results. SUI evolution time in months. Secondary diagnoses. 
Descriptive statistics, Student’s T, Fisher’s exact test were performed; p<0.05 is considered significant.
Results
Mean age was 70.02 years old for the whole sample (SD 7.31, median 71, range 45-86), being higher in group C. No differences were found between groups for body mas index, pTNM and Gleason score. 
Urodynamic studies reported that patients in group B had a lower bladder capacity with poor compliance, and that these results were associated with a worse result. 
Diabetes mellitus type 2 was associated with a worse result in all groups. 
Total continence without the use of pads was achieved in 85 patients in group A (89.47%), 35 patients in group B (74.46%) and 15 patient in group C (83.33%). 
In follow-up visits, 89 patients required readjustments (55.62%), and 71 patients did not require readjustment with a mean follow up of 24 months (range 6-48 months).
Interpretation of results
Artificial urinary sphincter is nowadays considered the gold standard for the management of severe stress urinary incontinence in males with a high success rate. However, device's operating might be difficult in patients with impaired cognitive function or decreased manual dexterity (2). Furthermore, recent studies suggest that prior radiation therapy may predict earlier reoperation in patients with artificial urinary sphincter and a higher complications rate (3).
The results show that  the MRS Remeex® system is highly effective in the treatment of male urinary incontinence, reaching a 89% cure rate in non-radiated patients. It is also highly effective after radiation therapy (83%), and this is an important fact compared to artifical urinary sphincter.  The best results are achieved when bladder compliance and capacity are not affected, confirming the device's strong control of the urethra. Thus it is important to diminish treatments' adverse events on the bladder (i.e., poor compliance due to radiation therapy) or bladder dysfunction due to other comorbidities (i.e., diabetes mellitus and neurogenic bladder). These results persisted in the long-term.
Concluding message
Among the devices to correct urinary incontinence after prostate cancer treatment, MRS Remeex® system with the readjustable suburethral tape shows good continence rates in situations of bad prognosis,  such as radiation therapy, severe urinary incontinence or incontinence of long evolution time, comparable to reference devices like the artificial urinary sphincter.
References
  1. N. Mottet, R.C.N. van den Bergh, E. Briers, L. Bourke, P. Cornford, M. De Santis, S. Gillessen, A. Govorov, J. Grummet, A.M. Henry, T.B. Lam, M.D. Mason, H.G. van der Poel, T.H. van der Kwast, O. Rouvière, T. Wiegel. G.Associates: T. Van den Broeck, M. Cumberbatch, N. Fossati, T. Gross, M. Lardas, M. Liew, L. Moris, I.G. Schoots, P.M. Willemse. EAU-ESTRO-ESUG-SIOR guidelines on Prostate Cancer, 2018. Available at http://uroweb.org/guideline/prostate-cancer/
  2. Raup VT, Eswara JR, Marshall SD, Vetter J, Brandes SB. Artificial Urinary Sphincters for Treatment of Urinary Incontinence in Elderly Males. Urol Int. 2016;97(2):200-4. doi: 10.1159/000445254.
  3. Sacomani CAR, Zequi SC, Costa WHD, Benigno BS, Campos RSM, Bachega W Jr, Guimarães GC. Long-term results of the implantation of the AMS 800 artificial sphincter for post-prostatectomy incontinence: a single-center experience. Int Braz J Urol. 2018 Jan-Feb;44(1):114-120. doi: 10.1590/S1677-5538.IBJU.2017.0165.
Disclosures
<span class="text-strong">Funding</span> None <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> IRB Complejo Hospitalario Universitario de Salamanca <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes