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Lambert E, Chartier-Kastler E, Vaessen C, Beaugerie A, Cotte J, Roupret M, Mozer P, Parra J, Seisen T, Lenfant L. Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach. Eur Urol 2024; 85:139-145. [PMID: 37914580 DOI: 10.1016/j.eururo.2023.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Periprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). OBJECTIVE To describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). DESIGN, SETTING, AND PARTICIPANTS Data of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. SURGICAL PROCEDURE Thirty-three patients underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. MEASUREMENTS Outcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision-free survival (SRFS). RESULTS AND LIMITATIONS RApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150-210] min vs OpAUSi: 245 [228-300] min; p < 0.001), estimated blood loss (RApAUSi: 20 [0-50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4-6] d vs OpAUSi: 11 [10-14] d; p < 0.001). Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014). Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500). The median follow-up periods were 118 (50-183) and 56 (25-84) mo for OpAUSi and RApAUSi, respectively (p < 0.001). A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature. CONCLUSIONS RApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery. PATIENT SUMMARY Compared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.
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Affiliation(s)
- Edward Lambert
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; J-ERUS/YAU Academic Urologists Working Group on Robot-Assisted Surgery, Paris, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Christophe Vaessen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Juliette Cotte
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Morgan Roupret
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Pierre Mozer
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Jérôme Parra
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Louis Lenfant
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
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Shokri P, Kharaz L, Talebian N, Borumandnia N, Ziaee SAM, Shakhssalim N. A systematic review and meta-analysis of complications of artificial urinary sphincters in female patients with urinary incontinence due to internal sphincter insufficiency. BMC Urol 2023; 23:97. [PMID: 37210489 DOI: 10.1186/s12894-023-01274-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches. METHODS Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted. RESULTS We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years. CONCLUSION The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications.
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Affiliation(s)
- Pourya Shokri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ladan Kharaz
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Talebian
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Mohsen Ziaee
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Pasdaran, Tehran, Iran
| | - Nasser Shakhssalim
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Pasdaran, Tehran, Iran
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Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence. World J Urol 2021; 39:3891-3896. [PMID: 33835209 DOI: 10.1007/s00345-021-03672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. METHODS This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. RESULTS Over a span of 26 years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5 month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5 months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. CONCLUSION Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.
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Takahashi S, Takei M, Asakura H, Gotoh M, Ishizuka O, Kato K, Koyama M, Takeyama M, Tomoe H, Yamanishi T, Yokoyama O, Yoshida M, Yoshimura Y, Yoshizawa T. Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition). Int J Urol 2021; 28:474-492. [PMID: 33650242 DOI: 10.1111/iju.14492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.
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Affiliation(s)
- Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Mineo Takei
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Kato
- Department of Female Urology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masami Takeyama
- Urogynecology Center, First Towakai Hospital, Takatsuki, Japan
| | - Hikaru Tomoe
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasukuni Yoshimura
- Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Yoshizawa
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
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Schroeder A, Munier P, Saussine C, Tricard T. Outcomes of laparoscopic artificial urinary sphincter in women with stress urinary incontinence: mid-term evaluation. World J Urol 2021; 39:3057-3062. [PMID: 33388876 DOI: 10.1007/s00345-020-03527-y] [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: 09/13/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. METHODS We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. RESULTS A total of 49 women (mean age 64 years, range 40-80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively. CONCLUSION Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.
