Die männliche Belastungsinkontinenz ist für den betroffenen Patienten meist sehr belastend. Nach Ausschöpfen aller konservativen Behandlungsmöglichkeiten ist die operative Therapie für viele von ihnen die letzte Chance auf Heilung. Über drei Jahrzehnte war die einzige chirurgische Option zur Behandlung der männlichen Belastungsinkontinenz der künstliche Harnröhrenschließmuskel. So wurde er zum Goldstandard. Aber dieser Goldstandard-Begriff wurde in der Zwischenzeit relativiert, da in den letzten 10 Jahren weitere operative Behandlungsmöglichkeiten entwickelt, eingeführt, evaluiert und in der Mehrzahl mittlerweile im Sinne einer zweiten Generation verbessert wurden (z. B. AdVance®, AdVanceXP® – American Medical Systems, Minnetonka, USA; ATOMS® mit vormals Inguinalund mittlerweile Skrotalport – Agency for Medical Innovations, Feldkirch, Österreich; Argus® – Promedon SA, Cordoba, Argentinien).

BACKGROUND:The AdVance male sling (American Medical Systems, Minnetonka, MN, USA) has been shown to be an efficacious device in short-term studies for postprostatectomy incontinence (PPI), but long-term studies are lacking. OBJECTIVE:Examine the intermediate-term outcome with the AdVance sling for PPI management. DESIGN, SETTING, AND PARTICIPANTS:A multicentre prospective evaluation was conducted on consecutive patients treated for PPI in three European tertiary reference centres. INTERVENTION:Patients were implanted with the AdVance male sling with no associated surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Measurements included daily pad usage, maximum flow rate (Qmax), postvoid residual urine (PVR), the International Consultation on Incontinence Questionnaire-Short Form, the Incontinence Quality of Life questionnaires, and complications of surgery. Paired Wilcoxon signed rank test univariable and multivariable analyses were used. RESULTS AND LIMITATIONS:Follow-up was available for 156 patients for the majority of parameters. Pad usage was significantly decreased compared with baseline at 12 mo and 3 yr (p<0.0001). At 12 mo, 76.9% of patients could be classified as cured or improved; this percentage was maintained at 3 yr (76.8%). Cure rates (58.6% vs 42.3%) and improvement rates (23.2% vs 25.0%) were higher in patients with mild or moderate incontinence compared with severe incontinence. Univariable analysis showed that pretreatment pad usage and severity of incontinence were both significant predictors of success (p=0.0355 and p=0.0420, respectively). However, in multivariable analysis, only pad usage was an independent predictor of success. There were no perioperative or severe postoperative complications. Most complications were Dindo grade I. Seven patients required a second treatment for stress urinary incontinence. There was no worsening over time. Limitations of this study included no comparator group, quality of life questionnaires in only two centres, and no 24-h pad test. CONCLUSIONS:The transobturator retroluminal repositioning sling suspension is effective and safe in the longer term for treating PPI.

Major depression is the most common psychiatric disorder. The diagnosis of depression depends on a patient's subjective complaints, and the nature of the heterogeneous disorder. Thus, there is no known biomarker for depression to date. Previous research has indicated that microRNAs are dysregulated in bipolar disorder and schizophrenia. We aimed to investigate microRNA dysregulation in plasma samples of patients with major depression. Venous blood samples of 50 depressed patients and 41 healthy controls were collected and the quantification of microRNAs was established using qRT-PCR. We found miR-320a significantly downregulated and miR-451a significantly upregulated in depressed patients. We also found miR-17-5p and miR-223-3p upregulated, but not as significantly as miR-451a. Merging our results with previous published data shows that the blood miR-320 family may be a potential microRNA family dysregulated in major depression. Research should be performed on miR-320-related pathways and their relationship to depression. Additionally, miR-451a could serve as a candidate biomarker for depression based on the acting mechanism of ketamine. Studies targeting miR-451a levels before and after treatment could be helpful.

