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Kaiho Y, Oikawa M, Kusumoto H, Kukimoto T, Morozumi K, Ito J. Treatment strategies for revision surgery of artificial urinary sphincter: A review. Int J Urol 2024. [PMID: 39219114 DOI: 10.1111/iju.15569] [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: 03/29/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Artificial urinary sphincters (AUS) are an effective treatment for male stress urinary incontinence (SUI). However, infection, erosion, mechanical failure, atrophy, and balloon deterioration cause device malfunction in approximately half of patients by 10 years after implantation. Many patients desire to regain urinary continence and require revision surgery (RS), including device removal and simultaneous or delayed implantation. Patients for whom RS is considered should be examined physically and by interview for signs of infection. Urethral erosion should be assessed using cystoscopy. If there is infection or erosion, all devices should be removed first, and a new device should be implanted several months later. During the RS, after strong adhesion around the urethra, transcorporal cuff implantation is a safe choice. Device removal and simultaneous implantation can be performed in the absence of infection or erosion. If a long time has passed since device implantation, the entire device should be replaced due to device aging and deterioration; however, if the time is short, only the defective component need be replaced. Intraoperative assessment of urethral health is necessary for device removal and implantation. If the urethra is healthy, a new cuff can be placed in the same position as the old cuff was removed from; however, if the urethra is unhealthy, the cuff can be implanted in a more proximal/distal position, or a transcorporal cuff implant may be chosen. This article reviews the literature on diagnostic and treatment strategies for recurrent SUI in male patients with AUS and proposes a flowchart for AUS revision.
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Affiliation(s)
- Yasuhiro Kaiho
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masaaki Oikawa
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroki Kusumoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takashi Kukimoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kento Morozumi
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Jun Ito
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Grabbert M, Bauer RM. [Urinary stress incontinence in men: diagnostic workup and modern surgical treatment]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:666-672. [PMID: 38814349 DOI: 10.1007/s00120-024-02355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/31/2024]
Abstract
Radical prostatectomy is the most common cause of urinary stress incontinence in male patients. The exact pathophysiology is not clearly defined but probably due multifactorial. Thorough preoperative diagnostic workup before surgical therapy appears to be crucial for good postoperative results. Various systems are available. The artificial urinary sphincter continues to be considered standard procedure with a high success rate, even in patients with more complex situations and severe urinary incontinence. However, there are also relevant complication and revision rates. Modern alternatives include various sling systems. The adjustable sling systems consist of a cushion that is placed against the urethral bulb and leads to a permanent increase in urethral resistance, which can be readjusted in different ways depending on the system implanted. The adjustable sling systems also seem to be an alternative in patients with a prior history of radiation therapy. The AdVance XP sling (Boston Scientific, Marlborough, MA, USA) is a fixed sling that corrects the postoperative hypermobility of the posterior urethra after radical prostatectomy and, thus, leads to a longer functional urethral length. Good long-term results after AdVance XP implantation are only possible in selected patients.
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Affiliation(s)
- Markus Grabbert
- Klinik für Urologie, Department Chirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland.
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Ameli G, Weibl P, Rutkowski M, Huebner WA. Using a stress reservoir to improve urine leakage after artificial urinary sphincter implantation. Int Urol Nephrol 2023; 55:3089-3094. [PMID: 37634237 DOI: 10.1007/s11255-023-03756-1] [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: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Although the longest efficacy record, some patients report about urinary leakage during higher intra-abdominal pressure after Artificial Urinary Sphincter (AUS) implantation. To improve the continent results, we placed in addition to the occluding cuff and the pressure regulating balloon, in a second procedure a stress-relief reservoir in lower abdomen, for additional passive pressure transmission to the occluding cuff. METHODS In this retrospective monocentric data analysis between 2011 and 2018, 80 patients with persistence incontinence after AUS implantation were included. Stress-relief reservoir was indicated in 12 patients with involuntary leakage of urine, that occurred when intra-abdominal pressure raised. RESULTS In all 12 cases, the stress reservoir was easily implanted and there were no intraoperative complications. In a mean follow-up time of 53 months, the pad per day usage (p/d) improved from 3 (± 1.2) to 1.7 (± 1.5) (p = 0.001). Two patients with multiple previous abdominal surgeries used an equal number of pads after SRR; however, an improvement during physical exertion was reported. Continence situation was evaluated with a questionnaire and was rated as "excellent", "good", or "satisfactory" by 11 (92%) patients. CONCLUSION The persistence of urinary incontinence after AUS is a challenging topic. Implantation of a stress reservoir in carefully selected patients with urinary leakage during higher intra-abdominal pressure is minimally invasive and offers new options to improve the proven long-term record of AUS. Certainly, more investigations are needed to determine the clinical relevance of this approach.