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Affiliation(s)
- Alice Schroeder
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France.
| | - Pierre Munier
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg 1 Place de L'Hôpital, 67000, Strasbourg, France
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Chartier-Kastler E, Vaessen C, Rouprêt M, Bassi S, Cancrini F, Phé V. Robot-assisted laparoscopic artificial urinary sphincter insertion in women with stress urinary incontinence: a pilot single-centre study. BJU Int 2020; 126:722-730. [PMID: 32558978 DOI: 10.1111/bju.15147] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter (AUS; AMS 800™, American Medical Systems, Minnetonka, MN, USA) implantation and revision in women with stress urinary incontinence (SUI). PATIENTS AND METHODS A pilot prospective monocentric study included all consecutive female patients with SUI and undergoing an AUS surgery (implantation or revision) using a robotic approach between 2012 and 2018. The AUS was implanted through a transperitoneal robotic approach. The dissection of the bladder neck was initiated using a posterior approach with a permanent visual control. Intraoperative and early postoperative complications were reported (Clavien-Dindo classification). Continence was defined as no pad usage. RESULTS A total of 41 patients, median (interquartile range [IQR]) age 67.5 (57-74.7) years were included. In the group of 27 patients undergoing an AUS implantation, one conversion to laparotomy, one bladder neck and one ureteric injury occurred. The AUS was not implanted in the two latest cases. Twelve minor (Clavien-Dindo Grade I-II) early postoperative complications occurring in 10 patients were reported. The median (IQR) follow-up was 19 (11-27) months. The continence rate was 84% (21/25 patients). In the group of 14 patients undergoing an AUS revision, no vaginal or bladder injury was reported. One patient had a bowel injury with conversion to laparotomy without AUS insertion. Two major (Clavien-Dindo Grade III-V) early postoperative complications occurred in two patients: one intraoperative bowel injury, which ultimately resulted in the death of the patient and one device infection requiring an explantation of the AUS. The median (IQR) follow-up was 18 (13.5-24.2) months. The continence rate was 83.3% (10/12 patients). CONCLUSION The results obtained after robot-assisted laparoscopic AUS implantation among women are promising despite the significant morbidity due to previous pelvic surgeries. Longer follow-up studies are needed.
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Affiliation(s)
- Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Christophe Vaessen
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Morgan Rouprêt
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
| | - Silvia Bassi
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France.,Urology, Sant'Andrea Hospital, Università degli Studi "La Sapienza" di Roma, Roma, Italy
| | - Fabiana Cancrini
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France.,Department of Urology, University of Verona, Verona, Italy
| | - Veronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris,, France
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Reus CR, Phé V, Dechartres A, Grilo NR, Chartier-Kastler EJ, Mozer PC. Performance and Safety of the Artificial Urinary Sphincter (AMS 800) for Non-neurogenic Women with Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency: A Systematic Review. Eur Urol Focus 2020; 6:327-338. [DOI: 10.1016/j.euf.2018.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/02/2018] [Accepted: 10/10/2018] [Indexed: 01/11/2023]
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Outcomes of artificial urinary sphincter in female with neurological stress urinary incontinence: a long-term follow-up. World J Urol 2020; 39:157-162. [PMID: 32052128 DOI: 10.1007/s00345-020-03105-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/22/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To report the outcomes of AUS in women with neurological SUI resulting from intrinsic sphincter deficiency after a follow-up from 3 to 20 years. METHODS The charts of female with moderate to severe neurological SUI who underwent open or laparoscopic AUS implantation between November 1994 and July 2014 were reviewed retrospectively. All patients were operated by a single experienced surgeon. Primary endpoint was a postoperative continence categorized as complete continence (no pads used), improved incontinence or unchanged incontinence. RESULTS Twenty-three women (mean age 54 years, range 19-77) underwent open or laparoscopic AUS implantation. At the last follow-up, 7 (30.4%) initial artificial urinary sphincters remained in situ and 9 (39.1%) patients had at least one revision or reimplantation. Sixteen patients were fully continent (69.6%), four (17.4%) had improved incontinence and three (13.0%) had unchanged incontinence. After a median follow-up of 11.6 years (3-22), 8 (34.8%) explanations in 7 patients and 16 (69.6%) revisions in 11 patients occurred. The average time without explanation or revision was 10.9 and 8.5 years, respectively. Survival rates without AUS explanation were 94.4%, 76.5%, 72.8%, 50% and without revision were 83.3%, 64.7%, 45.5% and 16.7% at 5, 10, 15 and 20 years, respectively. CONCLUSION Although all methods are imperfect at best, AUS remain toward our experience a good way to achieve long-term continence in female patients suffering from neurological SUI with preserved manual dexterity.
