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Taniguchi H, Takizawa N, Kinoshita H. Prevalence and risk factors for overactive bladder symptoms in patients with artificial urinary sphincter. Sci Rep 2024; 14:20332. [PMID: 39223151 PMCID: PMC11369108 DOI: 10.1038/s41598-024-68313-x] [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: 10/14/2023] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
To demonstrate the prevalence and risk factors for overactive bladder symptoms associated with artificial urinary sphincter implantation, we investigated the patients who underwent primary artificial urinary sphincter implantation with severe urinary stress incontinence. Forty-eight patients who completely answered the questionnaires of the overactive bladder symptom score before surgery were included. Patient characteristics, urinary status at pre and 1, 3, 6, and 12 months post-device activation, and predictive factors for overactive bladder symptoms were examined. Sixty percent of the patients had preoperative overactive bladder symptoms. Until 12 months after device activation, 35-40% of all patients had overactive bladder symptoms. The rate of persistent and de novo postoperative overactive bladder symptoms was 44.8% and 26.3%, respectively. Daily pad use was not different between patients w/wo overactive bladder symptoms. The only risk factor for postoperative overactive bladder symptoms was a max cystometoric capacity < 200 mL measured by a preoperative urodynamic study. Attention must be given to both persistent and de novo overactive bladder symptoms associated with artificial urinary sphincter implantation for patients with stress incontinence. Counsel should equally be provided for preoperative overactive bladder symptoms, especially in cases with a cystometric capacity < 200 mL.
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Affiliation(s)
- Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Nae Takizawa
- Department of Urology and Andrology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
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Bernard C, Bentellis I, El-Akri M, Durand M, Guérin O, Cornu JN, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Lecoanet P, Bruyère F, Capon G, Biardeau X, Karam E, Saussine C, Hermieu JF, Peyronnet B, Game X, Brierre T. Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102604. [PMID: 38417628 DOI: 10.1016/j.fjurol.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. MATERIAL AND METHODS Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). RESULTS Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. CONCLUSION The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Clémence Bernard
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
| | - Imad Bentellis
- Urology Department, Nice University Hospital, Nice, France
| | - Mehdi El-Akri
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Olivier Guérin
- Urology Department, Nice University Hospital, Nice, France
| | | | - Tiffany Cousin
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Hugo Dupuis
- Urology Department, CHU de Rouen, Rouen, France
| | | | | | - Pierre Lecoanet
- Urology Department, Nancy University Hospital, Nancy, France
| | | | - Grégoire Capon
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Biardeau
- Urology Department, Lille University Hospital, Lille, France
| | - Elias Karam
- Visceral Surgery and Liver Transplant Unit, CHU de Tours, Tours, France
| | | | | | | | - Xavier Game
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - Thibaut Brierre
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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Rojas Cruz C, Hakenberg O, Dräger DL. [Use of implants to treat male urinary incontinence]. Aktuelle Urol 2023; 54:449-456. [PMID: 37748511 DOI: 10.1055/a-2108-7615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Treatments for benign and malignant pathologies of the prostate can compromise urine control. Urinary incontinence (UI) affects the quality of life of patients and limits their ability to carry out usual activities. The degree of impact of UI is variable and the associated discomforts make patients seek treatment for it. At the center of the management of urinary incontinence in men are surgical interventions that seek to replace the affected sphincter function through implants. The artificial urinary sphincter since its development in the 1970s has been considered the standard of treatment for UI in men. More recently artificial sphincter and slings have been shown to be effective in a selected group of incontinent men. The goals of surgical treatment of incontinence include the preservation of bladder function, the ability to improve the strength of the urinary sphincter, and to reduce or eliminate urine leakage, and thereby improve the quality of life. The aim of the article is to present various implants for the correction of male urinary incontinence.
