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Findlay BL, Fadel A, Pence ST, Britton CJ, Linder BJ, Elliott DS. Natural History of Artificial Urinary Sphincter Erosion: Long-term Lower Urinary Tract Outcomes and Incontinence Management. Urology 2024:S0090-4295(24)00506-5. [PMID: 38944387 DOI: 10.1016/j.urology.2024.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/02/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To describe long-term lower urinary tract outcomes and incontinence management after AUS erosion, including risk factors associated with each outcome. METHODS We retrospectively reviewed our prospectively maintained AUS database for men undergoing device explantation for urethral erosion from January 1, 1986 to October 10, 2023. Outcomes included development of urethral stricture and management of post-explant incontinence (eg, pads/clamp, catheter, salvage AUS, supravesical diversion). Risk factors were tested for association with stricture formation and repeat AUS erosion using logistic regression. RESULTS Around 1943 unique patients underwent AUS implantation during the study period, and 217 (11%) had a device explantation for urethral erosion. Of these, 194 had complete records available and were included for analysis. Median follow-up from implantation was 7.5 years (IQR 2.7-13.7) and median time to erosion was 2 yrs (IQR 0-6). Ninety-six patients (49%) underwent salvage AUS placement. Of those, 38/96 (40%) were explanted for subsequent erosion. On multivariable analysis, no factors were significantly associated with risk of salvage AUS erosion. On multivariable model, pelvic radiation (OR 2.7; 95% CI 1.0-7.4) and urethral reapproximation during explant for erosion (OR 4.2; 95% CI 1.5-11.2) were significantly associated with increased risk of urethral stricture (P <.05). At the time of last follow-up, 69/194 (36%) patients had a functioning salvage AUS, including both initial and subsequent salvage implants. CONCLUSION Following AUS erosion, radiation history and urethral reapproximation at explantation were risk factors for development of urethral stricture. Salvage AUS replacement can be performed, but has a higher rate of repeat urethral erosion.
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Pitout A, Lecoanet P, Mazeaud C, Gaillard V, Poussot B, Tricard T, Saussine C, Brierre T, Game X, Beraud F, Biardeau X, Bruyere F, Robin D, El-Akri M, Chevallier D, Cousin T, Capon G, Cornu JN, Dupuis H, Monsaint H, Hermieu N, Hermieu JF, Léon P, Peyronnet B, Bentellis I. Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients. Int Neurourol J 2024; 28:147-155. [PMID: 38956774 PMCID: PMC11222826 DOI: 10.5213/inj.2448086.043] [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: 02/06/2024] [Accepted: 04/23/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort. METHODS We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components. RESULTS The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039). CONCLUSION In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.
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Affiliation(s)
- Alice Pitout
- Nancy Regional University Hospital Center Department of Urology, Nancy, France
| | - Pierre Lecoanet
- Clinic Louis Pasteur Department of Urology, Essey-lès-Nancy, France
| | - Charles Mazeaud
- Nancy Regional University Hospital Center Department of Urology, Nancy, France
| | | | | | | | | | | | - Xavier Game
- University Hospital of Toulouse, Toulouse, France
| | | | | | | | | | - Mehdi El-Akri
- University Hospital of Rennes Department of Urology, Rennes, France
| | | | | | | | | | | | | | | | | | | | - Benoit Peyronnet
- University Hospital of Rennes Department of Urology, Rennes, France
| | - Imad Bentellis
- University Hospital of Nice Department of Urology, Nice, France
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Loh-Doyle JC, Markarian E, Boyd SD, Ginsberg D. The 51-60 cm H 2O Artificial Urinary Sphincter Pressure Regulating Balloon: Indications and Outcomes. Urology 2024; 183:221-227. [PMID: 37805051 DOI: 10.1016/j.urology.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To describe the role and long-term outcomes of using the 51-60cm H2O pressure regulating balloon (PRB) in male patients with an artificial urinary sphincter (AUS). METHODS From 2005-2021, 90 patients with a variety of urethral risk factors underwent AUS placement with use of the low-pressure 51-60 cm H2O PRB to treat stress incontinence. Patient demographics, indication for use of the 51-60 cm H2O PRB, perioperative data, and postoperative outcomes were examined and Pearson's chi squared test and Wilcoxon rank sum test were used to identify associations with future revisions, erosion, and mechanical failure. RESULTS Ninety patients were included in the study. After median follow-up of 46.6months (range: 6-146months), 4 (4.44%) patients developed an erosion-related complication that required device removal, 4 developed an infection, and 3 underwent surgery for pump relocation. One patient had a reported mechanical failure of unknown source. Thirty patients underwent revision surgery to reduce incontinence. Of the 4 patients with erosion, 1 was due to iatrogenic catheterization. The remaining 3 had numerous urethral risk factors. Univariate analysis was performed to identify predictors of cuff erosion, infection, and revision in patients with a 51-60 cm H2O PRB. No significant associations were found including prior pelvic radiation, age at AUS placement, presence of inflatable penile prosthesis (IPP), prior AUS erosion, or previous urethroplasty. CONCLUSION The low-pressure 51-60 cm H2O PRB can be used in high-risk male patients with urinary incontinence with low rates of complications including erosion, infection, and mechanical failure. While patients may choose to undergo future revisional surgery to improve continence, the 51-60 cm H2O PRB should be considered as the initial PRB in patients with urethral risk factors.