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Affiliation(s)
- Ghazal Ameli
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria.
| | - Peter Weibl
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
| | - Michael Rutkowski
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
| | - Wilhelm Alexander Huebner
- Department of Urology, Teaching Hospital, Clinic of Korneuburg, Wienerring 3-5, 2100, Korneuburg, Austria
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Li Y, Li X, Yang Q. Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review. PLoS One 2023; 18:e0290949. [PMID: 37656677 PMCID: PMC10473540 DOI: 10.1371/journal.pone.0290949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. METHODS Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. RESULTS The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. CONCLUSION Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.
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Affiliation(s)
- Yue Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Xiao Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Qin Yang
- College of Nursing Dali University, Dali City, Yunnan province, China
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Wang F, Cao Z, Zhai L, Zhang J, Kong H, Lin W, Fan Y. Biomechanical study of the male lower urinary tract: Simulation of internal and external sphincters dyssynergia. J Biomech 2023; 149:111475. [PMID: 36780730 DOI: 10.1016/j.jbiomech.2023.111475] [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: 08/04/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Urethral sphincter dysfunction is an important cause of stress urinary incontinence (SUI). The most effective treatment is the insertion of an artificial urethral sphincter (AUS), which relies to a large extent on the surgeon's experience. However, there is no quantitative standard for cuff tightness, resulting in frequent postoperative complications. This study aimed to investigate the effect of internal and external sphincter dyssynergia on urodynamic parameters in the lower urinary tract. A geometric model of male lower urinary tract tissue was constructed from collodion slices, accounting for the active behavior of the internal and external sphincters. Normal and dyssynergic internal and external sphincters (active sphincter behavior was individually injured by 25%, 50%, 75%, or 100%) were simulated with fluid-structure interactions and changes in urethral stress, displacement, and urine flow rate were detected. We found that when the internal sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the internal sphincter decreased by 8.3%, 15.6%, 24.3%, and 35.7%, respectively. Additionally, when the external sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the external sphincter was reduced by 13.3%, 24.3%, 38.6%, and 46.6%, respectively. Internal sphincter injury primarily affects positions near the internal sphincter and prostate, while external sphincter injury affects the area between the prostate and urethral outlet. These data could facilitate the standardized evaluation of internal and external sphincter dysfunction and lead to novel methods of preoperative assessment for AUS surgery.
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Affiliation(s)
- Fang Wang
- College of Mechanical Engineering, Tianjin University of Science and Technology, The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, China; Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China.
