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Cousin T, Peyronnet B, Bentellis I, Lasri S, Taha F, Hermieu N, Boileau A, Zelmar A, Ciolek C, Dubois A, Leon P, Hermieu JF, Brierre T, Gamé X, Tricard T, Saussine C, Lecoanet P, Vidart A, Bruyère F, Cornu JN, Monsaint H, Biardeau X, Capon G. Which revision strategy is the best for non-mechanical failure of male artificial urinary sphincter? World J Urol 2023; 41:3663-3669. [PMID: 37902863 DOI: 10.1007/s00345-023-04670-y] [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: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Persistence or recurrence of stress urinary incontinence (prSUI) after artificial urinary sphincter (AUS) implantation may be secondary to non-mechanical failure (NOMECA). It have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. METHODS NOMECA was defined as prSUI, with normally functioning device, no erosion, infection or fluid loss. Exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revisions for NOMECA, including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), three increasing balloon pressure (BALLOON-UP), were performed in 10 centers. BALLOON-UP patients weren't included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were also categorized in COMPLETE-CHANGE vs. PARTIAL-CHANGE of the device. RESULTS The three-months complete continence rate was 70.8% with a significant difference between RELOC and DOWNSIZING groups (p = 0.04). COMPLETE CHANGE was significantly associated with complete continence status at three months in multivariate analysis (83.3% vs. 63.3%, OR = 2.7; CI 95% [1.1-7.1], p = 0.03). Estimated five-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9% (p = 0.16; p = 0.30). Those were significantly longer in COMPLETE-CHANGE vs PARTIAL-CHANGE (82.2% vs. 69.6%, p = 0.03); (71.2% vs. 58.2%, p = 0.047). CONCLUSIONS AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff. COMPLETE-CHANGE may improve functional outcomes, explantation-free and reoperation-free survivals.
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Affiliation(s)
- Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France.
| | | | | | - Sami Lasri
- Department of Urology, University of Lille, Lille, France
| | - Fayek Taha
- Department of Urology, University of Reims, Reims, France
| | | | - Adrien Boileau
- Department of Urology, University of Toulouse, Toulouse, France
| | - Augustin Zelmar
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Clement Ciolek
- Department of Urology, University of Nancy, Nancy, France
| | | | - Priscilla Leon
- Department of Urology, University of Reims, Reims, France
| | | | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | - Adrien Vidart
- Department of Urology, Foch Hospital, Suresnes, France
| | - Franck Bruyère
- Department of Urology, University of Tours, Tours, France
| | | | | | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
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Arnold PJ, Soyster ME, Burns RT, Mellon MJ. The role of urethral ligation after AUS failure and end stage urethra. Int Urol Nephrol 2022; 54:2827-2831. [PMID: 35913590 DOI: 10.1007/s11255-022-03315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To provide our single-center experience with an approach to refractory stress urinary incontinence (SUI) with permanent urethral ligation (PUL) and suprapubic tube (SPT) placement, in hopes of contributing to the limited body of research surrounding this surgical treatment option for patients with end-stage urethra (ESU). METHODS All patients undergoing PUL with SPT placement from 01/01/2018 to 04/30/2022 were identified from an institutional database. Institutional Review Board exempt status was granted for the conduct of this study. Patients were seen postoperatively at 1 month and 1 year. If there were any concerns of incontinence, an antegrade urethrogram via the SPT was performed. Descriptive statistics were used to evaluate patients. RESULTS Seven patients underwent PUL with SPT in our timeframe and were included in the study. All patients previously had an AUS placed, and two patients had a urethral sling previously placed. The median follow-up time was 21 months, ranging between 2 and 48 months. Complications included bladder spasms (43%) and continued leakage per urethra (14%). Of the 7 patients, 6 have reported continence through their urethra at their most recent follow-up. CONCLUSION This initial data suggest that PUL with SPT placement may be a viable surgical approach to treating refractory SUI, especially for patients with ESU who wish to avoid the morbidity associated with more formal supravesical diversion. Further study of this technique and longer follow-up is required to determine its long-term efficacy and tolerability for patients.
