Rehabilitation value of correction of urinary incontinence developed after radical prostatectomy by urethrosuspension with adjustable sling

Asratov A.T., Kachmazov A.A., Kostin A.A.

Introduction. Prostate cancer(PC)is among the most frequent malignant neoplasms. Radical prostatectomy (RP) is a popular method for treating patients with localized prostate cancer. Urinary incontinence is the most common complication after RP, aswell as erectile dysfunction,which substantially decreases patients’ quality of life

The aim of this study was to investigate the role of correction of urinary incontinence afterRP by performing urethrosuspension using theArgus®sling in orderto promote rehabilitation ofsuch patients and to evaluate their quality of life and psychological condition.

Material and methods. Clinical cases of 260 patients after radical prostatectomy due to prostate cancer were analyzed. Clinical examination was performed several times: 28 patientswere examined before and after the surgery, 30 patients – after 3 months, 33 patients – after 6 months, 36 patients – after 9 months, 51 patents – after one year, 44 patients – after two years, and 38 patients – after three years. The patients were also asked to fill in the SpilbergKhanin and King's Health questionnaires.

Results.During the post-operative monitoring,the study has demonstrated positive dynamics of the quality of life, according to the patients’ urological (King's method) and psychological (Spilberg-Khanin method of evaluation of anxiety)statuses.In a number of patients, urinary incontinencewasstill present even 12 months and more aer prostatectomy. In order to correct this symptom, a number of patients (n=31) underwent surgery aimed at placement of theArgus®sling.e analysis oftheir quality oflife and psychological condition revealed a substantial increase of these parameters.While all patientsreported being in a bad condition (according to theKing's questionnaire) before the surgery, after sling placement 32.3% of them reported that their condition was normal, 45.2% – good, 16.1% were in a satisfactory condition, and only 6,5% ofthem did not notice any improvement and still claimed that their healthwas poor. The improvement of patients’ health correlated with their psychological status. Patient’sstate and trait anxiety levelssubstantially decreased afterArgus® sling placement.There were almost no patientswith a lowlevel of anxiety (only one person had state anxiety score lessthan 30) before the surgery; afterwards, the proportion ofsuch patients was 87.1%, with the sharp decrease in the percentage of patients with middle and high levels of anxiety. Only 12,9% of patients still had high level of state anxiety, and 6.5% of patients demonstrated high level of trait anxiety. In these patients, the surgery appeared to be ineffective orwith lowefficiency,which accounted forthe preservation oftheir quality of life and psychological discomfort.

Conclusion. Our study convincingly demonstrated the rationale for the correction of urinary incontinence in patients with PC after RP. In particular, this procedure should be accompanied by urethrosuspension with the use of sling systems,which might be of paramount importance forthe rehabilitation of patients with PC.

Authors declarelack of the possibleconflicts of interests

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prostate cancer, prostatectomy, rehabilitation, quality of life, psychological status, urological status, surgical correction of urinary incontinence, Argus sling system

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