| | - Zhanhong Cao
- College of Mechanical Engineering, Tianjin University of Science and Technology, The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, China
| | - Lidong Zhai
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Jianguo Zhang
- College of Mechanical Engineering, Tianjin University of Science and Technology, The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, China
| | - Hu Kong
- College of Mechanical Engineering, Tianjin University of Science and Technology, The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, China
| | - Wanying Lin
- College of Mechanical Engineering, Tianjin University of Science and Technology, The Key Laboratory of Integrated Design and On-Line Monitoring of Light Industrial and Food Engineering Machinery and Equipment in Tianjin, Tianjin 300222, China
| | - Yubo Fan
- Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing 100176, China; Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Sciences and Medical Engineering, Beihang University, Beijing 100191, China
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Maurer V, Dahlem R, Howaldt M, Riechardt S, Fisch M, Ludwig T, Engel O. Transcroporal Artificial Urinary Sphincter Placement With Closure of Corporal Bodies—A Long-Term Analysis of Functional Outcomes. Front Surg 2022; 9:918011. [PMID: 35722536 PMCID: PMC9198723 DOI: 10.3389/fsurg.2022.918011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives An artificial urinary sphincter (AUS) is the gold standard for postoperative stress urinary incontinence (SUI). The transcorporal AUS (TC) placement constitutes the main salvage option in high-risk patients suffering from SUI with fragile urethras. The literature analyzing long-term outcomes with respect to explantation rates, continence, and erectile function is scarce. Methods and Patients Retrospective data collection was performed in 2011. TC was applied according to a standardized protocol. TC was implanted after bulbar urethroplasty or double-cuff (DC) explantation. After TC placement, the tunica albuginea was closed in order to minimize the risk of postoperative bleedings and erectile dysfunction. Activation was performed 6 weeks postoperatively. Further follow-up (FU) was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were explantation/objective, subjective, and social continence rates. Objective or social continence was defined as the use of 0 pads/day or <2 pads/day, respectively. Thereupon, postoperative bleedings and erectile function were analyzed. Results A total of 39 high-risk patients were available for analysis. The median age was 72 years. In total, 84.6%, 10.3%, and 2.6% had a history of radical prostatectomy, TURP, and radical cystectomy, respectively. In total, 61.5% had a history of radiation therapy of the prostate, 41% had a history of urethral surgery, and 95% had a history of double cuff explantation. The median FU was 27 months. Objective, subjective, and social continence were 54.5%, 69.7%, and 78.8%, respectively. The median pad usage was 1 pad/day [1–2.5]. Only one patient suffered from a postoperative hematoma. In total, 15.4% of the patients were able to have an erection preoperatively, compared to 7.7% after TC placement. The estimated mean explantation-free survival of the TC was 83 months in the Kaplan–Meier analysis. Conclusions TC AUS implantation constitutes a viable salvage approach in high-risk SUI patients with a mean device survival of almost 7 years and high social continence rates of almost 80%. An intraoperative closure of the tunica albuginea after TC placement allows for very low rates of postoperative hematoma and supports postoperative erectile rigidity.
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Affiliation(s)
- Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
- Correspondence: Valentin Maurer
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marian Howaldt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A. Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
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Kuhlencord K, Dahlem R, Vetterlein MW, Abrams-Pompe RS, Maurer V, Meyer CP, Riechardt S, Fisch M, Ludwig TA, Marks P. Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach. Front Surg 2022; 9:829517. [PMID: 35223979 PMCID: PMC8863868 DOI: 10.3389/fsurg.2022.829517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives The objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation. Patients and Methods Data of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate. Results Out of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4). Conclusion We observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.
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Affiliation(s)
- Katharina Kuhlencord
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S. Abrams-Pompe
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, Asklepios Medical Center Harburg, Hamburg, Germany
| | - Christian P. Meyer
- Department of Urology, Clinic Herfurt, University of Bochum, Herfurt, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A. Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Phillip Marks
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Hoeh B, Müller SC, Kluth LA, Wenzel M. Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion - A Narrative Review. Front Surg 2021; 8:688394. [PMID: 34434956 PMCID: PMC8381645 DOI: 10.3389/fsurg.2021.688394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this narrative review is to discuss and highlight recently published studies regarding the surgical management of patients suffering from prostate cancer treatment complications. Focus will be put on the recalcitrant and more complex cases which might lead to urinary diversion as a definite, last resort treatment. It is in the nature of every treatment, that complications will occur and be bothersome for both patients and physicians. A small percentage of patients following prostate cancer treatment (radical prostatectomy, radiation therapy, or other focal therapies) will suffer side effects and thus, will experience a loss of quality of life. These side effects can persist for months and even years. Often, conservative management strategies fail resulting in recalcitrant recurrences. Prostate cancer patients with "end-stage bladder," "devastated outlet," or a history of multiple failed interventions, are fortunately rare, but can be highly challenging for both patients and Urologists. In a state of multiple previous surgical procedures and an immense psychological strain for the patient, urinary diversion can offer a definite, last resort surgical solution for this small group of patients. Ideally, they should be transferred to centers with experience in this field and a careful patient selection is needed. As these cases are highly complex, a multidisciplinary approach is often necessary in order to guarantee an improvement of quality of life.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Stefan C Müller
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
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Khouri RK, Ortiz NM, Dropkin BM, Joice GA, Baumgarten AS, Morey AF, Hudak SJ. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep 2021; 22:30. [PMID: 33779844 DOI: 10.1007/s11934-021-01045-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. RECENT FINDINGS Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.