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Chung E, Liao L, Kim JH, Wang Z, Kitta T, Lin ATL, Lee KS, Ye L, Chu P, Kaiho Y, Takei M, Jiang H, Lee J, Masuda H, Tse V. The Asia-Pacific AMS800 artificial urinary sphincter consensus statement. Int J Urol 2023; 30:128-138. [PMID: 36375037 PMCID: PMC10100264 DOI: 10.1111/iju.15083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
This Asia-Pacific (AP) AMS 800™ artificial urinary sphincter (AUS) consensus statement aims to provide a set of practical recommendations to assist surgeons with the AMS 800 device surgery. The AP consensus committee consisted of key opinion leaders with extensive experience with AMS 800 surgery across several AP countries. The panel reviewed and discussed relevant findings with emphasis on locoregional and specific clinical challenges relevant to the AP region. Recommendations were made in key areas namely (1) patient selection and informed consent process; (2) preoperative assessment; (3) dealing with co-existing urological disorders; (4) surgical principles and intraoperative troubleshooting; (5) postoperative care; (6) special populations; and (7) cost analysis and comparative review. The AMS 800 device should be offered to males with moderate to severe stress urinary incontinence (SUI). Full informed consent should be undertaken, and emphasis is placed on surgical contraindications and high-risk candidates. The presence of a surgical mentor or referral to experts is recommended in complex AUS candidates. Preoperative cystoscopy with or without multichannel urodynamic study is necessary and patients with pre-existing urological disorders should be treated adequately and clinically stable before surgery. Adherence to strict patient selection and safe surgical principles are critical to ensure excellent clinical outcomes and minimize complications. Given that InhibiZone-coated device is not available in many AP countries, the use of prophylactic antibiotics pre-and post-operatively are recommended. The AMS 800 device should be prepared according to the manufacturer's guidelines and remains a cost-effective treatment for male SUI. The AMS 800 device remains the surgical benchmark for male SUI but is associated with certain mechanical limitations and a unique set of complications.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,AndroUrology Centre, Brisbane, Queensland, Australia
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre and Capital Medical University, Beijing, China
| | - Jang Hwan Kim
- Department of Urology and Urological Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Zhong Wang
- Department of Urology and Andrology, Ninth Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Takeya Kitta
- Department of Urology, Hokkaido University, Sapporo, Japan
| | | | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Liefu Ye
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Peggy Chu
- Department of Surgery, Tuen Mun Hospital, Hong Kong SAR, China
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Hai Jiang
- Department of Urology, the First Affiliated Hospital of Zhejiang University Medical College, Hangzhou, China
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Hitoshi Masuda
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Vincent Tse
- Department of Urology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Altaweel W, Almesned R, Seyam R. A comparison of the perineal and penoscrotal approaches in artificial urinary sphincter implantation for the control of male stress urinary incontinence. Ann Saudi Med 2023; 43:57-61. [PMID: 36739496 PMCID: PMC9899335 DOI: 10.5144/0256-4947.2023.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The two most common surgical approaches to treat stress urinary incontinence in men are the traditional perineal and the new penoscrotal approach for artificial urinary sphincter (AUS) implantation. Each method carries its own advantages and disadvantages. The few reports that compare the approaches have disparate outcomes. OBJECTIVE Compare the outcome of first time AUS implantation by the perineal versus the penoscrotal approach. DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS AND METHODS We included all male patients who underwent primary perineal or penoscrotal AUS placement between June 2004 and October 2018 at our tertiary care hospital. Patients were followed at least one year postoperatively. MAIN OUTCOME MEASURES Rates of dry, infection, erosion, malfunction, atrophy, revision. SAMPLE SIZE 44 males who underwent 68 procedures. RESULTS Twenty-five (56.8%) patients underwent a perineal and 19 (43.2%) underwent a penoscrotal approach. The patients had 68 procedures: 36 (52.9%) perineal and 32 (47.1%) penoscrotal approaches. The median (25th-75th percentiles) age at the time of surgery was 61.0 (51.0-68.0) years (n=68 procedures). The median (25th-75th percentiles) operative time was significantly shorter for the penoscrotal approach, 87 (69-140), vs. 93 (72-210) minutes for the perineal approach (P=.016). The 44 patients were followed up for a mean (SD) of 52.5 (20.3) months for the 68 procedures. Postoperative complications occurred in 16 (36.36%) patients; 11 (44%) perineal approach patients and 5 (26.3%) penoscrotal. There were no significant differences in complications of infection, erosion, malfunction, or urethral atrophy between the two groups. Only removal/revision was significantly more common with the perineal approach (10 patients perineal and two patients penoscrotal, P=.042). At the last follow-up, dryness was comparable among groups. CONCLUSION The outcomes of AUS placement are comparable between perineal and penoscrotal approaches in terms of complications and one year dryness. The penoscrotal approach however has shorter operative time and less need for revision and removal. LIMITATIONS Small sample size, single-center. CONFLICT OF INTEREST None.
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Affiliation(s)
- Waleed Altaweel
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Razan Almesned
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf Seyam
- From the Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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6
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Brierre T, Roumiguie M, Soulie M, Rischmann P, Thoulouzan M, Game X. [Comparison of penoscrotal and perineal approaches for implantation of an artificial urinary sphincter in man]. Prog Urol 2021; 31:1182-1191. [PMID: 34801387 DOI: 10.1016/j.purol.2021.08.238] [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: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Artificial urinary sphincter is considered the gold standard of treatment for male urinary incontinence because of intrinsic sphincter deficiency. The objective of our study was to compare the functional results and complications of the penoscrotal and perineal incision for the implantation of artificial urinary sphincter. MATERIAL AND METHODS A retrospective, monocentric study comparing the perioperative and long-term results of primary implantation of an artificial urinary sphincter in men, performed by the penoscrotal or the perineal incision, was conducted in a French university hospital. RESULTS Between April 2004 and February 2019, 175 patients were implanted (118 by penoscrotal incision and 57 by perineal incision) by 19 surgeons. Cuff placement approach depended on surgeon preference. The average follow-up was 34.2 ± 35.6 months. Cuff size was smaller in the penoscrotal group (4 [4;5] vs 4.5[4;5] p<0.001). At the end of follow-up, the rates of complete continence, social continence, reintervention for any reason, explantation, and revision was similar between the two groups. CONCLUSION Long-term outcomes of penoscrotal and perineal artificial sphincter implantation were similar between the two groups. Prospective multicenter studies are needed to confirm these results.
