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Miao S, He Q, Zhang Y, Wang L, Jin X, Bao C, Wang W. Management of urinary incontinence after radical cystectomy and orthotopic neobladder: A scoping review of international practices. Nurs Open 2023; 10:6618-6634. [PMID: 37408112 PMCID: PMC10495704 DOI: 10.1002/nop2.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To identify and describe international practice in incontinence management after radical cystectomy and orthotopic neobladder. MATERIALS AND METHODS A systematic scoping review following the methodology of the Joanne Briggs Institute was conducted in which the application searched 15 data sources to identify papers published in English, from 1979 to 2022. RESULTS Of the 16 papers that met the eligibility criteria, articles in Eastern countries mainly focus on the effect of conservative treatment, while in Western countries, more attention is paid to the effect of surgical treatment. Clinical characteristics of patients included conservative treatment failure, duration of post-operative intervention and unique differential treatment of male and female patients. Reported factors influencing the achievement of urinary incontinence (UI) include lack of evidence to guide management practice, limited value of conservative treatment, high risk of surgical treatment and uncertainty of efficacy; currently, early behavioural research and multimodal rehabilitation training have good results. CONCLUSIONS UI in neobladder patients is a distressing condition that is difficult to treat and often requires high-quality rehabilitation guidance and surgical intervention. Further research to address current knowledge gaps is important to inform practice.
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Affiliation(s)
- ShuYing Miao
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - QingWei He
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - YuanFeng Zhang
- Department of UrologyShantou Central HospitalShantouChina
| | - LiJuan Wang
- Nursing Studies, School of MedicineZhejiang UniversityHangzhouChina
| | - XiaoDong Jin
- Department of UrologyThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - ChunXiang Bao
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Wei Wang
- Nursing Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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[ARTIFICIAL URINARY SPHINCTER IMPLANTATION AFTER ILEAL NEOBLADDER RECONSTRUCTION: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2022; 112:34-37. [PMID: 35046234 DOI: 10.5980/jpnjurol.112.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 62-year-old man was referred to our department for artificial urinary sphincter (AUS) implantation as treatment for total incontinence after laparoscopic radical prostatectomy. Preoperative cystoscopy revealed bladder tumor that was proven to be high-grade micropapillary urothelial carcinoma by transurethral resection. We performed radical cystectomy with ileal neobladder reconstruction, followed by AUS implantation to treat incontinence. The AUS implantation procedure was performed 5 months after total cystectomy and resulted in significant continence recovery. To date, AUS implantation after neobladder reconstruction has not been reported in Japan, although some case series have described this procedure overseas. In our view, AUS implantation is a useful therapeutic option for incontinence in patients undergoing neobladder reconstruction.
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Schneider MP, Burkhard FC. Management of Incontinence After Orthotopic Bladder Substitution Post-Radical Cystectomy. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00517-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kaufman MR, Milam DF, Johnsen NV, Cleves MA, Broghammer JA, Brant WO, Jones LA, Brady JD, Gross MS, Henry GD. Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional Analysis. J Urol 2018; 199:1037-1041. [DOI: 10.1016/j.juro.2017.11.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Mario A. Cleves
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Abstract
Although currently still the gold standard treatment for post-prostatectomy urinary incontinence, the artificial urinary sphincter (AUS) (AMS800) is an invasive procedure with associated risks factors. In this paper, we aim to outline what the scientific literature and what we personally believe are the factors that are useful and/or necessary to mitigate these risks, including both patient factors and surgeon factors. We also review special populations, including transcorporal (TC) AUS approach, AUS with inflatable penile prosthesis, AUS after male urethral sling, AUS erosion management, and AUS after orthotopic urinary diversion.