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Affiliation(s)
- Roger K Khouri
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Adam S Baumgarten
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Queissert F, Hüsch T, Kretschmer A, Anding R, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Homberg R, Pfitzenmaier J, Naumann CM, Nyarangi-Dix J, Hofmann T, Rose A, Schweiger J, Hübner W, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. High/low-volume center experience predicts outcome of AMS 800 in male stress incontinence: Results of a large middle European multicenter case series. Neurourol Urodyn 2020; 39:1856-1861. [PMID: 32567709 DOI: 10.1002/nau.24444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/07/2020] [Indexed: 11/06/2022]
Abstract
AIM To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study. METHODS As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high-volume centers. RESULTS Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high-volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P < .001), used the perineal approach significantly more often (78% vs 67.7%; P = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P = .002). With a mean follow-up of 18 months, the revision rate was significantly higher at low-volume centers (38.5% vs 26.7%; P = .037), urethral erosion being the main reason for revision. Social continence (0-1 pads/24 h) was achieved significantly more often in high-volume centers (45.5% vs 24.2%; P = .002). CONCLUSIONS Our study showed significantly better continence results and lower revision rates at high-volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | | | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Hospital Lueneburg, Lueneburg, Germany
| | - Alexander Friedl
- Department of Urology, Goettlicher Heiland Vienna, Vienna, Austria
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm, Hamm, Germany
| | | | - Carsten M Naumann
- Department of Urology and Pediatric Urology, St. Elisabeth Hospital, Neuwied, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Torben Hofmann
- Department of Urology, Diakonie Hospital Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Josef Schweiger
- Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
| | - Wilhelm Hübner
- Department of Urology, Hospital Weinviertel Korneuburg, Korneuburg, Austria
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
| | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Andres J Schrader
- Department of Urology and Pediatric Urology, University Hospital Munster, Munster, Germany
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11
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The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation. World J Urol 2019; 38:2289-2294. [DOI: 10.1007/s00345-019-03029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
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12
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Distal Double Cuff Vs Transcorporal Cuff as Salvage Options—A Prospective Analysis of Different Artificial Urinary Sphincter (AMS 800) Implantation Sites. Urology 2019; 133:234-239. [DOI: 10.1016/j.urology.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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13
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Guachetá Bomba PL, Ocampo Flórez GM, Echeverría García F, García-Perdomo HA. Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis. Ther Adv Urol 2019; 11:1756287219875581. [PMID: 31632464 PMCID: PMC6769218 DOI: 10.1177/1756287219875581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP). Methods: This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included. Results: Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies. Conclusions: Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.