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Affiliation(s)
- T Brierre
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
| | - M Roumiguie
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - M Soulie
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - P Rischmann
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - M Thoulouzan
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - X Game
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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7
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Khouri RK, Ortiz NM, Dropkin BM, Joice GA, Baumgarten AS, Morey AF, Hudak SJ. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep 2021; 22:30. [PMID: 33779844 DOI: 10.1007/s11934-021-01045-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. RECENT FINDINGS Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.
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Affiliation(s)
- Roger K Khouri
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Adam S Baumgarten
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Waseda Y, Yokoyama M, Toide M, Tokairin Y, Fujii Y. [REPARATIVE SURGERY OF PRESSURE-REGULATING BALLOON HERNIA AFTER ARTIFICIAL URINARY SPHINCTER REPLACEMENT: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2021; 112:150-153. [PMID: 35858811 DOI: 10.5980/jpnjurol.112.150] [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: 06/15/2023]
Abstract
A 74-year-old male with post-prostatectomy incontinence underwent artificial urinary sphincter replacement due to device malfunction. Three months after the replacement surgery, he presented for a consultation due to a bulging area in his lower abdomen. Computed tomography revealed a hernia of the pressure-regulating balloon (PRB), while the device was working well. In the reparative surgery, reopening the lower abdominal incision, the PRB was carefully restored to its previous position after creating a sufficient submuscular space. As the rectus abdominis fascia showed an adequate strength, the fascia was tightly sutured without using a prosthetic mesh. Thereafter, the patient has been free from incontinence for two and a half years without hernia recurrence. Given the mechanical nature of the device, replacement surgery is sometimes required over time. Tissue fragility due to repetitive surgeries and increasing ambient pressure due to space reduction derived from the PRB deflation could cause PRB hernia. Such cases can be treated under careful manipulation without damaging the device. Considering the future potential need for repeated surgery, it would be preferable not to use prosthetic mesh, as it can cause dense adhesion.
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Affiliation(s)
- Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University
- Department of Urology, Tokyo Metropolitan Ohtsuka Hospital
| | | | - Masahiro Toide
- Department of Urology, Tokyo Medical and Dental University
| | - Yutaka Tokairin
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University
- Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University
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Queissert F, Hüsch T, Kretschmer A, Anding R, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Naumann CM, Nyarangi-Dix J, Hofmann T, Rose A, Schweiger J, Hübner W, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. High/low-volume center experience predicts outcome of AMS 800 in male stress incontinence: Results of a large middle European multicenter case series. Neurourol Urodyn 2020; 39:1856-1861. [PMID: 32567709 DOI: 10.1002/nau.24444] [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] [Received: 04/02/2020] [Accepted: 06/07/2020] [Indexed: 11/06/2022]
Abstract
AIM To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study. METHODS As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers. RESULTS Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002). CONCLUSIONS Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Hospital Lueneburg, Lueneburg, Germany
| | - Alexander Friedl
- Department of Urology, Goettlicher Heiland Vienna, Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | | | - Carsten M Naumann
- Department of Urology and Pediatric Urology, St. Elisabeth Hospital, Neuwied, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Josef Schweiger
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Andres J Schrader
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
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10
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Twenty years later: is the scrotal one-incision AUS of value? Int J Impot Res 2020; 34:243-251. [PMID: 32488211 DOI: 10.1038/s41443-020-0317-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
The artificial urinary sphincter, known as AMS 800, has been the gold standard for treating moderate to severe stress urinary incontinence in males for 40 years. Yet, the number of sphincters done globally is quite small and the majority of urologists doing them are infrequent implanters. Estimates for 2019 showed half of implanters did only one implant that year and worldwide only around 13,000 implantations were performed. The traditional two-incision technique of perineal exposure for cuff placement and abdominal incision for pump and pressure regulating balloon persists as the most common technique to surgically place an artificial urinary sphincter. Present estimates are that upwards of 80% are done via the perineal approach and that approach is the highly favored incision of large volume centers. The scrotal one-incision approach was invented by Wilson 20 years ago and was aimed at making the implantation of a sphincter quicker, easier and safer for the occasional implanter. These physicians perform 1-2 devices per year, comprise 60% of implanters who perform the surgery yearly, and implant 22% of all implanted devices. Our article targets these infrequent inserters discussing the history of the two techniques and what the authors have learned about the advantages and hazards of the one scrotal incision procedure over the last two decades.
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Staniorski CJ, Singal A, Nettey O, Yura E, Keeter MK, Kielb S, Hofer MD. Revisiting the penoscrotal approach to artificial urinary sphincter surgery: how does it compare to a perineal incision for initial implantation? World J Urol 2020; 39:871-876. [PMID: 32440696 DOI: 10.1007/s00345-020-03244-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Artificial urinary sphincters (AUS) remain the gold standard to treat male stress urinary incontinence. AUS implantation can be performed through a penoscrotal or perineal incision depending on surgeon preference. METHODS The present study compares initial AUS implantation through two surgical approaches focusing on outcomes of continence and revision. All AUS implanted at an academic medical center between 2000 and 2018 were retrospectively reviewed. RESULTS A total of 225 AUS implantations were identified, of which, 114 patients who underwent virgin AUS placement were included in the study with a mean follow-up of 28.5 months. A total of 68 patients (59.6%) had AUS placement through penoscrotal incision; while, 46 (40.4%) had a perineal incision. While operative time was significantly shorter for penoscrotal placement (98.6 min vs. 136.3 min, p = 0.001), there were no significant differences in continence rates between either surgical approach with 76.5% socially continent defined as using zero to less than 1 pad per day (safety pad). The overall rate of device erosion or infection was not significantly different between groups. However, the rate of revision or replacement was significantly higher in the perineal group (26.1% v. 8.8%; p = 0.01). On multivariate analysis, the penoscrotal incision predicted a lower rate of device revision (p = 0.01). CONCLUSIONS The penoscrotal approach of AUS placement is associated with shorter operative time. While we observed a lower revision rate compared to the perineal approach, there were equivalent continence outcomes.