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Barakat B, Franke K, Hijazi S, Schakaki S, Gauger U, Hasselhof V, Vögeli TA. A systematic review and meta-analysis of clinical and functional outcomes of artificial urinary sphincter implantation in women with stress urinary incontinence. Arab J Urol 2020; 18:78-87. [PMID: 33029411 PMCID: PMC7473178 DOI: 10.1080/2090598x.2020.1716293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/21/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the complications and results of artificial urinary sphincter (AUS) implantation in women with stress urinary incontinence (SUI). METHODS A selective database search using keywords (1990-2019) was conducted to validate the effectiveness of the AUS in women. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised. The meta-analysis included 964 women (15 studies) with persistent SUI. The Newcastle-Ottawa score was used to determine the quality of the evidence in each study. The success rate and complications associated with the AUS were analysed. RESULTS Meta-analysis of the published studies showed that complete continence was achieved at a mean rate of 79.6% (95% confidence interval [CI] 72.2-86.6%) and a significant improvement was achieved in 15% (95% CI 10-25%). The mean (range) follow-up was 22 (6-204) months. The mean number of patients per study was 68. The mean (range) explantation rate was 13 (0-44)%. Vaginal erosion occurred in a mean (range) of 9 (0-27)% and mechanical complications in 13 (0-47)%. Infections accounted for 7% of the complications. The total mean (range) revision rate of the implanted AUS was 15.42 (0-44)%. The mean (range) size of the cuff used was 6.7 (5-10) cm. CONCLUSION Our present analysis showed that implantation of an AUS in women with severe UI is an effective treatment option after failure of first-line therapy. However, the currently available study population is too small to draw firm conclusions. ABBREVIATIONS AMS: American Medical Systems; AUS: artificial urinary sphincter; EAU: European Association of Urology; LE: Level of Evidence; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QoL: quality of life; SHELTER: Services and Health for Elderly in Long TERm care (study); SUI: (stress) urinary incontinence.
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Knut Franke
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
| | - Samer Schakaki
- Department of Urology, Hospital Osnabrück, Osnabrück, Germany
| | | | | | - Thomas-Alexander Vögeli
- Department of Urology and Pediatric Urology, University Hospital RWTH Aachen, Aachen, Germany
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Tricard T, Jochum F, Bergerat S, Munier P, Schroeder A, Saussine C. Outcomes of open artificial urinary sphincter in women with stress urinary incontinence: long-term follow up. Ther Adv Urol 2019; 11:1756287219874676. [PMID: 31555345 PMCID: PMC6747852 DOI: 10.1177/1756287219874676] [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: 06/04/2019] [Accepted: 08/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years. Methods: The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence. Results: A total of 63 women (mean age: 58 years, range: 17–82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively. Conclusions: In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.