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Affiliation(s)
- Peter J Arnold
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, USA.
| | - Mary E Soyster
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, USA
| | - Ramzy T Burns
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, USA
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, USA
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Reoperative Anti-incontinence Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-021-00642-3] [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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Rabinowitz MJ, Haney NM, Liu JL, Dani H, Cohen AJ, Wright EJ. Immediate Artificial Urinary Sphincter (AUS) Reactivation at the Time of Urethral Cuff Exchange is Not Associated with Increased Erosion Rate. Urology 2021; 157:253-256. [PMID: 34343563 DOI: 10.1016/j.urology.2021.07.021] [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: 05/26/2021] [Revised: 06/19/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To retrospectively evaluate the outcomes of immediate artificial urinary sphincter (AUS) reactivation in patients after urethral cuff replacement. It is common practice to delay reactivation of an AUS for four to six weeks following surgery to replace a failed urethral cuff. This is due to concerns about local tissue edema risking obstruction and concerns for urethral erosion. Despite these concerns, there are no published data to support this practice. METHODS Retrospective chart review of single surgeon procedures performed from 2005-2020. Patients with urethral cuff replacement for recurrent stress incontinence due to compression or mechanical failure were included. RESULTS Thirty-four patients were identified who had immediate reactivation of the AUS following urethral cuff exchange. Thirty of these patients (88.2%) had radical prostatectomy and five patients also underwent further radiation therapy (14.7%). At 6 months follow-up, there was no reported events of erosion. Likewise, 32/34 (94%) of patients had no complications and reported expected urinary function of the AUS. Urinary retention was not observed. One patient required further re-exploration for a complication within his AUS system (2.9%), and another was ultimately unsatisfied with their unchanged baseline continence despite a fully functioning AUS (2.9%). CONCLUSIONS In this series, we observe that immediate reactivation of the AUS after urethral cuff exchange is a safe and reasonable management approach. Limitations of this analysis include a single institution, retrospective study. However, early AUS reactivation after device revision has not been reported in the literature and warrants further investigation given the impact on patient quality of life.
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Affiliation(s)
| | - Nora M Haney
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine
| | - James L Liu
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine
| | - Hasan Dani
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine
| | - Andrew J Cohen
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine
| | - E James Wright
- The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine.
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Sayedahmed K, Rosenhammer B, Burger M, Goßler C. Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success. Urol Int 2021; 106:261-268. [PMID: 34289484 DOI: 10.1159/000517386] [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: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION After implantation of an artificial urinary sphincter (AUS) due to stress urinary incontinence, in some cases revision procedures may be necessary. This is mostly due to device infection or cuff erosion in the long term. The aim of this study was to evaluate the impact of early revision procedures (prior to or immediately after AUS activation) on the long-term outcome. METHODS We retrospectively evaluated patients who underwent primary AUS implantation between 2006 and 2019. Patients with previous radiotherapy, urethroplasty, urethral stent placement, or repeat AUS implantation were excluded. Early revision was defined as prior to or immediately after AUS activation and comprised pump repositioning or cuff size adaptation due to difficulties in using the pump, persistent urinary incontinence, or urinary retention. Patients were compared with regard to complication rates, functional outcome, and patient satisfaction. Univariable and multivariable logistic regression analyses were performed to analyze risk factors for early AUS revision. Kaplan-Meier analysis evaluated explantation-free survival. RESULTS A total of 250 patients were included. Twenty patients (8%) required early revision (pump repositioning in 15 cases [75%], cuff downsizing in 3 cases [15%], and cuff upsizing in 2 cases [10%]). Mean follow-up was 78.6 months. 96.4% of all patients were objectively continent at the time of last follow-up without differences between both groups, and patient satisfaction was high in both groups. No differences with regard to mechanical implant failure, tissue atrophy, and AUS explantation due to cuff erosion or implant infection were observed. Explantation-free survival was comparable in both groups. On univariable logistic regression analysis, coronary artery disease and transcorporal cuff placement were associated with early AUS revision. CONCLUSION Early revision after AUS implantation can be performed without negative impact on the long-term outcome.