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Affiliation(s)
| | - Ashima Singal
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Oluwarotimi Nettey
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Yura
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthias D Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Abstract
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
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Affiliation(s)
- Kole P Akula
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
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13
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Queissert F, Huesch T, Kretschmer A, Anding R, Kurosch M, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Pfitzenmaier J, Naumann CM, Wotzka C, Nyarangi-Dix J, Hoffmann T, Herrmann E, Obaje A, Rose A, Homberg R, Abdunnur R, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study. Int Neurourol J 2019; 23:219-225. [PMID: 31607101 PMCID: PMC6790824 DOI: 10.5213/inj.1938032.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter. METHODS A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project. RESULTS Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P<0.001). Multivariate analysis showed that, apart from cuff size (P=0.03), prior irradiation (P<0.001) and the penoscrotal approach (P=0.036) were associated with an increased erosion rate. Continence rate tended to be highest with median cuff sizes (4-5.5 cm). CONCLUSION Apart from irradiation and the penoscrotal approach, small cuff size is a risk factor for urethral erosion. Results are best with cuff sizes of 4.5-5.5 cm.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
| | - Tanja Huesch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
| | - Ralf Anding
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Lueneburg Hospital, Lueneburg, Germany
| | - Alexander Friedl
- Department of Urology, Goettlicher Heiland Hospital of Vienna, Vienna, Austria
| | | | - Carsten M. Naumann
- Department of Urology and Pediatric Urology, University Hospital of Kiel, Kiel, Germany
| | - Carola Wotzka
- Department of Urology, Diaconal Hospital of Stuttgart, Stuttgart, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Torben Hoffmann
- Department of Urology, Diaconal Hospital of Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Edwin Herrmann
- Department of Urology and Robotic Surgery, Prosper-Hospital, Recklinghausen, Germany
| | - Alice Obaje
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | - Rudi Abdunnur
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
| | - Ricarda M. Bauer
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Andres J. Schrader
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
| | - Debates on Male Incontinence (DOMINO)-Project
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
- Department of Urology, Lueneburg Hospital, Lueneburg, Germany
- Department of Urology, Goettlicher Heiland Hospital of Vienna, Vienna, Austria
- Department of Urology, Bethel Evangelical Hospital, Bielefeld, Germany
- Department of Urology and Pediatric Urology, University Hospital of Kiel, Kiel, Germany
- Department of Urology, Diaconal Hospital of Stuttgart, Stuttgart, Germany
- Department of Urology and Pediatric Urology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Urology, Diaconal Hospital of Schwaebisch Hall, Schwaebisch Hall, Germany
- Department of Urology and Robotic Surgery, Prosper-Hospital, Recklinghausen, Germany
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
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14
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Loh-Doyle JC, Ashrafi A, Nazemi A, Ghodoussipour S, Thompson E, Wayne K, Boyd SD. Dual Prosthetic Implantation After Radical Cystoprostatectomy and Neobladder: Outcomes of the Inflatable Penile Prosthesis and Artificial Urinary Sphincter in Bladder Cancer Survivors. Urology 2019; 127:127-132. [PMID: 30664894 DOI: 10.1016/j.urology.2019.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To determine the impact of radical cystectomy and orthotopic neobladder (NB) diversion on device-related outcomes in patients who undergo subsequent placement of both, an artificial urinary sphincter (AUS) and 3-piece inflatable penile prosthesis. MATERIALS AND METHODS Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n = 48, non-neobladder group). RESULTS No intraoperative complications were observed. After median follow-up of 94 months (12-177 months), 1 patient developed an infection of their penile prosthesis and 4 patients developed an erosion of their AUS. In each case, the infection did not involve the other device. Two patients required revision surgery of their penile prosthesis due to mechanical failure (reservoir leak, n = 1; cylinder aneurysm, n = 1). Twenty-one patients underwent elective revision surgery to improve continence (cuff downsizing, n = 18; pressure-regulating balloon exchange, n = 3). There were 6 cases of AUS mechanical failure. No reservoir-related complications such as herniation or erosion were observed. Compared to the control group of non-neobladder patients, there were no significant differences in prosthetic infection, mechanical failure, and revision surgery. CONCLUSION The AUS and 3-piece inflatable penile prosthesis can coexist safely in patients with NB without an increased risk of device-related complications.