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Affiliation(s)
- Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, 67000 Strasbourg, France
| | - Floriane Jochum
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Sébastien Bergerat
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Pierre Munier
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Alice Schroeder
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
| | - Christian Saussine
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 1 place de l'Hôpital, Strasbourg, France
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Kourbanhoussen K, Cecchi M, Chevrot A, Costa P, Droupy S, Wagner L. Sphincter urinaire artificiel robot chez la femme : début d’expérience. Prog Urol 2019; 29:371-377. [DOI: 10.1016/j.purol.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
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Implantation du sphincter artificiel AMS 800® chez la femme par cœlioscopie robot-assistée : expérience monocentrique. Prog Urol 2019; 29:246-252. [DOI: 10.1016/j.purol.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/19/2018] [Accepted: 12/15/2018] [Indexed: 11/17/2022]
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Bracchitta D, Costa P, Borojeni S, Ménard J, Bryckaert PE, Mandron É. Laparoscopic artificial urinary sphincter implantation in women with stress urinary incontinence: update on 13 years’ experience in a single centre. BJU Int 2019; 123:E14-E19. [DOI: 10.1111/bju.14653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Damiano Bracchitta
- Department of Urology; Clinique du Pré; Technopôle Université; Le Mans France
- Division of Urology; Department of Translational Research; University of Pisa; Pisa Italy
| | - Pedro Costa
- Department of Urology; Clinique du Pré; Technopôle Université; Le Mans France
- Centro Hospitalar de Vila Nova de Gaia/Espinho; Angers Portugal
| | - Shahed Borojeni
- Department of Urology; Clinique du Pré; Technopôle Université; Le Mans France
| | - Johann Ménard
- Department of Urology; Clinique du Pré; Technopôle Université; Le Mans France
| | | | - Éric Mandron
- Department of Urology; Clinique du Pré; Technopôle Université; Le Mans France
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Ruiz-Hernández M, López-Fando L, Gómez de Vicente JM, Jiménez-Cidre MA, Sánchez-Gallego MD, Lorca-Álvaro J, Díaz-Pérez D, Burgos-Revilla FJ. A new approach to laparoscopic implantation of the artificial urinary sphincter: Vesicovaginal approach to the bladder neck. Actas Urol Esp 2019; 43:44-50. [PMID: 30064705 DOI: 10.1016/j.acuro.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck. MATERIAL AND METHODS We present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection. RESULTS Surgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent. CONCLUSIONS We present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.
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Affiliation(s)
- M Ruiz-Hernández
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España.
| | - L López-Fando
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - J M Gómez de Vicente
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - M A Jiménez-Cidre
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - M D Sánchez-Gallego
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - J Lorca-Álvaro
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - D Díaz-Pérez
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
| | - F J Burgos-Revilla
- Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, España
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Peyronnet B, O'Connor E, Khavari R, Capon G, Manunta A, Allue M, Hascoet J, Nitti VW, Gamé X, Gilleran J, Castro-Sader L, Cornu JN, Waltregny D, Ahyai S, Chung E, Elliott DS, Fournier G, Brucker BM. AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review. Neurourol Urodyn 2018; 38 Suppl 4:S28-S41. [PMID: 30298943 DOI: 10.1002/nau.23833] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/26/2018] [Indexed: 11/06/2022]
Abstract
AIMS To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). METHODS A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. RESULTS Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. CONCLUSIONS AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.
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Affiliation(s)
| | - Eabhann O'Connor
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Marta Allue
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Victor W Nitti
- Department of Urology, New York University, New York, New York
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
| | - Luis Castro-Sader
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - David Waltregny
- Department of Urology, University Hospital of Liege, Liege, Belgium
| | - Sascha Ahyai
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Eric Chung
- Department of Urology, The University of Queensland, Brisbane, Australia
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AUA Guidelines on Stress Urinary Incontinence: What Is New in the Guidelines? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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de Vries AM, Heesakkers JP. Contemporary diagnostics and treatment options for female stress urinary incontinence. Asian J Urol 2018; 5:141-148. [PMID: 29988831 PMCID: PMC6033196 DOI: 10.1016/j.ajur.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/13/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022] Open
Abstract
Stress urinary incontinence is not a deadly disease, but for the large population of women suffering from it, it is a very important issue. Especially in the continuously aging population all over the world, there is more and more need for treatment of this serious medical condition. Treatment of female stress urinary incontinence exists already for ages. In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments. The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers. Luckily there are many options available and the field is developing quickly. In recent years many new medical devices have been developed, that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications. This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.
