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Vrijens D, Kendall H, Hervé F. Neurological sphincter deficiency: is there a place for artificial urinary sphincter? World J Urol 2024; 42:69. [PMID: 38308692 PMCID: PMC10838219 DOI: 10.1007/s00345-023-04716-1] [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: 06/02/2023] [Accepted: 09/26/2023] [Indexed: 02/05/2024] Open
Abstract
PURPOSE Neurogenic stress urinary incontinence (N-SUI) is a condition with serious impact on the quality of life. There are several treatment modalities of which the artificial urinary sphincter (AUS) stands out as the most suitable technique for addressing sphincter insufficiency. In this article, the purpose is to describe practical considerations, outcomes, and complications of the artificial urinary sphincter in neurological sphincter deficiency in both males and females. METHODS A narrative review of the current literature. RESULTS The outcomes of AUS are reasonably good in patients with NLUTD, the surgical technique is discussed as well as the limitations and special considerations in this complex and heterogeneous patient population. CONCLUSION The available evidence suggests that its efficacy and functional durability may be lower in patients with neurogenic lower urinary tract dysfunction (NLUTD) compared to those without neurological deficits. However, studies have shown that AUS can still provide effective and safe continence outcomes in both male and female patients, with long-term device survival rates ranging from several years to over a decade.
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Affiliation(s)
- Desiree Vrijens
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Harry Kendall
- Departement of Urology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - François Hervé
- Departement of Urology, University Hospital of Ghent, Ghent, Belgium
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Fan YH, Shen YC, Hsu CC, Chow PM, Chang PC, Lin YH, Chang SJ, Jiang YH, Liao CH, Wang CC, Wu CT, Kuo HC. Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury. J Clin Med 2023; 12:jcm12041400. [PMID: 36835937 PMCID: PMC9963408 DOI: 10.3390/jcm12041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
This study aimed to present a comprehensive literature review of the efforts of a spinal cord injury workgroup in Taiwan regarding urologic surgery for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI). Surgical procedures should be viewed as a final option for managing patients with SCI who have persistent symptoms and complications that cannot be resolved by other means. Surgeries can be grouped according to their purpose: reducing bladder pressures, reducing urethra resistance, increasing urethra resistance, and urinary diversion. The choice of surgery depends on the type of LUTD based on urodynamic tests. Additionally, cognitive function, hand motility, comorbidities, efficacy of surgery, and related complications should be considered.
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Affiliation(s)
- Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Yuan-Chi Shen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chih-Chen Hsu
- Department of Urology, Taipei Hospital, Ministry of Health and Welfare, Taipei 24233, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yu-Hua Lin
- Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei 10002, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 23702, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117)
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Musco S, Ecclestone H, 't Hoen L, Blok BFM, Padilla-Fernández B, Del Popolo G, Groen J, Pannek J, Kessler TM, Karsenty G, Phé V, Sartori AM, Castro-Diaz D, Rizwan H. Efficacy and Safety of Surgical Treatments for Neurogenic Stress Urinary Incontinence in Adults: A Systematic Review. Eur Urol Focus 2021; 8:1090-1102. [PMID: 34509413 DOI: 10.1016/j.euf.2021.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Controversy still exists regarding the balance of benefits and harms for the different surgical options for neurogenic stress urinary incontinence (N-SUI). OBJECTIVE To identify which surgical option for N-SUI offers the highest cure rate and best safety without compromising urinary tract function and bladder management. EVIDENCE ACQUISITION A systematic review was performed under the auspices of the European Association of Urology Guidelines Office and the European Association of Urology Neuro-Urology Guidelines Panel according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. EVIDENCE SYNTHESIS A total of 32 studies were included. Overall, 852 neurourological patients were surgically treated for N-SUI. The treatment offered most often (13/32 studies) was an artificial urinary sphincter (AUS; 49%, 416/852) and was associated with a need for reintervention in one-third of patients. More than 200 surgical revisions were described. Overall, 146/852 patients (17%) received concomitant bladder augmentation, mainly during placement of an AUS (42%, 62/146) or autologous sling (34% of women and 14% of men). Following pubovaginal sling placement, dryness was achieved in 83% of cases. A significant improvement in N-SUI was observed in 87% (82/94) of women following placement of a synthetic midurethral sling. Efficacy after insertion of an adjustable continence therapy device (ACT 40%, proACT 60%) was reported for 38/128 cases (30%). The cure rate for bulking agents was 35% (9/25) according to 2/32 studies, mainly among men (90%). The risk of bias was highly relevant. Baseline and postoperative cystometry were missing in 13 and 28 studies, respectively. CONCLUSIONS The evidence is mainly reported in retrospective studies. More than one intervention is often required to achieve continence because of coexisting neurogenic detrusor overactivity, low compliance, or the onset of complications in the medium and long term. Urodynamic data are needed to better clarify the success of N-SUI treatment with the different techniques. PATIENT SUMMARY Our review shows that insertion of an artificial urinary sphincter for urinary incontinence is effective but is highly associated with a need for repeat surgery. Other surgical options may have lower continence rates or a risk of requiring intermittent catheterization, which patients should be informed about before deciding on surgery for their incontinence.