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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.
| | - Emily Markarian
- 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
| | - David Ginsberg
- USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Sacco E, Marino F, Gandi C, Bientinesi R, Totaro A, Moretto S, Gavi F, Campetella M, Racioppi M. Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes. J Clin Med 2023; 12:jcm12083021. [PMID: 37109357 PMCID: PMC10141998 DOI: 10.3390/jcm12083021] [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: 02/26/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800®) transalbugineal implantation. At a median (IQR) follow-up of 60 (24-84) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04-98.92) and 91.76% (95% CI: 75.23-97.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0-1 pads per day) rate was 82.98% (CI 95%: 68.83-91.10) at 12 mos and 76.81% (CI 95%: 60.56-87.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence.
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Affiliation(s)
- Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefano Moretto
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Kurtzman JT, Kerr P, Blum R, Han DS, Baas W, Argade S, Brandes SB. The role of transcorporal cuff placement in high-risk and ultra-high-risk patients: are they actually helpful? World J Urol 2023; 41:879-884. [PMID: 36749394 DOI: 10.1007/s00345-023-04284-4] [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: 09/29/2022] [Accepted: 01/02/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the incidence of artificial urinary sphincter (AUS) explant in high-risk patients and to evaluate the relationship between transcorporal cuff (TCC) placement and explant risk in this population. METHODS We retrospectively reviewed all AUS insertions performed on high-risk patients by a single surgeon from 2010 to 2020. "High-risk" was defined as having ≥ 1 urethral risk factor: pelvic radiation, urethroplasty, recalcitrant urethral/bladder neck stenosis, urethral stenting, or previous AUS erosion/infection. Patients with ≥ 2 factors were "ultra-high-risk." Time-to-event analyses were used to assess all-cause-, infection/erosion-related-, and mechanical failure-related explant-free survival. Subgroup analyses were performed for patients with a history of radiation and urethral dissection. RESULTS The final cohort included 68 men, mean age of 67 years (SD 11), and 77 AUS cuffs. Mean follow-up was 32 months (IQR 6-50). 29% of cuffs (n = 22) were transcorporal. 32 cuffs (42%) were explanted. All-cause explant-free survival was 64% at 1 year and 52% at 2 years. Classification as "ultra-high-risk" was not associated with explant risk (all p-values > 0.05). TCC placement was associated with an increased risk of explant for infection/erosion across all patients (HR 2.74, p = 0.03) and in radiated patients (n = 50; HR 4.1, p = 0.04), but not in patients with prior urethral dissection (n = 52; HR 1.98, p = 0.21). CONCLUSION High-risk patients have a high rate of AUS explant and TCC placement may not be protective in this population. TCC placement was associated with an increased risk of infection/erosion in radiated patients, but not in those with a history of open urethral surgery.
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Affiliation(s)
- Jane T Kurtzman
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA
| | - Preston Kerr
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA
| | - Ruth Blum
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA
| | - David S Han
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA
| | - Wesley Baas
- Division of Urology, Washington University, St. Louis, MO, USA
| | - Shilpa Argade
- Division of Urology, Washington University, St. Louis, MO, USA
| | - Steven B Brandes
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY, 10032, USA.