Even though the artificial sphincter is still the treatment of choice in the surgical therapy of male stress urinary incontinence, recent developments have introduced numerous minimally invasive treatment options with acceptable clinical results. The male slings have been included into the EAU guidelines for treatment of male stress urinary incontinence. A distinct choice of patients and treatment options will lead to the highest chance of success. Besides the adjustable compressive slings, the non-adjustable and non-compressive AdVance (R) Sling offers a possible option for a functional approach to treatmentratio. A critical assessment of all these methods remains essential and prospective randomized trials are still missing.

Auch wenn der artifizielle Sphinkter nach wie vor das Standardverfahren in der operativen Therapie der männlichen Belastungsharninkontinenz darstellt, sind durch die Entwicklungen in den letzten Jahren zahlreiche Methoden eingeführt worden, die zunehmend minimal-invasiver werden und dabei akzeptable Ergebnisse erzielen. Die suburethralen Schlingenplastiken sind in die Leitlinien zur Behandlung der männlichen Belastungsharninkontinenz der EAU aufgenommen worden. Eine differenzierte Auswahl von Patient und Therapieverfahren bietet hierbei insgesamt die höchsten Chancen auf Erfolg. Neben den adjustierbaren komprimierenden Schlingen bietet die Advance®-Schlinge als nicht adjustierbare und nicht komprimierende Schlinge möglicherweise einen funktionalen Therapieansatz. Eine kritische Prüfung der verschiedenen Operationsmethoden bleibt essentiell und es fehlen prospektive Daten, die die einzelnen Methoden gegen einander randomisieren.

Stress urinary incontinence (SUI) following radical cystectomy and orthotopic ileal neobladder construction represents a challenging problem. The incidence of incontinence following this surgery is reported to be 30-60% and is - despite a better understanding of the male (and female) pelvic anatomy - still regarded as an adverse outcome of this surgery.Therapeutic options have been limited up until now and include pharmacological agents, surgical treatment and pelvic floor training with only moderate amelioration of the symptoms and often unacceptable side effects. Nevertheless, urinary continence is probably the most important key to patient satisfaction.Here we introduce the perineal approach of the functional retrourethral mesh as a new and innovative sling suspension based on a non-obstructive procedure in a patient with urinary stress incontinence after ileal neobladder. The sling adjusts the changed anatomy after radical cystectomy returning it to the former preoperative position and thus continence can be achieved again. The approach of the sling in a patient with ileal neobladder is safe and the good result concerning continence is promising.

For the treatment of male stress urinary incontinence (SUI) the functional retrourethral sling (AdVance sling) is a safe and minimal invasive treatment option with good cure and improvement rates. After radiotherapy the urethra and sphincter region can be afflicted and so e.g. the mobility of the urethra reduced. We evaluated the effectiveness of the AdVance sling after radical prostatectomy and additional adjuvant radiotherapy in the treatment of (SUI).

Stress incontinence after radical prostatectomy has a huge impact on quality of life for men. Two to five percent of the patients with incontinence after radical prostatectomy exhibit a persistent incontinence over 1 year despite conservative therapy attempts. For these patients surgical treatment is recommended. We evaluated the changes in quality of life after implantation of a retrourethral sling.

Despite improved operative techniques the number of patients suffering from urinary incontinence after radical prostatectomy cannot be ignored. The recommended therapy after radical prostatectomy is initially to attempt conservative therapy during the first 6-12 months. If there is no improvement in the incontinence an operative procedure is recommended. An artificial sphincter which has been established over decades has good long-term results but is also beset by diverse problems. Recently diverse minimally invasive procedures have been introduced for therapy of male stress incontinence which are effective due to compression or have a functional therapeutical approach.

The application of slings for the treatment of male stress urinary incontinence (SUI) is one of the fastest developments in urology. The reason for the introduction of the functional retrourethral sling was to treat the SUI by relocating the posterior urethra into a more proximal position without disturbing the sphincter mechanism. Thus, in patients with residual sphincter function continence can achieved again. The aim of this study was to evaluate the complications after implantation of this new functional retrourethral sling.