1
|
Sacco E, Marino F, Gandi C, Bientinesi R, Totaro A, Moretto S, Gavi F, Campetella M, Racioppi M. Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes. J Clin Med 2023; 12:jcm12083021. [PMID: 37109357 PMCID: PMC10141998 DOI: 10.3390/jcm12083021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800®) transalbugineal implantation. At a median (IQR) follow-up of 60 (24-84) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04-98.92) and 91.76% (95% CI: 75.23-97.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0-1 pads per day) rate was 82.98% (CI 95%: 68.83-91.10) at 12 mos and 76.81% (CI 95%: 60.56-87.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence.
Collapse
Affiliation(s)
- Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Stefano Moretto
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
2
|
Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
3
|
Sacco E, Gandi C, Marino F, Totaro A, Di Gianfrancesco L, Palermo G, Pierconti F, Racioppi M, Bassi P. Artificial urinary sphincter significantly better than fixed sling for moderate post-prostatectomy stress urinary incontinence: a propensity score-matched study. BJU Int 2020; 127:229-237. [PMID: 32744793 DOI: 10.1111/bju.15197] [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: 12/11/2022]
Abstract
OBJECTIVE To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post-prostatectomy urinary incontinence (PPI) using propensity score-matching analysis to enhance the validity of the comparison (Canadian Task Force classification II-2). PATIENTS AND METHODS Consecutive men with moderate (3-5 pads/day) stress-prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800® ; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow-up. Preoperative assessment included 24-h pad usage, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), urethrocystoscopy, and urodynamics if indicated. Propensity score-matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least 'much improved' response at 12-months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. RESULTS Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24-h pad usage was four in both groups (P = 0.10), and median follow-up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0-1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow-up. At the last follow-up, the median 24-h leakage volumes, median ICIQ-SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re-interventions, although Clavien-Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. CONCLUSION We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.
Collapse
Affiliation(s)
- Emilio Sacco
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Gandi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Marino
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Totaro
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Di Gianfrancesco
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Palermo
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Racioppi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierfrancesco Bassi
- "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
4
|
Haylen BT, Lee JK, Sivagnanam V, Cross A. What if there were no tapes? Neurourol Urodyn 2018; 37:2026-2034. [DOI: 10.1002/nau.23741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022]
|
5
|
Collado Serra A, Domínguez-Escrig J, Gómez-Ferrer Á, Batista Miranda E, Rubio-Briones J, Solsona Narbón E. Prospective follow-up study of artificial urinary sphincter placement preserving the bulbospongiosus muscle. Neurourol Urodyn 2016; 36:1387-1394. [DOI: 10.1002/nau.23119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - José Rubio-Briones
- Department of Urology; Instituto Valenciano de Oncología; Valencia Spain
| | | |
Collapse
|
6
|
Selph JP, Madden-Fuentes R, Peterson AC, Webster GD, Lentz AC. Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair. Urology 2015; 86:608-12. [DOI: 10.1016/j.urology.2015.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
|
7
|
Traitement chirurgical de dernier recours en cas de cystite radique après radiothérapie externe du cancer de la prostate : analyse monocentrique. Cancer Radiother 2013; 17:282-7. [DOI: 10.1016/j.canrad.2013.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 04/02/2013] [Accepted: 04/10/2013] [Indexed: 11/21/2022]
|
8
|
Chung E, Ranaweera M, Cartmill R. Newer and novel artificial urinary sphincters (AUS): the development of alternatives to the current AUS device. BJU Int 2013. [PMID: 23194117 DOI: 10.1111/j.1464-410x.2012.11614.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The current artificial urinary sphincter (AUS), AMS 800 (American Medical Systems, Minnesota, MN, USA) is considered the standard of care for the treatment of urinary incontinence (UI). While the long-term effectiveness, safety, and durability of the current model of the AMS 800 are well documented, it is not without its limitations and complications. Over the last few years, improvements in design and innovative research into AUS devices have increased the treatment arsenal in male UI. METHODS Articles from peer-reviewed journals, abstracts from scientific meetings and electronic literature searches formed the basis of this review. RESULTS Newer AUS models, e.g. FlowSecure, Zephyr, Pro-ACT and other novel experimental AUS devices, are designed to simulate a healthy human sphincter and address the limitation of the existing AMS 800 device. CONCLUSIONS Newer and novel AUS models are innovative and showed promising outcomes in short- to intermediate-term follow-up. However, there exists the need for prospective randomised clinical trials and complete reporting of adverse and long-term results before these AUS models can replace the existing AMS 800 device.