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Affiliation(s)
- Jeffrey C Loh-Doyle
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Akbar Ashrafi
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Azadeh Nazemi
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Eli Thompson
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kevin Wayne
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stuart D Boyd
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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15
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Impact of Radiation and Transcorporeal Artificial Sphincter Placement in Patients with Prior Urethral Cuff Erosion: Results from a Retrospective Multicenter Analysis. J Urol 2018; 200:1338-1343. [DOI: 10.1016/j.juro.2018.06.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 11/13/2022]
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16
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The assessment and management of post-prostatectomy stress urinary incontinence. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Kaiho Y, Masuda H, Takei M, Hirayama T, Mitsui T, Yokoyama M, Kitta T, Kawamorita N, Nakagawa H, Iwamura M, Arai Y. Surgical and Patient Reported Outcomes of Artificial Urinary Sphincter Implantation: A Multicenter, Prospective, Observational Study. J Urol 2018; 199:245-250. [DOI: 10.1016/j.juro.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Yasuhiro Kaiho
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hitoshi Masuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takahiko Mitsui
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Nakagawa
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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18
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Benson CR, Ayoub HI, Westney OL. Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement. Int Braz J Urol 2017; 44:355-361. [PMID: 29144629 PMCID: PMC6050573 DOI: 10.1590/s1677-5538.ibju.2017.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/29/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE We present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy. MATERIALS AND METHODS We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model. RESULTS The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications. CONCLUSIONS We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.
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Affiliation(s)
- Cooper R Benson
- University of Texas Health Science Center At Houston McGovern Medical School, USA
| | - Hajar I Ayoub
- University of Texas Health Science Center At Houston McGovern Medical School, USA
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19
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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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20
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The Artificial Urinary Sphincter: Evolution and Implementation of New Techniques in the Man with Stress Incontinence After Treatment for Prostate Cancer. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Yafi FA, DeLay KJ, Stewart C, Chiang J, Sangkum P, Hellstrom WJ. Device Survival after Primary Implantation of an Artificial Urinary Sphincter for Male Stress Urinary Incontinence. J Urol 2017; 197:759-765. [DOI: 10.1016/j.juro.2016.08.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Faysal A. Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kenneth J. DeLay
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Carrie Stewart
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jason Chiang
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wayne J.G. Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana
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22
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Collado Serra A, Domínguez-Escrig J, Gómez-Ferrer Á, Batista Miranda E, Rubio-Briones J, Solsona Narbón E. Prospective follow-up study of artificial urinary sphincter placement preserving the bulbospongiosus muscle. Neurourol Urodyn 2016; 36:1387-1394. [DOI: 10.1002/nau.23119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - José Rubio-Briones
- Department of Urology; Instituto Valenciano de Oncología; Valencia Spain
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23
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Kretschmer A, Hüsch T, Thomsen F, Kronlachner D, Obaje A, Anding R, Pottek T, Rose A, Olianas R, Friedl A, Hübner W, Homberg R, Pfitzenmaier J, Grein U, Queissert F, Naumann CM, Schweiger J, Wotzka C, Nyarangi-Dix JN, Hofmann T, Seiler R, Haferkamp A, Bauer RM. Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series. Urol Int 2016; 97:205-11. [DOI: 10.1159/000446351] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
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24
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Bauer RM, Oelke M, Hübner W, Grabbert M, Kirschner-Hermanns R, Anding R. [Urinary incontinence in men]. Urologe A 2016; 54:887-99; quiz 900. [PMID: 26081822 DOI: 10.1007/s00120-015-3826-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.
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Affiliation(s)
- R M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland,
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25
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Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and Management of Postprostatectomy Incontinence: A Systematic Review of Current Literature. Eur Urol Focus 2016; 2:245-259. [PMID: 28723370 DOI: 10.1016/j.euf.2016.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/22/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Radical prostatectomy is the most common reason for male stress urinary incontinence. There is still uncertainty about its diagnostic and therapeutic management. OBJECTIVE To evaluate current evidence regarding the diagnosis and therapy of postprostatectomy incontinence (PPI). EVIDENCE ACQUISITION A systematic review of the literature was performed in October 2015 using the Medline database. EVIDENCE SYNTHESIS Diagnosis and conservative treatment of PPI are currently mostly based on expert opinions. Pelvic floor muscle training is the noninvasive treatment of choice of PPI. For invasive management of moderate to severe PPI, the artificial urinary sphincter is still the treatment of choice, but an increasing number of adjustable and nonadjustable, noncompressive as well as compressive devices are used more frequently. However, no randomized controlled trial has yet investigated the outcome of one specific surgical treatment or compared the outcome of different surgical treatment options. CONCLUSIONS The level of evidence addressing the surgical management of PPI is still unsatisfactory. Further research is urgently needed. PATIENT SUMMARY Incontinence after the removal of the prostate (postprostatectomy incontinence) is the most common cause of male stress urinary incontinence. First-line therapy is physiotherapy and lifestyle changes. If no satisfactory improvement is obtained, various surgical treatment options are available. The most commonly used is the artificial urinary sphincter, but other treatment options like male slings are also available.