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Affiliation(s)
| | - Ginna Marcela Ocampo Flórez
- UROGIV Research Group, Universidad del Valle, Cali, Colombia, and Department of Urology, Universidad CES, Medellín, Colombia
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14
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Queissert F, Huesch T, Kretschmer A, Anding R, Kurosch M, Kirschner-Hermanns R, Pottek T, Olianas R, Friedl A, Pfitzenmaier J, Naumann CM, Wotzka C, Nyarangi-Dix J, Hoffmann T, Herrmann E, Obaje A, Rose A, Homberg R, Abdunnur R, Loertzer H, Bauer RM, Haferkamp A, Schrader AJ. Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study. Int Neurourol J 2019; 23:219-225. [PMID: 31607101 PMCID: PMC6790824 DOI: 10.5213/inj.1938032.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim was to study the correlation between cuff size and outcome after implantation of an AMS 800 artificial urinary sphincter. METHODS A total of 473 male patients with an AMS 800 sphincter implanted between 2012 and 2014 were analyzed in a retrospective multicenter cohort study performed as part of the Central European Debates on Male Incontinence (DOMINO) Project. RESULTS Single cuffs were implanted in 54.5% and double cuffs in 45.5% of the patients. The cuffs used had a median circumference of 4.5 cm. Within a median follow of 18 months, urethral erosion occurred in 12.8% of the cases and was associated significantly more often with small cuff sizes (P<0.001). Multivariate analysis showed that, apart from cuff size (P=0.03), prior irradiation (P<0.001) and the penoscrotal approach (P=0.036) were associated with an increased erosion rate. Continence rate tended to be highest with median cuff sizes (4-5.5 cm). CONCLUSION Apart from irradiation and the penoscrotal approach, small cuff size is a risk factor for urethral erosion. Results are best with cuff sizes of 4.5-5.5 cm.
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Affiliation(s)
- Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
| | - Tanja Huesch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
| | - Ralf Anding
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Martin Kurosch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Tobias Pottek
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Roberto Olianas
- Department of Urology, Lueneburg Hospital, Lueneburg, Germany
| | - Alexander Friedl
- Department of Urology, Goettlicher Heiland Hospital of Vienna, Vienna, Austria
| | | | - Carsten M. Naumann
- Department of Urology and Pediatric Urology, University Hospital of Kiel, Kiel, Germany
| | - Carola Wotzka
- Department of Urology, Diaconal Hospital of Stuttgart, Stuttgart, Germany
| | - Joanne Nyarangi-Dix
- Department of Urology and Pediatric Urology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Torben Hoffmann
- Department of Urology, Diaconal Hospital of Schwaebisch Hall, Schwaebisch Hall, Germany
| | - Edwin Herrmann
- Department of Urology and Robotic Surgery, Prosper-Hospital, Recklinghausen, Germany
| | - Alice Obaje
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
| | - Achim Rose
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
| | - Roland Homberg
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
| | - Rudi Abdunnur
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
| | - Hagen Loertzer
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
| | - Ricarda M. Bauer
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Andres J. Schrader
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
| | - Debates on Male Incontinence (DOMINO)-Project
- Department of Urology and Pediatric Urology, University Hospital of Muenster, Muenster, Germany
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
- Department of Urology, Ludwig-Maximilians University Hospital, Großhadern Campus, Munich, Germany
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
- Department of Urology, Lueneburg Hospital, Lueneburg, Germany
- Department of Urology, Goettlicher Heiland Hospital of Vienna, Vienna, Austria
- Department of Urology, Bethel Evangelical Hospital, Bielefeld, Germany
- Department of Urology and Pediatric Urology, University Hospital of Kiel, Kiel, Germany
- Department of Urology, Diaconal Hospital of Stuttgart, Stuttgart, Germany
- Department of Urology and Pediatric Urology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Urology, Diaconal Hospital of Schwaebisch Hall, Schwaebisch Hall, Germany
- Department of Urology and Robotic Surgery, Prosper-Hospital, Recklinghausen, Germany
- Department of Urology, St. Bernward Hospital Hildesheim, Hildesheim, Germany
- Department of Urology and Pediatric Urology, Helios Hospital Duisburg, Duisburg, Germany
- Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm GmbH, Hamm, Germany
- Department of Urology and Pediatric Urology, Helios Hospital Schwelm, Schwelm, Germany
- Department of Urology and Pediatric Urology, Westpfalz Medical Center, Kaiserslautern, Germany
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15
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Maurer V, Marks P, Dahlem R, Rosenbaum CM, Meyer CP, Riechardt S, Fisch M, Ludwig T. Functional outcomes of artificial urinary sphincter implantation with distal bulbar double cuff in men with and without a history of external beam radiotherapy: an analysis of a prospective database. BJU Int 2019; 124:1040-1046. [DOI: 10.1111/bju.14882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Valentin Maurer
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Phillip Marks
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Roland Dahlem
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Clemens M. Rosenbaum
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Christian P. Meyer