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Affiliation(s)
- Khalid Sayedahmed
- Department of Urology, Menoufia University, Shibin Al Kawm, Egypt.,Department of Urology, Rhein-Maas Hospital, Wuerselen, Germany
| | - Bernd Rosenhammer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany
| | - Christopher Goßler
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Centre, Regensburg, Germany,
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Peyronnet B, Cornu JN. Re: Paul Abrams, Lynda D. Constable, David Cooper, et al. Outcomes of a Noninferiority Randomised Controlled Trial of Surgery for Men with Urodynamic Stress Incontinence After Prostate Surgery (MASTER). Eur Urol 2021;79:812-23. Eur Urol 2021; 79:e178-e179. [PMID: 33795177 DOI: 10.1016/j.eururo.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022]
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Redmond E, Tong S, Zemp L, Hoy N, Rourke KF. Improved artificial urinary sphincter outcomes using a transcorporal cuff placement in patients with a "fragile urethra". Can Urol Assoc J 2020; 14:E621-E624. [PMID: 32569562 PMCID: PMC7704083 DOI: 10.5489/cuaj.6431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The artificial urinary sphincter (AUS) is the most effective treatment option for incontinence after prostate cancer treatment. However, patients with a "fragile urethra" (defined as prior radiotherapy, previous failed AUS, or previous urethroplasty) are at increased risk of AUS failure. The aim of this study was to evaluate outcomes using standard and transcorporal cuff placement in this group of patients. METHODS A retrospective review was performed on patients with a fragile urethra who underwent AUS insertion between 2004 and 2017. The primary outcome was the need for AUS revision. Secondary outcome measures included change in pad use, patient satisfaction, continence (≤1 pad/day), improvement (≥50% change in pad use), and cuff erosion rates. RESULTS Seventy-six patients met the criteria for inclusion, with a mean age of 71.6 years and a mean followup of 37.9 months. A total of 42.1% had prior radiotherapy, 56.6% had a history of failed AUS, and 19.7% had previous urethroplasty. Transcorporal cuff placement was performed in 31.6% (n=24). These patients had lower revision (20.8% vs. 36.5%; p=0.05) and erosion rates (8.3% vs. 17.3%; p=0.09). There was no significant difference in functional outcomes such as continence (66.7% vs. 73.1%; p=0.57), improvement (100% vs. 90.4%;p=0.17), or satisfaction (82.6% vs. 69.4%; p=0.26), nor for 90-day complications (4.2% vs. 9.6%; p=0.41). CONCLUSIONS AUS insertion is an effective treatment option for post-prostatectomy incontinence in the setting of a fragile urethra. Transcorporal cuff placement in this subset of patients may be recommended, as it is associated with lower revision and erosion rates compared to standard cuff placement.
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Affiliation(s)
- Elaine Redmond
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Steven Tong
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Logan Zemp
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nathan Hoy
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Chung E. Artificial urinary sphincter surgery in the special populations: neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups. Asian J Androl 2020; 22:45-50. [PMID: 31793444 PMCID: PMC6958990 DOI: 10.4103/aja.aja_128_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some “high-risk” populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD 4000, Australia.,University of Queensland, Princess Alexandra Hospital, Brisbane, QLD 4000, Australia.,Macquarie University Hospital, Sydney, NSW 2109, Australia
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Van Dyke M, Ortiz N, Baumgarten A, Ward E, Baker R, Hudak S, Morey A. Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time? Neurourol Urodyn 2020; 40:211-218. [PMID: 33034933 DOI: 10.1002/nau.24535] [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: 04/22/2020] [Revised: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 11/11/2022]
Abstract
AIMS Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion. METHODS From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I). RESULTS PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I. CONCLUSIONS For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.
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Affiliation(s)
- Maia Van Dyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolas Ortiz
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adam Baumgarten
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Ward
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan Baker
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven Hudak
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Allen Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Khouri RK, Baumgarten AS, Ortiz NM, Ward EE, Baker RC, VanDyke ME, Yi YA, Hudak SJ, Morey AF. Pressure Regulating Balloon Herniation: A Correctable Cause of Artificial Urinary Sphincter Malfunction. Urology 2020; 139:188-192. [DOI: 10.1016/j.urology.2020.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/22/2023]
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Loh-Doyle JC, Nazemi A, Ashrafi A, Doumanian LR, Ginsberg DA, Boyd SD. Predictors of Device-related Complications After Exchange of the Pressure-regulating Balloon in Men With an Artificial Urinary Sphincter. Urology 2020; 135:154-158. [DOI: 10.1016/j.urology.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
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Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival. Eur Urol Focus 2019; 5:887-893. [DOI: 10.1016/j.euf.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/21/2022]
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Efficacy of Pressure Regulating Balloon Exchange in Men With Post Artificial Urinary Sphincter Persistent or Recurrent Stress Urinary Incontinence. Urology 2019; 123:252-257. [DOI: 10.1016/j.urology.2018.07.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 11/21/2022]
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Loh-Doyle JC, Hartman N, Nazemi A, Wayne K, Doumanian LR, Ginsberg DA, Boyd SD. Mechanical failure rates of artificial urinary sphincter components: Is the 3.5-cm urethral cuff at higher risk? Neurourol Urodyn 2018; 38:187-192. [DOI: 10.1002/nau.23825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey C. Loh-Doyle
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Natalie Hartman
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Azadeh Nazemi
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Kevin Wayne
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Leo R. Doumanian
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - David A. Ginsberg
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Stuart D. Boyd
- USC Institute of Urology, Division of Genitourinary Reconstruction and Prosthetics, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine; University of Southern California; Los Angeles California
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Pearlman AM, Rasper AM, Terlecki RP. Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon. Investig Clin Urol 2018; 59:275-279. [PMID: 29984343 PMCID: PMC6028470 DOI: 10.4111/icu.2018.59.4.275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/29/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose Rate of continence after artificial urinary sphincter (AUS) placement appears to decline with time. After appropriate workup to exclude inadvertent device deactivation, development of urge or overflow incontinence, and fluid loss, many assume recurrent stress urinary incontinence (rSUI) to be secondary to nonmechanical failure, asserting urethral atrophy as the etiology. We aimed to characterize the extent of circumferential urethral recovery following capsulotomy and that of pressure regulating balloon (PRB) material fatigue in men undergoing AUS revision for rSUI. Materials and Methods Retrospective review of a single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessments were identified. Results The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75 years. Mean time between AUS placement and revision was 103 months. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1 cm; range 0.5–2.5 cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Six of 7 patients underwent PRB interrogation. Four of these 6 PRBs (66.7%) demonstrated pressures in a category below the reported range of the original manufacturer rating. Conclusions Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and/or morbidity.