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Affiliation(s)
- Alexander Kretschmer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany.
| | - Wilhelm Hübner
- Landesklinikum Weinviertel Korneuburg, Klinik für Urologie, Kornneuburg, Austria
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricarda M Bauer
- Ludwig-Maximilians-Universität, Urologische Klinik und Poliklinik, Campus Großhadern, Munich, Germany
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27
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Kretschmer A, Buchner A, Grabbert M, Stief CG, Pavlicek M, Bauer RM. Risk factors for artificial urinary sphincter failure. World J Urol 2015; 34:595-602. [PMID: 26253655 DOI: 10.1007/s00345-015-1662-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/31/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To analyze revision rates and risk factors for artificial urinary sphincter failure. METHODS Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan-Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant. RESULTS After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure. CONCLUSIONS Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.
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Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Micaela Pavlicek
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
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28
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Reznicek DG, Bryson R, Kramer AC. Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon. Sex Med Rev 2015; 3:48-55. [DOI: 10.1002/smrj.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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29
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[Diagnosis and surgical treatment of postprostatectomy stress incontinence: recommendation of the working group Urologische Funktionsdiagnostik und Urologie der Frau]. Urologe A 2015; 53:847-53. [PMID: 24903836 DOI: 10.1007/s00120-014-3531-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Today, for the surgical treatment of postprostatectomy incontinence, several treatment options are available, e.g., adjustable and functional sling systems, artificial sphincter, bulking agents, and balloons. However, no recommendations in terms of specific diagnostic tools and differentiated treatment options for everyday life are available. Our aim is to provide some clinically relevant recommendations for the necessary diagnostic workup and different treatment options of postprostatetectomy incontinence to support clinical decisions in everyday life. Treatment selection should be based on contraindications. However, there is a broad overlap of the various surgical options.
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30
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Hamann MF, Naumann CM, Knüpfer S, Jünemann KP, Bauer R. [Urogynecology II: urinary incontinence in men and women: surgical treatment of urinary incontinence and prolapse]. Urologe A 2014; 53:1671-80; quiz 1681-2. [PMID: 25316184 DOI: 10.1007/s00120-014-3607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Numerous surgical procedures are available for the treatment of stress urinary incontinence in women and men. On a par with classical therapy options (e.g. colposuspension and artificial sphincter prosthesis) suburethral tape procedures have become established as the minimally invasive standard of care. Regarding comorbidities and recurrent urinary incontinence, therapeutic procedures should be modified on an individual basis. It is crucial to involve patients in therapeutic decision-making and counseling should be given with respect to all conservative and operative alternatives.
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Affiliation(s)
- M F Hamann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold Heller Str. 7, 24105, Kiel, Deutschland,
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Selph JP, McKim SE, Langston JP, Carson CC. Deep Venous Thrombosis as a Complication of Reservoir Placement in Post-Prostatectomy Erectile Dysfunction and Urinary Incontinence Prosthetic Surgery. Sex Med Rev 2014; 2:59-63. [PMID: 27784590 DOI: 10.1002/smrj.28] [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
INTRODUCTION In 2014, most radical surgery for carcinoma of the prostate, and often the bladder, is done with the robotic-assisted laparoscopic approach. While proponents argue that nerve sparing, blood loss, and recovery times are improved with the robotic-assisted approach, changes in postoperative pelvic anatomy have made subsequent placement of inflatable devices for erectile dysfunction and incontinence more difficult. Because of the obliteration of the space of Retzius and opening of the peritoneum, the classic placement of the reservoirs of these devices is compromised. AIM Ectopic reservoir placement has attempted to alleviate these problems, but reservoir migration and problematic locations of these reservoirs persist. METHOD We report two cases of deep venous thrombosis after reservoir placement for inflatable prosthetic devices. MAIN OUTCOME MEASURE AND RESULTS Patients may manifest these placement problems with symptoms of vascular compromise postoperatively. CONCLUSION Early identification and reservoir relocation can eliminate the vascular issues and maintain inflatable device function. Selph JP, McKim SE, Langston JP, and Carson CC. Deep venous thrombosis as a complication of reservoir placement in post-prostatectomy erectile dysfunction and urinary incontinence prosthetic surgery. Sex Med Rev 2014;2:59-63.
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Affiliation(s)
- John Patrick Selph
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen E McKim
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Culley C Carson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
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[Modern operative treatment possibilities in male stress urinary incontinence]. Urologe A 2014; 53:339-40, 342, 344-5. [PMID: 24522693 DOI: 10.1007/s00120-013-3351-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postprostatectomy incontinence (PPI) is one of the most feared complications of radical prostatectomy with major impact on quality of life and social well-being. In recent years due to improved surgical techniques a reduction of the postoperative incontinence rate was achieved. However, due to the increasing number of radical prostatectomies performed for prostate cancer, a substantial and increasing number of patients are suffering from postoperative stress urinary incontinence. If conservative treatment fails, surgical therapy is recommended. For decades, the artificial urinary sphincter was the reference standard for moderate to severe postoperative male stress urinary incontinence. However, patients' demand on minimally invasive treatment options is high. Age or advanced prostate cancer should not be an exclusion criterion for surgical treatment of persistent PPI.