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Affiliation(s)
- Allert M. de Vries
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Jaggi A, Drake M, Siddiqui E, Fatoye F. A comparison of the treatment recommendations for neurogenic lower urinary tract dysfunction in the national institute for health and care excellence, European Association of Urology and international consultations on incontinence guidelines. Neurourol Urodyn 2018; 37:2273-2280. [PMID: 29664124 DOI: 10.1002/nau.23581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/12/2018] [Indexed: 01/22/2023]
Abstract
AIMS Healthcare guidelines are an important vehicle in establishing up-to-date evidence based medicine (EBM) in clinical practice. Due to varying development processes, clinical guidelines created by different institutions can often contain contrasting recommendations. This can have implications for optimal and standardized patient care across management settings. METHODS The similarities and differences of treatment recommendations made in the National Institute for Health and Care Excellence (NICE), The European Association of Urology (EAU), and the International Consultation on Continence (ICI) guidelines for neurogenic lower urinary tract dysfunction (NLUTD) were assessed. RESULTS The guidelines generally agree on their approach to conservative management, including behavioral therapies, and catheterization techniques. There was discrepancy on the benefit of using an alpha blocker in NLUTD and bladder outlet obstruction (BOO) and administering Botulinum toxin A (Onabotulinum-A) in NLUTD. The highest degree of divergence was seen in recommendations for surgical treatments, where the EAU made gender-specific recommendations, and gave continent urinary diversion higher preference than given in the NICE and ICI guidelines. CONCLUSIONS In the absence of high-quality clinical evidence, many of the recommendations made across all three guidelines are based on expert opinion. NICE, the EAU and ICI have similarities but they place differing emphasis on costs and expert opinion, which translated in notably different recommendations. It is evident that increased research efforts, possibly in the form of prospective registries, pragmatic trials, and resource utilization studies are necessary to improve the underlying evidence base for NLUTD, and subsequently the strength and concordance of recommendations across guidelines.
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Affiliation(s)
- Ashley Jaggi
- Manchester Metropolitan University, Manchester, United Kingdom
| | | | | | - Francis Fatoye
- Manchester Metropolitan University, Manchester, United Kingdom
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Outcome of rolled fortified vaginal flap operation on female patients with intrinsic sphincteric deficiency: 2-year follow-up. Int Urogynecol J 2018; 30:393-399. [PMID: 29594319 DOI: 10.1007/s00192-018-3621-7] [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: 01/05/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluate the 2-year outcome of the rolled fortified vaginal flap (RFVF) operation for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD). METHODS A prospective study of 20 women suffering from SUI due to ISD was conducted. All patients were subjected to history-taking, clinical examination, cough stress test, and urodynamics. Symptom severity and quality of life (QoL) were assessed using the Arabic version of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). All studied women were followed up for 24 months to detect success rate, any postoperative complications, and reveal changes in the quality of life. RESULTS Mean age was 53 ± 8 years. Preoperative Valsalva leak point pressure was 50.1 ± 11.3 cmH2O. After a follow-up period of 24 months, only 2 patients (10%) showed mild stress incontinence with mean VLPP 80± 3 cm H2O. Postoperative mean maximum flow rate (Q-max) and mean Pdet-Qmax showed no significant difference from the preoperative results (P = 0.115 and 0.187 respectively). The quality of life domain of the ICIQ-UI-SF decreased significantly from 73.5 ± 12.1% (preoperatively) to 2.6 ± 8.1% (after a 1-year follow-up), P < 0.001 and then showed a slight increase to 4.5 ± 10.6 at 24 months' follow-up. CONCLUSION The RFVF operation has a success rate of 90% after a 24-month follow-up. It significantly improved the quality of life of women with SUI due to ISD.
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Al Adem KM, Bawazir SS, Hassen WA, Khandoker AH, Khalaf K, McGloughlin T, Stefanini C. Implantable Systems for Stress Urinary Incontinence. Ann Biomed Eng 2017; 45:2717-2732. [PMID: 29022114 DOI: 10.1007/s10439-017-1939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023]
Abstract
Stress urinary incontinence (SUI), the involuntary urine leakage due to failure of the urethral closure mechanism, is a global health challenge with substantial human suffering and socioeconomic costs. Approximately 167 million male and female patients are predicted to suffer from SUI in 2018, worldwide. A wide range of surgical interventions are available for the treatment of SUI. Severe cases, however, usually require the implantation of artificial urinary sphincter devices. This review comparatively presents and analyzes the working principles, as well as the challenges, associated with the current implantable SUI systems in clinical use. These include slings, urethral bulking agents, artificial urinary sphincters, and adjustable continence devices. It further reports on recent research progress and state-of-the-art in the field of SUI implants, including an original approach proposed by the authors with a pressure feedback sensory mechanism. The new emerging field of artificial muscle devices, including electroactive polymers, provides a promising innovative solution for replacing the weakened urethral sphincter in SUI patients.