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Affiliation(s)
- Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
| | - Hazel Ecclestone
- Department of Urology, Taranaki District Health Board, New Plymouth, New Zealand
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Barbara Padilla-Fernández
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Véronique Phé
- Department of Urology, Sorbonne University, Pitié-Salpêtrière Academic Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David Castro-Diaz
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Hamid Rizwan
- Department of Urology, University College London and London Spinal Injuries Unit, London, UK
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Chartier-Kastler E, Guillot-Tantay C, Ruggiero M, Cancrini F, Vaessen C, Phé V. Outcomes of robot-assisted urinary sphincter implantation for male neurogenic urinary incontinence. BJU Int 2021; 129:243-248. [PMID: 34174147 DOI: 10.1111/bju.15528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation (R-AUS) in men with neurogenic stress urinary incontinence (SUI). PATIENTS AND METHODS A monocentric retrospective study included all consecutive adult male neuro-urological patients who underwent R-AUS for SUI between January 2011 and August 2018. The AUS was implanted via a transperitoneal robot-assisted laparoscopic approach. Intraoperative and early postoperative complications were reported (Clavien-Dindo classification). Continence was defined as no pad usage. Revision and explantation rates were also evaluated. RESULTS Overall, 19 men with a median (interquartile range [IQR]) age of 45 (37-54) years were included. No conversion to laparotomy was needed. Three minor (Clavien-Dindo Grade I-II) early postoperative complications occurring in three (15.8%) patients were reported. The median (IQR) follow-up was 58 (36-70) months. At the end of the follow-up, the continence rate was 89.5%. The AUS revision and explantation rates were 5.3% and 0%, respectively. CONCLUSION A R-AUS is a safe and efficient procedure for AUS implantation in adult male neuro-urological patients, referring to the challenging open technique.
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Affiliation(s)
- Emmanuel Chartier-Kastler
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Cyrille Guillot-Tantay
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Marina Ruggiero
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Fabiana Cancrini
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France.,Department of Medical and Surgical Sciences and Translational Medicine, Sant 'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Christophe Vaessen
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
| | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Academic Hospital, Sorbonne Université Medical School, Paris, France
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Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence. World J Urol 2021; 39:3891-3896. [PMID: 33835209 DOI: 10.1007/s00345-021-03672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. METHODS This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. RESULTS Over a span of 26 years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5 month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5 months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. CONCLUSION Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.