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Sathianathen NJ, McGuigan SM, Moon DA. Outcomes of artificial urinary sphincter implantation in the irradiated patient. BJU Int 2014; 113:636-41. [DOI: 10.1111/bju.12518] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Segal RL, Cabrini MR, Harris ED, Mostwin JL, Bivalacqua TJ, Burnett AL. Combined Inflatable Penile Prosthesis-Artificial Urinary Sphincter Implantation: No Increased Risk of Adverse Events Compared to Single or Staged Device Implantation. J Urol 2013; 190:2183-8. [DOI: 10.1016/j.juro.2013.06.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Robert L. Segal
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mercelo R. Cabrini
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Elaine D. Harris
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jacek L. Mostwin
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Trinity J. Bivalacqua
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Arthur L. Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Islah M, Cho SY, Son H. The current role of the artificial urinary sphincter in male and female urinary incontinence. World J Mens Health 2013; 31:21-30. [PMID: 23658862 PMCID: PMC3640149 DOI: 10.5534/wjmh.2013.31.1.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/20/2012] [Accepted: 01/03/2013] [Indexed: 01/27/2023] Open
Abstract
The evolution of the artificial urinary sphincter has affected the current surgical options for urinary incontinence. With its unique features, the artificial urinary sphincter (AUS) has been an attractive option for the treatment of urinary incontinence regardless of gender. The current paper discusses the indications, contraindications, types of devices, surgical approaches, outcomes, and complications of the AUS in the treatment of both male and female urinary incontinence. A PubMed review of the available literature was performed and articles reporting implantation of artificial urinary sphincters for urinary incontinence in both male and female patients were evaluated. There was a comparable satisfactory continence rate after the implantation of an AUS (59~97% in males vs. 60~92% in females). In comparison, there were some differences in the indications, contraindications, surgical approaches, outcomes, and complications of the AUS implanted for urinary incontinence in male and female patients. AUS implantation is a safe and effective surgical option for the treatment of urinary incontinence of various etiologies. Continuous evolution of the device has made it an attractive option for the treatment of both male and female urinary incontinence.
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Affiliation(s)
- Mar Islah
- Urology Unit, Department of Surgery, Kulliyyah of Medicine, Jalan Hospital, International Islamic University, Kuantan, Malaysia
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The experience of artificial urinary sphincter implantation by a single surgeon in 15 years. Kaohsiung J Med Sci 2013; 29:157-60. [DOI: 10.1016/j.kjms.2012.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/06/2011] [Indexed: 11/22/2022] Open
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Lee D, Romero C, Alba F, Westney OL, Wang R. Simultaneous penile prosthesis and male sling/artificial urinary sphincter. Asian J Androl 2012. [PMID: 23202702 DOI: 10.1038/aja.2012.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.
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Affiliation(s)
- Dominic Lee
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Anusionwu I, Miles-Thomas J, Hernandez DJ, Wright EJ. Anatomical and Manometric Comparison of Perineal and Transscrotal Approaches to Artificial Urinary Sphincter Placement. J Urol 2012; 188:1834-6. [DOI: 10.1016/j.juro.2012.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Indexed: 10/27/2022]
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Staerman F, G-Llorens C, Leon P, Leclerc Y. ZSI 375 artificial urinary sphincter for male urinary incontinence: a preliminary study. BJU Int 2012; 111:E202-6. [PMID: 22937774 DOI: 10.1111/j.1464-410x.2012.11468.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess retrospectively the safety and efficacy of an artificial urinary sphincter, the ZSI 375 device (Zephyr Surgical Implants, Geneva, Switzerland), in male patients with moderate-to-severe stress urinary incontinence after a prostate or bladder intervention. PATIENTS AND METHODS The ZSI 375 device is a one-piece device consisting of an adjustable cuff, moulded to fit around the urethra, which is connected by a tube to a pump and a pressure-regulating tank. It has no abdominal reservoir. Patients underwent a perineal incision for cuff placement and an inguinal incision for pump and tank scrotal placement. Complications and pads used to manage incontinence were recorded. RESULTS Between May 2009 and April 2011, 36 patients underwent ZSI 375 device placement. The median (range) follow-up was 15.4 (6-28) months. No patient experienced bladder overactivity, chronic urinary retention, or any other adverse effect after device activation. Complications leading to device removal arose in four patients (one case of erosion, three cases of infection). Social continence (0 or 1 pad/day) was achieved in 28/36 patients (78%) at 3 months and 26/36 patients (73%) at 6 months after device activation. In 12/14 patients for a sphincter closure pressure range of 60-70 cm H2O, in 3/3 patients for a range of 70-80 cm H2O and in 2/11 for a range of 90-100 cm, H2O social continence was achieved only after increasing the pressure of the cuff by trans-scrotal injection of saline. CONCLUSIONS The ZSI 375 device is safe and effective but our follow-up may not have been long enough to identify all potential complications. Further research is needed to confirm these results and extend our investigation, for instance, to the peno-scrotal approach.