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Affiliation(s)
- Kenana M Al Adem
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Sarah S Bawazir
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Waleed A Hassen
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Tim McGloughlin
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Cesare Stefanini
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE.
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Ferreira C, Brychaert PE, Menard J, Mandron E. Laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency: Mid-term outcomes. Int J Urol 2017; 24:308-313. [PMID: 28215049 DOI: 10.1111/iju.13296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/26/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To analyze the safety and the mid-term continence rates of laparoscopic implantation of artificial urinary sphincter in women. METHODS A total of 52 women with intrinsic sphincter deficiency underwent a laparoscopic artificial urinary sphincter implantation from 2005 to 2015 at Surgical Clinic Du Pré, Le Mans, France. The artificial urinary sphincter was implanted around the bladder neck by a transperitoneal laparoscopic approach to the Retzius space. Urodynamic assessment was carried out. Postoperative functional outcome was defined as success (no leaking, no pad use), improvement (>50% decrease in number of leakages, >50% decrease in number of pads used or use of light protection) or failure (<50% improvement, persistent or increased leaking). Outcome measures also included perioperative and long-term complications. RESULTS The mean age of the patients was 69.1 years (range 64-82 years). After a mean follow up of 37.5 months (median 24 months; range 1-125 months), 38 (77.6%) patients were considered to be continent (no leakage, no pads), and eight (16.3%) improved their grade of incontinence. Three patients abandoned the follow-up schedule and were excluded. There was no perioperative severe complication. Artificial urinary sphincter revision was needed in 11 (22.4%) patients, requiring a total of seven redo procedures and four permanent sphincter removals. The main reasons for redo procedures were six (11.2%) mechanical problems and one vaginal erosion (2%). CONCLUSIONS Herein we report one of the largest series with the longest follow up evaluating the outcomes of laparoscopic artificial urinary sphincter implantation in female patients. This approach seems to be a safe and effective treatment option for patients with intrinsic sphincter deficiency.
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Affiliation(s)
- Carlos Ferreira
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
| | | | - Johann Menard
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
| | - Eric Mandron
- Department of Urology, Surgical Clinic Du Pré, Technopôle Université, Le Mans, France
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Baldissera-Aradas J, Rodríguez-Villamil L, González-Rodríguez I, Gil-Ugarteburu R, Fernández-Pello-Montes S, Mosquera-Madera J. Laparoscopic implantation of artificial urinary sphincter: An option for treating recurrent female urinary incontinence. Actas Urol Esp 2016; 40:406-11. [PMID: 26905948 DOI: 10.1016/j.acuro.2015.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case in Spain, to our knowledge, of laparoscopic implantation of AUS as treatment for female recurrent urinary incontinence. MATERIAL AND METHODS Under general anaesthesia, patient was placed in supine decubitus with slight Trendelenburg, access to the vagina was verified. Through a transperitoneal pelvic laparoscopic approach, Retzius space was opened and then the laterovaginal spaces up to the endopelvic fascia. To facilitate the dissection of the bladder neck, we inserted a swab into the vagina, performing simultaneous traction and countertraction manoeuvres. As an access port for the AUS, we widened the incision of the lower trocar. We adjusted the periurethral cuff and then placed the reservoir and the pump in the laterovesical space and the labia majora of the vulva, respectively. Lastly, we connected the 3 AUS elements and peritoneum was closed to isolate AUS from the intestine. RESULTS The surgical time was 92min, the estimated blood loss was <100cc(3) and the hospital stay was 48h. There were no intraoperative or postoperative complications. The AUS was activated at 6 weeks. At 24 months, patient managed the AUS adequately and total continence was achieved. CONCLUSIONS Laparoscopic implantation of AUS is a feasible technique. Transvaginal traction and countertraction manoeuvres can prevent intraoperative lesions.
