Recommandations pour le traitement de l’incontinence urinaire féminine non neurologique par le sphincter artificiel urinaire

Severe Complications of Artificial Urinary Sphincter Placement in a Young Woman With Neurogenic Urinary Incontinence: A Case Report

This article reports a case of a 40-year-old woman with a history of myelomeningocele and neurogenic urinary incontinence who developed erosion and fistula formation following the placement of an artificial urinary sphincter (AUS) when she was 18 years old. The patient had a long-standing history of urinary incontinence that was unresponsive to prior surgeries for meningomyelocele. She reported the loss of uro-fecal material from the vagina but did not seek further medical evaluation until the age of 40. Clinical examination revealed protruding tubes from the suprapubic region. The administration of a contrast agent through one of the two tubes led to the visualization of intestinal loops, and the administration of a contrast agent through the urethra confirmed the connection between the rectum, urinary bladder, and vagina. Due to the absence of reliable surgical history and in the absence of abdominal discomfort, bilateral nephrostomies were initially performed to prevent further uro-fecal material loss. The patient showed significant improvement, decided to not seek further evaluation and surgical treatment, and remained socially integrated during the follow-up period of 20 years. This case highlights the severe consequences of AUS placement in a young woman with neurogenic urinary incontinence and emphasizes the importance of proper patient selection and management in the presence of underlying neurological disorders.

Long-term device survival after a first implantation of AMS800™ for stress urinary incontinence: Comparison between men and women

PURPOSE

The artificial urinary sphincter is the reference treatment for stress urinary incontinence in men, but it remains rarely used in women. This study aimed to compare long-term device survival between women and men, after the first implantation of an AMS800™ artificial urinary sphincter (Boston Scientific) for the treatment of a non-neurogenic stress urinary incontinence.

MATERIALS AND METHODS

This retrospective cohort study included all patients with nonneurogenic stress urinary incontinence who underwent surgery in a large-volume university hospital between 2000 and 2013. The primary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Men and women were matched 3:1 according to age and year of implantation. Differences were analyzed using a Cox model accounting for matching and applying time intervals because hazards were not proportional over time. Sensitivity analyzes were performed, excluding firstly a population with a history of radiotherapy and secondly a population with more than one previous surgery for urinary incontinence.

RESULTS

A total of 107 women were matched to 316 men. Median follow-up was 6.0 years (Q1-Q3 1.8-9.4): 7.0 years (Q1-Q3 3.1-10.3) for women and 5.1 years (Q1-Q3 1.3-9.1) for men. During the follow-up, 56 patients had an explantation of the device: 44 men (13.9%) and 12 women (11.2%), and 113 had a revision: 85 men (26.9%) and 28 women (26.1%). Men have a significantly higher risk of explantation or revision than women between 6 months and 8 years after implantation (hazard ratio 2.12 [1.29-3.48]). Before 6 months and after 8 years, there were no significant differences. Both sensitivity analyses found consistent results.

CONCLUSIONS

This study suggests that device survival seems better in women after the first 6 months.

Systematic review of guidelines for urinary incontinence in women

INTRODUCTION AND OBJECTIVE

Urinary incontinence in women is the subject of multiple recommendations all over the world. The aim of our study was to compare methodologies and search for inconsistencies in texts and grades in these guidelines.

METHODS

Seventeen recommendations from different medical societies in English, French and German were included. Their methodologies were analyzed, including writing methods, cyclicity, level of evidence (LE) and grades. The recommendations were synthesized and inconsistencies in texts and grades were studied. The quality of recommendations was evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) scale.

RESULTS

Methods, rigour and cyclicity varied depending on societies. LE and grades are broadly consensual for higher LE and grades and less so for lower LE and grades. The Collège National des Gynécologues et Obstétriciens Français, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, the European Association of Urology, the International Consultation on Urological Diseases and the National Institute for Health and Care Excellence have an AGREE score ≥ 80 % (third quartile). Grading and textual inconsistencies are explained by the order of studies or the absence of high LE.

CONCLUSION

With the present study we closely explored comparatively the methods and semantics of recommendations for urinary incontinence in women.

Artificial Urinary Sphincter: Report of the 2015 Consensus Conference

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™.

[Pelvic radiotherapy and artificial urinary sphincter in women]

OBJECTIVES

A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR).

POPULATION AND METHODS

From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n=206) and the other group with PR (group 2; n=9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure.

RESULTS

Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P<0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation.

CONCLUSION

AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.