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Affiliation(s)
- Amy Marcia Pearlman
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Comparison of Adjuvant Radiation Therapy Before or After Artificial Urinary Sphincter Placement: A Multi-Institutional, Retrospective Analysis. Urology 2018; 113:160-165. [DOI: 10.1016/j.urology.2017.11.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022]
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Yarlagadda VK, Kilgore ML, Selph JP. Analysis of cost of component replacement versus entire device replacement during artificial urinary sphincter revision surgery. Neurourol Urodyn 2018; 37:1931-1936. [DOI: 10.1002/nau.23533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Vidhush K. Yarlagadda
- Department of Urology; University of Alabama at Birmingham School of Medicine; Birmingham, Alabama
| | - Meredith L. Kilgore
- School of Public Health; University of Alabama at Birmingham; Birmingham, Alabama
| | - John P. Selph
- Department of Urology; University of Alabama at Birmingham School of Medicine; Birmingham, Alabama
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Maximilien B, Aublea A, Gillibert A, Delcourt C, Grise P, Cornu JN. Urethral pressure controlled balloon refilling or balloon change for artificial sphincter secondary procedure? Prog Urol 2017; 28:209-214. [PMID: 29217348 DOI: 10.1016/j.purol.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To report our experience of inflating or changing pressure balloon to treat recurrent urinary incontinence after AMS800® implantation instead of changing all the devices. PATIENTS AND METHODS A retrospective study was conducted in a tertiary reference center between 2005 and 2015. All patients, treated by AMS800® implantation for post-prostatectomy urinary incontinence and whom balloon was subsequently changed or inflated, were included. Main clinical end point was the need for another surgery. Secondary end points were urethral erosion, infection, and efficacy on pad test and pad use. RESULTS Thirty-one patients were included. All had had a 61-70cm H20 balloon implanted, with a single cuff (13 with transcorporeal placement). Twenty-one patients had their balloon changed for a 71-80cm H20 type, while 10 patients had their balloon refilled (median 3mL [range 2-7]). Median follow-up was 23 months (range 1-129). Overall rate of another subsequent surgery was 48.3% (n=15). Erosion and atrophy occurred more frequently after balloon repressurizing than after balloon replacement (80% vs 33%, P=0.024). At last follow-up, median pad use was higher in repressurizing group (2 vs 1, P=0.033). CONCLUSION Balloon repressurizing is associated with a higher erosion and reoperation rate than changing pressure balloon. Continence results seem better when PRB is changed. It could be an alternative instead of changing all devices in patients with frail urethra. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- B Maximilien
- Département d'urologie, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
| | - A Aublea
- Département d'urologie, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - A Gillibert
- Département de statistique, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - C Delcourt
- Département d'urologie, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - P Grise
- Département d'urologie, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - J-N Cornu
- Département d'urologie, CHU de Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
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Truzzi JC, Sacomani CR, Prezotti J, Silvinato A, Bernardo WM. Male urinary incontinence: Artificial sphincter. Rev Assoc Med Bras (1992) 2017; 63:664-680. [PMID: 28977103 DOI: 10.1590/1806-9282.63.08.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/22/2022] Open
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Kretschmer A, Nitti V. Surgical Treatment of Male Postprostatectomy Incontinence: Current Concepts. Eur Urol Focus 2017; 3:364-376. [DOI: 10.1016/j.euf.2017.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/12/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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VanDyke ME, Viers BR, Pagliara TJ, Scott JM, Shakir N, Dugi DD, Cordon BH, Hofer MD, Morey AF. Permanent Bulbar Urethral Ligation: Emerging Treatment Option for Incontinent Men With End-stage Urethra. Urology 2017; 105:186-191. [DOI: 10.1016/j.urology.2017.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022]
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22
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A Systematic Approach to the Evaluation and Management of the Failed Artificial Urinary Sphincter. Curr Urol Rep 2017; 18:18. [DOI: 10.1007/s11934-017-0666-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Biardeau X, Aharony S, Campeau L, Corcos J. Artificial Urinary Sphincter: Report of the 2015 Consensus Conference. Neurourol Urodyn 2017; 35 Suppl 2:S8-24. [PMID: 27064055 DOI: 10.1002/nau.22989] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The AMS800™ device, by far the most frequently implanted artificial urinary sphincter (AUS) worldwide, is considered to be the "gold-standard" when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management, and follow-up AMS800™ implantation or revision. MATERIALS AND METHODS Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible. RESULTS A total of 25 urologists were invited to participate, 19 able to attend the conference. The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a eight-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, outcomes, special populations, and the future of AUSs. CONCLUSION These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™.