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Affiliation(s)
- William O Brant
- Division of Urology, Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah, USA.,Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Francisco E Martins
- Department of Urology, University of Lisbon, School of Medicine, Hospital Santa Maria, Lisbon, Portugal
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Urethral Stricture Outcomes After Artificial Urinary Sphincter Cuff Erosion: Results From a Multicenter Retrospective Analysis. Urology 2017; 104:198-203. [DOI: 10.1016/j.urology.2017.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/19/2022]
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Zhang YG, Song QX, Song B, Zhang DL, Zhang W, Wang JY. Diagnosis and Treatment of Urinary Incontinence after Orthotopic Ileal Neobladder in China. Chin Med J (Engl) 2017; 130:231-235. [PMID: 28091417 PMCID: PMC5282682 DOI: 10.4103/0366-6999.198012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi-Xiang Song
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bo Song
- Department of Urology, Southwest Hospital, Chongqing 400038, China
| | - Da-Lei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Cordon BH, Singla N, Singla AK. Artificial urinary sphincters for male stress urinary incontinence: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:175-83. [PMID: 27445509 PMCID: PMC4938139 DOI: 10.2147/mder.s93637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.
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Affiliation(s)
- Billy H Cordon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ajay K Singla
- Department of Urology, University of Toledo College of Medicine, Toledo, OH, USA
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Suarez OA, McCammon KA. The Artificial Urinary Sphincter in the Management of Incontinence. Urology 2016; 92:14-9. [PMID: 26845050 DOI: 10.1016/j.urology.2016.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
Despite the emergence of different devices in the treatment of postprostatectomy urinary incontinence, the AMS 800 (American Medical Systems, Minnetonka, MN) remains the gold standard for the treatment of stress urinary incontinence in men. We reviewed the current literature regarding the indications, surgical principles, outcomes, and complications of artificial urinary sphincter placement for stress urinary incontinence after prostatectomy. Despite all the available information, heterogeneous data, different success definitions, and the lack of high-quality prospective studies with long-term follow-up, it is difficult to compare outcomes between studies. In spite of these, the perineal implantation of a single cuff artificial urinary sphincter has withstood the test of time.
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Eswara JR, Chan R, Vetter JM, Lai HH, Boone TB, Brandes SB. Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study. Urology 2015; 86:176-80. [PMID: 26142602 DOI: 10.1016/j.urology.2015.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the results of various single-component artificial urinary sphincter (AUS) revision techniques for continued/recurrent stress urinary incontinence (SUI). Although AUS placement for male SUI has a high rate of success, revisions may be performed for mechanical failure of an isolated component or continued/recurrent SUI. MATERIALS AND METHODS From 1993 to 2012, 90 AUS revisions including urethral cuff downsizing (19), pressure-regulating balloon replacement (18), cuff repositioning (11), or tandem cuff placement (42) were performed at 2 institutions. End points included reoperation, incontinence failure, and urethral erosion. The Kruskal-Wallis test was used to compare continuous variables, and the log-rank test was used to compare Kaplan-Meier curves. RESULTS Mean age was 70.2 years, and median follow-up was 33.6 months. Median time to revision was 28.9 months. Tandem cuff placement was associated with a lower rate of incontinence failure (P = .02), whereas cuff repositioning was associated with a higher rate of incontinence failure (P = .02). An increased rate of mechanical failure was observed with cuff downsizing (P = .01). Among options for revision (1) cuff downsizing is associated with a higher rate of mechanical failure, and (2) cuff repositioning with the same size is associated with a higher rate of incontinence failure, whereas (3) tandem cuff placement is associated with a lower rate of recurrent SUI compared to other types of AUS revision. CONCLUSION Cuff repositioning is associated with an increased rate of persistent incontinence after AUS revision whereas tandem cuff placement is associated with a lower rate of recurrent or persistent incontinence.
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Affiliation(s)
- Jairam R Eswara
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
| | - Robert Chan
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - H Henry Lai
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Timothy B Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Steven B Brandes
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Jellison FC. Evaluation and Treatment of Overactive Bladder after History of Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Goldmark E, Ginsberg D. Evaluation, Treatment and Management of Urinary Incontinence in Patients with Orthotopic Neobladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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