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Silke Riechardt
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Margit Fisch
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Tim Ludwig
- Department of Urology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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16
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Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation. World J Urol 2019; 38:183-191. [DOI: 10.1007/s00345-019-02756-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022] Open
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17
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Maurer V, Marks P, Dahlem R, Rosenbaum C, Meyer CP, Riechardt S, Fisch M, Ludwig T. Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty. World J Urol 2019; 37:647-653. [DOI: 10.1007/s00345-019-02631-y] [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] [Accepted: 01/04/2019] [Indexed: 12/01/2022] Open
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18
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Tutolo M, Cornu JN, Bauer RM, Ahyai S, Bozzini G, Heesakkers J, Drake MJ, Tikkinen KAO, Launonen E, Larré S, Thiruchelvam N, Lee R, Li P, Favro M, Zaffuto E, Bachmann A, Martinez-Salamanca JI, Pichon T, De Nunzio C, Ammirati E, Haab F, Van Der Aa F. Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn 2018; 38:710-718. [PMID: 30575997 DOI: 10.1002/nau.23901] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 11/08/2022]
Abstract
AIMS To assess efficacy and safety as well as predictive factors of dry rate and freedom from surgical revision in patients underwent AUS placement. The artificial urinary sphincter (AUS) is still considered the standard for the treatment of moderate to severe post-prostatectomy stress urinary incontinence (SUI). However, data reporting efficacy and safety from large series are lacking. METHODS A multicenter, retrospective study was conducted in 16 centers in Europe and USA. Only primary cases of AUS implantation in non-neurogenic SUI after prostate surgery, with a follow-up of at least 1 year were included. Efficacy data (continence rate, based on pad usage) and safety data (revision rate in case of infection and erosion, as well as atrophy or mechanical failure) were collected. Multivariable analyses were performed in order to investigate possible predictors of the aforementioned outcomes. RESULTS Eight hundred ninety-two men had primary AUS implantation. At 32 months mean follow-up overall dry rate and surgical revision were 58% and 30.7%, respectively. Logistic regression analysis showed that patients without previous incontinence surgery had a higher probability to be dry after AUS implantation (OR: 0.51, P = 0.03). Moreover institutional case-load was positively associated with dry rate (OR: 1.18; P = 0.005) and freedom from revision (OR: 1.51; P = 0.00). CONCLUSIONS The results of this study showed that AUS is an effective option for the treatment of SUI after prostate surgery. Moreover previous incontinence surgery and low institutional case-load are negatively associated to efficacy and safety outcomes.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Ricarda M Bauer
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Sascha Ahyai
- Department of Urology, University-Medical-Center Hamburg, Hamburg, Germany.,Department of Urology, University Hospital Göttingen, Göttingen, Germany
| | | | - John Heesakkers
- Department of Urology, Radboud University Nijmegen MC, Nijmegen, The Netherlands
| | - Marcus J Drake
- University of Bristol and Bristol Urological Institute, Bristol, United Kingdom
| | - Kari A O Tikkinen
- Department of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ene Launonen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, United Kingdom
| | - Richard Lee
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Philip Li
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Michele Favro
- Department of Urology, Ospedale Maggiore Della Carità Di Novara, Novara, Italy
| | - Emanuele Zaffuto
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Juan I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas Pichon
- Department of Urology, Angers University Hospital, Angers, France
| | - Cosimo De Nunzio
- Department of Urology, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Enrico Ammirati
- Department of Urology, Azienda Ospedaliera Universitaria, Città Della Salute E Della Scienza, Ospedale Molinette, Turin, Italy
| | | | - Frank Van Der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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[Sphincter and corpus cavernosum prostheses as components of endoprosthetics in urology]. Urologe A 2018; 57:211-222. [PMID: 29417194 DOI: 10.1007/s00120-018-0570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Artificial urinary sphincters and penile corpus cavernosum prostheses are effective for patients who are not adequately treated by conservative treatment or pharmacotherapy. Both of these devices show good results concerning functional outcome if used within the correct patient selection. Penile prostheses are meant to be the last line of treatment for severe erectile dysfunction after failure of conventional treatment. Artificial urinary sphincters are the treatment of choice for severe urinary stress incontinence. Although the surgical procedure is an easy one, only highly experienced centers should perform the implantation due to minimization of infections and loss of function. Because of the hydraulic working principle of both devices, check-ups on a regular basis are strongly recommended. In the case of a loss of function or infections, a rapid and targeted treatment is the key to make new implantations possible in the future.