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Shen YC, Chiang PH. Is the penoscrotal approach inferior to the perineal approach for artificial sphincter implantation in male urinary incontinence? A preliminary experience. Int J Urol 2012; 19:786-9. [DOI: 10.1111/j.1442-2042.2012.03013.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dual implantation of artificial urinary sphincter and inflatable penile prostheses for concurrent male urinary incontinence and erectile dysfunction. Adv Urol 2011; 2011:178312. [PMID: 22162678 PMCID: PMC3226319 DOI: 10.1155/2011/178312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/04/2011] [Indexed: 11/24/2022] Open
Abstract
Erectile dysfunction and urinary incontinence secondary to sphincter dysfunction are common conditions affecting many men worldwide with a negative effect on quality of life. They are encountered in a number of etiologies most commonly following radical prostatectomy in which they coexist in the same patient. Implantations of an artificial urinary sphincter and inflatable penile prosthesis have proven to be effective in the treatment of both conditions should conservative and minimally invasive measures fail. The recent literature has shown that dual implantation of these devices is feasible and safe with a durable clinical outcome. Once indicated, this can be done in a synchronous or nonsynchronous manner; however, the emerging of the single transverse scrotal incision as well as advancement in the prostheses has made synchronous dual implantation more favourable and appealing option. It provides time and cost savings with an evidence of high patient satisfaction. Synchronous dual implantation should be offered initially when indicated. This paper discusses the surgical techniques of artificial urinary sphincter and inflatable penile prosthesis dual implantation in the management of concurrent moderate-to-severe urinary incontinence and medically refractive erectile dysfunction, in addition to highlighting the existing literature pertaining to this approach.
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Bauer RM, Gozzi C, Hübner W, Nitti VW, Novara G, Peterson A, Sandhu JS, Stief CG. Contemporary management of postprostatectomy incontinence. Eur Urol 2011; 59:985-96. [PMID: 21458914 DOI: 10.1016/j.eururo.2011.03.020] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT In recent years, despite improvement in the surgical technique, the prevalence of postprostatectomy incontinence has increased due to a rise in the number of radical prostatectomies performed annually. OBJECTIVE The aim of this review is to evaluate contemporary noninvasive and invasive treatment options for postprostatectomy incontinence. EVIDENCE ACQUISITION In August 2010, a review of the literature was performed using the Medline database. EVIDENCE SYNTHESIS All articles concerning noninvasive and invasive treatment for postprostatectomy incontinence were included. CONCLUSIONS No randomised controlled trials exist to compare currently used noninvasive and invasive treatments for postprostatectomy incontinence. Pelvic floor muscle training is recommended for the initial treatment of stress urinary incontinence (SUI). Additionally, antimuscarinic therapy should be applied for urgency or urge incontinence. For decades, the artificial urinary sphincter was the reference standard for persistent SUI. Nowadays, male slings are an alternative for men with mild to moderate postprostatectomy SUI.
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Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilian-University, Munich, Germany.
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Current Opinion in Urology. Current world literature. Curr Opin Urol 2010; 20:533-8. [PMID: 20940575 DOI: 10.1097/mou.0b013e32834028bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bibliography: Current world literature. Female urology. Curr Opin Urol 2010; 20:343-6. [PMID: 20531093 DOI: 10.1097/mou.0b013e32833bd73a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Asynchronous implantation of a penile prosthesis (AMS 700) in patients with an artificial urinary sphincter (AMS 800): what functional outcomes can we expect from the AMS 1500?]. Prog Urol 2010; 22:354-9. [PMID: 22541906 DOI: 10.1016/j.purol.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/27/2011] [Accepted: 12/11/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report the functional results and morbidity after metachronous implantation of an AMS 800 artificial urinary sphincter (AUS) and an AMS 700 inflatable penile prosthesis (IPP). PATIENTS AND METHODS From the 250 patients treated in our department between 2000 and 2011 for the insertion of an AUS, we retrospectively selected patients who also underwent implantation of an IPP. The following data were recorded: age, aetiology of urinary incontinence (UI) and erectile dysfunction (ED), treatment history of UI/ED, date of insertion of the AUS and the IPP and time gap between the two implants. We evaluated both the pad-test and the number of protective pads used per day, before and after AUS insertion. We also analysed the IIEF5 score before and after IPP. Patients were reviewed at 3, 6 and 12 months and annually thereafter. RESULTS In total, five patients were included. The median age was 69 years. The median follow-up after IPP was 22.6 months and the time gap between the two implants was 50 months. The aetiology of UI and ED was prostate surgery in four cases. Complete continence without leakage was observed in three patients and the IIEF5 score increased from 6.6 preoperatively to 22.2 for four patients. One patient developed a urethral erosion of the AUS cuff 6 months after implantation of the IPP. The AUS cuff has been explanted but the patient remains continent with the IPP cylinders semi-inflated. CONCLUSION From our small study, it appears that the combined use of an AMS 800 AUS and an AMS 700 IPP was a feasible and efficacious option in patients with concomitant refractory UI and ED.
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Djakovic N, Huber J, Nyarangi-Dix J, Hohenfellner M. Der artifizielle Sphinkter für die Inkontinenztherapie. Urologe A 2010; 49:515-24. [DOI: 10.1007/s00120-010-2265-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Placement of artificial urinary sphincters: perineal or penoscrotal? Nat Rev Urol 2009. [DOI: 10.1038/nrurol.2009.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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