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Affiliation(s)
- X Biardeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - S Aharony
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | | | - L Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
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Hervé F, Lumen N, Goessaert AS, Everaert K. Persistent urinary incontinence after a robot-assisted artificial urinary sphincter procedure: lessons learnt from two cases. BMJ Case Rep 2016; 2016:bcr-2016-216971. [PMID: 27797881 DOI: 10.1136/bcr-2016-216971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report describes 2 cases of persistent urinary incontinence in the beginning of the learning curve of robot-assisted bladder neck implantation of an artificial urinary sphincter (RA-AUS) in men at risk for erosion due to neurological lesions. Among a series of 4 RA-AUS, 2 patients still experienced urinary incontinence after surgery. A complete urological workup was strictly normal and did not show any device malfunction. However, during an AUS revision in these two patients, exploration revealed that the cuff was not tight enough. This issue was resolved by placing smaller cuffs. After re-do surgery, one of the two patients no longer had urinary incontinence, while the second patient was lost to follow-up. Insufficient tightness of the cuff could be explained by an inability of the surgeon to feel the force while pulling the cuff around the urethra due to the absence of haptic sensation in robotic surgery.
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Affiliation(s)
- François Hervé
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Karel Everaert
- Department of Urology, Universitair Ziekenhuis Gent, Gent, Belgium
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25
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Cordon BH, Singla N, Singla AK. Artificial urinary sphincters for male stress urinary incontinence: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:175-83. [PMID: 27445509 PMCID: PMC4938139 DOI: 10.2147/mder.s93637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The artificial urinary sphincter (AUS), which has evolved over many years, has become a safe and reliable treatment for stress urinary incontinence and is currently the gold standard. After 4 decades of existence, there is substantial experience with the AUS. Today AUS is most commonly placed for postprostatectomy stress urinary incontinence. Only a small proportion of urologists routinely place AUS. In a survey in 2005, only 4% of urologists were considered high-volume AUS implanters, performing >20 per year. Globally, ~11,500 AUSs are placed annually. Over 400 articles have been published regarding the outcomes of AUS, with a wide variance in success rates ranging from 61% to 100%. Generally speaking, the AUS has good long-term outcomes, with social continence rates of ~79% and high patient satisfaction usually between 80% and 90%. Despite good outcomes, a substantial proportion of patients, generally ~25%, will require revision surgery, with the rate of revision increasing with time. Complications requiring revision include infection, urethral atrophy, erosion, and mechanical failure. Most infections are gram-positive skin flora. Urethral atrophy and erosion lie on a spectrum resulting from the same problem, constant urethral compression. However, these two complications are managed differently. Mechanical failure is usually a late complication occurring on average later than infection, atrophy, or erosions. Various techniques may be used during revisions, including cuff relocation, downsizing, transcorporal cuff placement, or tandem cuff placement. Patient satisfaction does not appear to be affected by the need for revision as long as continence is restored. Additionally, AUS following prior sling surgery has comparable outcomes to primary AUS placement. Several new inventions are on the horizon, although none have been approved for use in the US at this point.
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Affiliation(s)
- Billy H Cordon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ajay K Singla
- Department of Urology, University of Toledo College of Medicine, Toledo, OH, USA
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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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