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21
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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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22
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Adamsky MA, Boysen WR, Cohen AJ, Ham S, Dmochowski RR, Faris SF, Bales GT, Cohn JA. Evaluating the Role of Postoperative Oral Antibiotic Administration in Artificial Urinary Sphincter and Inflatable Penile Prosthesis Explantation: A Nationwide Analysis. Urology 2017; 111:92-98. [PMID: 28964819 DOI: 10.1016/j.urology.2017.07.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether postoperative oral antibiotics are associated with decreased risk of explantation following artificial urinary sphincter (AUS) or inflatable penile prosthesis (IPP) placement. Although frequently prescribed, the role of postoperative oral antibiotics in preventing AUS or IPP explantation is unknown. MATERIALS AND METHODS We queried the MarketScan database to identify male patients undergoing AUS or IPP placement between 2003 and 2014. The primary end point was device explantation within 3 months of placement. Multivariate regression analysis controlling for clinical risk factors assessed the impact of postoperative oral antibiotic administration on explant rates. RESULTS We identified 10,847 and 3594 men who underwent IPP and AUS placement, respectively, between 2003 and 2014. Postoperative oral antibiotics were prescribed to 60.6% of patients following IPP placement and 61.1% of patients following AUS placement. The most frequently prescribed antibiotics were fluoroquinolones (35.6%), cephalexin (17.7%), trimethoprim/sulfamethoxazole (7.0%), and amoxicillin-clavulanate (3.2%). Explant rates did not differ based upon receipt of oral antibiotics (antibiotics vs no antibiotics: IPP: 2.2% vs 1.9%, P = .18, AUS: 3.9% vs 4.0%, P = .94). On multivariate analysis, no individual class of antibiotic was associated with decreased odds of device explantation. CONCLUSION Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.
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Affiliation(s)
| | | | - Andrew J Cohen
- Section of Urology, University of Chicago Medicine, Chicago, IL
| | - Sandra Ham
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah F Faris
- Section of Urology, University of Chicago Medicine, Chicago, IL
| | - Gregory T Bales
- Section of Urology, University of Chicago Medicine, Chicago, IL
| | - Joshua A Cohn
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, Einstein Healthcare Network, Philadelphia, PA; Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA.
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Anti-incontinence Surgery in High-Risk Male Patients with Stress Urinary Incontinence—an Updated Review. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0444-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barski D, Gerullis H, Otto T. Review of surgical implant procedures for male incontinence after radical prostatectomy according to IDEAL framework. Updates Surg 2017; 69:327-338. [DOI: 10.1007/s13304-017-0460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/01/2017] [Indexed: 12/27/2022]
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Myers JB, Brant WO, Hotaling JN, Lenherr SM. Urethral Strictures and Artificial Urinary Sphincter Placement. Urol Clin North Am 2017; 44:93-103. [DOI: 10.1016/j.ucl.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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