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Re: Xavier Biardeau, Jérôme Rizk, François Marcelli, Vincent Flamand. Robot-assisted Laparoscopic Approach for Artificial Urinary Sphincter Implantation in 11 Women with Urinary Stress Incontinence: Surgical Technique and Initial Experience. Eur Urol 2015;67:937-42. Eur Urol 2015; 69:e45-6. [PMID: 26456681 DOI: 10.1016/j.eururo.2015.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 10/22/2022]
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Reply to Véronique Phé, Morgan Rouprêt, and Emmanuel Chartier-Kastler's Letter to the Editor re: Xavier Biardeau, Jérôme Rizk, François Marcelli, Vincent Flamand. Robot-assisted Laparoscopic Approach for Artificial Urinary Sphincter Implantation in 11 Women with Urinary Stress Incontinence: Surgical Technique and Initial Experience. Eur Urol 2015;67:937-42. Eur Urol 2015; 69:e47-8. [PMID: 26454705 DOI: 10.1016/j.eururo.2015.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022]
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Peyronnet B, Vincendeau S, Tondut L, Bensalah K, Damphousse M, Manunta A. Artificial urinary sphincter implantation in women with stress urinary incontinence: preliminary comparison of robot-assisted and open approaches. Int Urogynecol J 2015; 27:475-81. [PMID: 26431841 DOI: 10.1007/s00192-015-2858-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to compare outcomes of open and robot-assisted artificial urinary sphincter (AUS) implantation in female patients. METHODS The charts of all female patients who underwent an AUS implantation between 2008 and 2014 in a single center were retrospectively reviewed. From 2008 to 2012, AUS were implanted using an open approach and from 2013 to 2014 using a robot-assisted approach. Perioperative and functional parameters were compared between groups. The primary endpoint was continence status. RESULTS Twenty-four women were assessed: 16 in the open group and eight in the robot-assisted group. Three patients had neurogenic stress urinary incontinence. Most patients had undergone previous procedures for urinary incontinence (15 in the open group and seven in the robotic group). Mean operative time was similar in both groups (214 vs. 211 min; p = 0.90). Postoperative complicationsrate was lower in the robot-assisted group (25 vs. 75 %; p = 0.02). There was a trend toward a lower intraoperative complication rate (37.5 vs. 62.5 %; p = 0.25), decreased blood loss (17 ml vs. 275 ml; p = 0.22), and shorter length of stay (3.5 vs. 9.3 days; p = 0.09) in the robot-assisted group. Continence rates were comparable in both groups (75 vs. 68.8 %; p = 0.75). Three AUS explantations were needed in the open group (18.8 %) compared with one in the robot-assisted group (12.5 %; p = 0.70). CONCLUSIONS In female patients, the robot-assisted approach compared with open AUS implantation could decrease intraoperative and postoperative complication rates, length of hospital stay, and blood loss.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, CHU Rennes, Rennes, France. .,Service d'Urologie, Hopital Pontchaillou, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | | | | | | | - Mireille Damphousse
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
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Herrera-Imbroda B, Lara MF, Izeta A, Sievert KD, Hart ML. Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter. Adv Drug Deliv Rev 2015; 82-83:106-16. [PMID: 25453264 DOI: 10.1016/j.addr.2014.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 01/19/2023]
Abstract
Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI.
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Billault C, Chartier-Kastler E, Rouprêt M, Robain G, Phé V. Functional outcomes of adjustable continence therapy (ACT™) balloons in women aged >80 years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency. World J Urol 2015; 33:1897-903. [DOI: 10.1007/s00345-015-1520-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/16/2015] [Indexed: 10/24/2022] Open
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