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

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, as well 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 after RP by performing urethrosuspension using the Argus® sling in order to promote rehabilitation of such 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 patients were 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 Spilberg-Khanin 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 incontinence was still present even 12 months and more after prostatectomy. In order to correct this symptom, a number of patients (n=31) underwent surgery aimed at placement of the Argus® sling. The analysis of their quality of life and psychological condition revealed a substantial increase of these parameters. While all patients reported being in a bad condition (according to the King'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% of them did not notice any improvement and still claimed that their health was poor. The improvement of patients’ health correlated with their psychological status. Patient’s state and trait anxiety levels substantially decreased after Argus® sling placement. There were almost no patients with a low level of anxiety (only one person had state anxiety score less than 30) before the surgery; afterwards, the proportion of such 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 or with low efficiency, which accounted for the preservation of their 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 for the rehabilitation of patients with PC.