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Miller D, Pekala K, Zhang X, Orikogbo O, Rogers D, Fuller TW, Maganty A, Rusilko P. Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation. Cureus 2022; 14:e25519. [PMID: 35800826 PMCID: PMC9246464 DOI: 10.7759/cureus.25519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/29/2022] [Indexed: 11/05/2022] Open
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7
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Mamane J, Sanchez S, Lellouch AG, Gaillard V, Poussot B, Tricard T, Saussine C, Brierre T, Game X, Beraud F, Biardeau X, Bruyere F, Robin D, El-Akri M, Chevallier D, Durand M, Bentellis I, Cousin T, Capon G, Cornu JN, Dupuis H, Monsaint H, Corbel L, Hermieu N, Hermieu JF, Pitout A, Lecoanet P, Peyronnet B, Leon P. Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study. Neurourol Urodyn 2021; 41:332-339. [PMID: 34816473 DOI: 10.1002/nau.24825] [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: 07/10/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the impact of an history of radiation therapy on the outcomes of artificial urinary sphincter (AUS) implantation in male patients. METHODS The charts of all patients who underwent AUS implantation for stress urinary incontinence (SUI) after prostate surgery in thirteen centers between 2004 and 2020 were retrospectively reviewed. We excluded patients with neurogenic SUI. Continence rates and incidence of complications, revision and cuff erosion were evaluated. The outcomes in irradiated men were compared to those of non irradiated men. RESULTS A total of 1277 patients who had an AUS met the inclusion criteria with a median age of 70 years, of which 437 had an history of prior radiotherapy. There was no difference in comorbidities. In irradiated patients, postoperative social continence, urethral atrophy and infection rates were respectively 75.6%, 2.4% and 9.5% and 76.8%, 5.4%, and 5.8% in nonirradiated men (respectively, p = 0.799, p = 0.128, p = 0.148). There were more urethral erosion in irradiated male patients. After a mean follow up of 36.8 months, the explantation free survival was poorer in irradiated patients (p = 0.001). CONCLUSION These data suggest that pelvic radiotherapy before AUS adversely affect device survival with and increased greater occurrence of infection-erosion and therefore of explantation.
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Affiliation(s)
- Jordan Mamane
- Department of Urology, University of Reims, Reims, France
| | - Stéphane Sanchez
- Department of Medical Information Evaluation and Performance, Troyes Hospital, Troyes, France
| | - Alexandre G Lellouch
- Department of Plastic Reconstructive Surgery, European Georges Pompidou Hospital, Paris, France.,Division of Plastic and Reconstructive Surgery, and Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Gaillard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Baptiste Poussot
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | - Thibaut Brierre
- Department of Urology, University of Toulouse, Toulouse, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
| | - Florian Beraud
- Department of Urology, University of Lille, Lille, France
| | | | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | - Damien Robin
- Department of Urology, University of Reims, Reims, France
| | - Mehdi El-Akri
- Department of Urology, University of Nice, Nice, France
| | | | | | - Imad Bentellis
- Department of Urology, University of Rennes, Rennes, France
| | - Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Hugo Dupuis
- Department of Urology, University of Rouen, Rouen, France
| | | | - Luc Corbel
- Department of Urology, Clinic Plérin, Plérin, France
| | | | | | - Alice Pitout
- Department of Urology, University of Nancy, Nancy, France
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Chertack NA, Caldwell KM, Joice GA, Kavoussi M, Dropkin BM, Ortiz NM, Baumgarten AS, Shakir NA, Sanders SC, Hudak SJ, Morey AF. Long-term lower urinary tract sequelae following AUS cuff erosion. Neurourol Urodyn 2021; 41:229-236. [PMID: 34559913 DOI: 10.1002/nau.24801] [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: 05/24/2021] [Revised: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022]
Abstract
AIMS To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. RESULTS A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.
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Affiliation(s)
- Nathan A Chertack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelly M Caldwell
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mehraban Kavoussi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adam S Baumgarten
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nabeel A Shakir
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah C Sanders
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra. World J Urol 2021; 39:4449-4457. [PMID: 34272596 DOI: 10.1007/s00345-021-03783-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare transcorporal vs bulbar artificial urinary sphincter (AUS) implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this population. METHODS The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. The primary endpoint was device explantation-free survival. Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal. RESULTS 464 patients were included for analysis. 88 patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. Explantation-free survival was similar in both groups (estimated 5-year explantation free survival rates 55.3% vs. 58.4%; p=0.98). In the subgroup of patients with a history of previous AUS explantation, transcorporal approach tended to bring longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate analysis, the only risk factor of shorter explantation-free survival was the history of previous AUS explantation (HR=2.65; p=0.01). CONCLUSIONS Transcorporal AUS implantation was not associated with longer explantation-free survival. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival and this subgroup of patients may be the only one to draw benefits of transcorporal AUS implantation.
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10
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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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11
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Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures. World J Urol 2019; 38:3055-3060. [DOI: 10.1007/s00345-019-03028-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/18/2019] [Indexed: 01/10/2023] Open
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12
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Distal Double Cuff Vs Transcorporal Cuff as Salvage Options—A Prospective Analysis of Different Artificial Urinary Sphincter (AMS 800) Implantation Sites. Urology 2019; 133:234-239. [DOI: 10.1016/j.urology.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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13
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Smith JA. This Month in Adult Urology. J Urol 2018. [DOI: 10.1016/j.juro.2018.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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