Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis.

The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP).

This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included.

Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17-174.35) and 45.14 (95% CI: 11.09-183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09-6.56). We found a low risk of bias in most studies.

Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.

Therapeutic advances in urology. 2019 Sep 29*** epublish ***

Pedro Luis Guachetá Bomba, Ginna Marcela Ocampo Flórez, Fernando Echeverría García, Herney Andrés García-Perdomo

UROGIV Research Group, Department of Urology, Universidad del Valle, Cali, Colombia., UROGIV Research Group, Universidad del Valle, Cali, Colombia, and Department of Urology, Universidad CES, Medellín, Colombia., Department of Urology, Universidad del Valle, Cali-Colombia, Cll 4B #36-00, Cali 439, Colombia.