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Gasmi A, Perrouin-Verbe MA, Hascoet J, Bey E, Jezequel M, Voiry C, Perrouin-Verbe B, Gamé X, Manunta A, Lenormand L, Capon G, Peyronnet B. Long-term outcomes of artificial urinary sphincter in female patients with spina bifida. Neurourol Urodyn 2020; 40:412-420. [PMID: 33197064 DOI: 10.1002/nau.24576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 02/04/2023]
Abstract
AIMS To report the long-term functional outcomes of artificial urinary sphincter (AUS) implantation in female patients with spinal dysraphism and stress urinary incontinence (SUI) related to intrinsic sphincter deficiency (ISD). METHODS The charts of all spina bifida female patients with SUI due to ISD who underwent AUS (AMS 800) implantation between 2005 and 2019 at three academic departments of urology were retrospectively reviewed. Reoperation was defined as either revision or explantation of the AUS device. Reoperation-free survival of the AUS device was estimated using the Kaplan-Meier method. Continence status as per patients' subjective assessment was categorized as follows: complete continence (no pads), improved continence, unchanged SUI or worsened SUI. RESULTS Twenty-three patients were included, 69.6% were self-catheterizing. The median follow-up was 14 years. Median time to first reoperation was 10 years. Survival rates without reoperation were 85.9%, 41.8%, 34.6%, and 20.9% at 5, 10, 15, 20 years, respectively. Survival rates without AUS explantation were 90.7%, 66.3%, 55.2%, and 41.4% at 5, 10, 15, 20 years, respectively. None of the patients who underwent device explantation had a new AUS implanted. The only predictive factor of reoperation-free survival was the type of spinal dysraphism (hazards ratio = 3.60 for closed vs. open dysraphism; p = .04). At last follow-up, 17 of the 23 patients were fully continent (73.9%). CONCLUSION AUS in female patients with spina bifida may be associated with satisfactory long-term functional outcomes and a high reoperation rate. The median time to first reoperation was similar to what is reported in the male AUS literature (10 years).
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Affiliation(s)
- Anis Gasmi
- Department of Urology, University of Rennes, Rennes, France
| | | | - Juliette Hascoet
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Elsa Bey
- Department of Urology, University of Nantes, Nantes, France
| | - Magali Jezequel
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Caroline Voiry
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
- Department of Urology, University of Nantes, Nantes, France
| | - Loic Lenormand
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France
- Department of Urology, University of Nantes, Nantes, France
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Peyronnet B, Greenwell T, Gray G, Khavari R, Thiruchelvam N, Capon G, Ockrim J, Lopez-Fando L, Gilleran J, Fournier G, Van Koeveringe GA, Van Der Aa F. Current Use of the Artificial Urinary Sphincter in Adult Females. Curr Urol Rep 2020; 21:53. [PMID: 33098485 DOI: 10.1007/s11934-020-01001-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. RECENT FINDINGS While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50 years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France. .,Service d'Urologie, Hopital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Gary Gray
- Department of Urology, University of Alberta, Edmonton, Canada
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Luis Lopez-Fando
- Department of Urology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
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Rehder P, Stuehmeier J, Jelisejevas LA, Gulacsi A, Horninger W, Pedrini M. World record: Single AMS 800 artificial urinary sphincter functioning uninterrupted for 29 years in male paraplegic patient. Urol Case Rep 2020; 32:101240. [PMID: 32426235 PMCID: PMC7225619 DOI: 10.1016/j.eucr.2020.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/26/2022] Open
Abstract
Lapides has revolutionized the treatment of neurogenic patients by introducing routine intermittent catheterization in 1971. This drastically lowered mortality from urosepsis. Scott introduced the artificial urinary sphincter (AUS) in 1972. This gave a completely new perspective for incontinent patients by dramatically increasing the quality of life. In patients with neurogenic urinary incontinence, the principles of care are preserving renal function, maintaining a low-pressure reservoir, allowing unobstructed urine flow and providing continence. We describe a male patient that received an AUS with a bladder neck cuff that functioned without revision for 29 years. After 30 years, AUS exchange proved successful.
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Affiliation(s)
- Peter Rehder
- Medical University Innsbruck, Department of Urology, 35 Anich Street, 6020, Innsbruck, Austria
| | - Jannik Stuehmeier
- Medical University Innsbruck, Department of Urology, 35 Anich Street, 6020, Innsbruck, Austria
| | | | - Alexandra Gulacsi
- Medical University Innsbruck, Department of Urology, 35 Anich Street, 6020, Innsbruck, Austria
| | - Wolgang Horninger
- Medical University Innsbruck, Department of Urology, 35 Anich Street, 6020, Innsbruck, Austria
| | - Marco Pedrini
- Medical University Innsbruck, Department of Urology, 35 Anich Street, 6020, Innsbruck, Austria
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