Collapse
Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | | | | |
Collapse
|
9
|
Abdou A, Cornu JN, Sèbe P, Ciofu C, Peyrat L, Cussenot O, Haab F. [Salvage therapy with artificial urinary sphincter after Advance™ male sling failure for post-prostatectomy incontinence: a first clinical experience]. Prog Urol 2012; 22:650-6. [PMID: 22999090 DOI: 10.1016/j.purol.2012.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/18/2012] [Accepted: 06/30/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the clinical outcome following artificial urinary sphincter (AUS) implantation after failure of Advance™ sub-urethral male sling for post-prostatectomy incontinence (PPI). METHODS A prospective evaluation was conducted about consecutive patients who received an AUS after failure of Advance™ therapy in one tertiary reference center. Evaluation included medical history, pad use and operative data (duration, cuff size, technical difficulties). Follow-up was scheduled at 1, 6, 12 months and yearly thereafter. Clinical outcome was evaluated by pad use, patient global impression of improvement (PGI-I) scale and assessment of side effects. Cure was defined as no pad usage. RESULTS Twelve patients were included in this evaluation. Median follow-up was 20 months (12-43). No patient was lost to follow-up. Four patients had a history of radiation therapy and all patients had mild or moderate PPI with previous failed Advance™ surgery. Median (range) operative time was 47 minutes (40-60). No technical problem occurred during AUS implantation. Hospital stay duration and catheterization duration were respectively 2 days and 24 hours in all but one case. At last follow-up, 10/12 patients (83%) were cured and fully satisfied. Two were improved, wearing only one pad per day. Postoperative complications were noted in two cases (17%) (one case of cutaneous erosion and one case of superficial iliac wound infection). CONCLUSIONS AUS implantation is feasible in patients who have undergone Advance™ male sling implantation. Mid-term results of this procedure are comparable to those obtained after first line AUS implantation.
Collapse
Affiliation(s)
- A Abdou
- Service d'urologie, université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, groupe hospitalo-universitaire Est, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | | | | | | | | | | | | |
Collapse
|
10
|
Lentz AC, Peterson AC, Webster GD. Outcomes following artificial sphincter implantation after prior unsuccessful male sling. J Urol 2012; 187:2149-53. [PMID: 22503016 DOI: 10.1016/j.juro.2012.01.119] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Despite the proven success and durability of the artificial urinary sphincter many patients elect an AdVance® sling as the initial treatment of male stress incontinence. We determined whether sling placement would change the outcome of an ensuing artificial urinary sphincter. MATERIALS AND METHODS A total of 29 patients with stress urinary incontinence after failed sling placement were treated with an AMS 800® artificial urinary sphincter between January 2006 and May 2011. A control group of 136 men with a primary artificial urinary sphincter was used for comparison. Preoperative and postoperative evaluation included demographic variables, voiding diary, 24-hour pad weight, urodynamic characteristics, operative time, estimated blood loss, complication rate, followup and cuff selection. RESULTS There was no statistical difference in urodynamic characteristics, operative variables or the complication rate. Pad use was reported as less than 1 pad daily in 96% of patients (28 of 29) with a secondary artificial urinary sphincter at 3-month followup. At 20.7 months 6.9% of patients (2 of 29) treated with an artificial urinary sphincter after the male sling required revision of the artificial urinary sphincter. The overall complication rate in the control group was 8.8% (12 of 136 patients) with a 2.2% infection rate (3 of 136). The overall complication rate in the artificial urinary sphincter plus male sling group was 6.9% (2 of 29 patients) with a 0% infection rate. CONCLUSIONS Patients who require an artificial urinary sphincter after an initial male sling seem to fare as well as those who undergo primary artificial urinary sphincter implantation.
Collapse
Affiliation(s)
- Aaron C Lentz
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | |
Collapse
|
11
|
Abstract
Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented.
Collapse
Affiliation(s)
- Peter T. Dorsher
- Department of Physical Medicine and Rehabilitation, Mayo College of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Peter M. McIntosh
- Department of Physical Medicine and Rehabilitation, Mayo College of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| |
Collapse
|
12
|
Implantation of Artificial Urinary Sphincter in Patients With Post-Prostatectomy Incontinence, and Preoperative Overactive Bladder and Mixed Symptoms. J Urol 2011; 185:2254-9. [DOI: 10.1016/j.juro.2011.02.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Indexed: 11/23/2022]
|
13
|
Mandron E, Bryckaert PE, Papatsoris AG. Laparoscopic artificial urinary sphincter implantation for female genuine stress urinary incontinence: technique and 4-year experience in 25 patients. BJU Int 2011; 106:1194-8; discussion 1198. [PMID: 20132197 DOI: 10.1111/j.1464-410x.2010.09206.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE to assess the safety, feasibility and efficacy of laparoscopic implantation of the artificial urinary sphincter (AUS) in women with genuine stress urinary incontinence (SUI). PATIENTS AND METHODS from April 2005 to July 2009, 25 women (mean age 66.8 years) with genuine SUI had a laparoscopic implantation of the AUS (AMS 800(TM) , American Medical Systems, Minnetonka, MN, USA). Patients had a negative Marshall test and urodynamic studies showed decreased closure pressure. All patients had a history of urogynaecological surgery. Transperitoneal laparoscopic access was created with two midline 10-mm and two lateral 5-mm trocars. One of the lateral port incisions was later extended to facilitate urethrovaginal dissection with scissors and dissector, and the insertion and assembly of the AUS. In six cases of concomitant genito-urinary prolapse, laparoscopic anterior and posterior mesh promontofixation was also performed. RESULTS the AUS was successfully implanted in all cases with no conversion to open surgery. There were no intra- or perioperative complications, except one vaginal perforation which was repaired during surgery. The mean operative duration was 92 min (71 min without and 123 min with simultaneous promontofixation). Five patients developed urinary retention, which was managed with re-insertion of the urethral catheter for 2 days in four and with insertion of a suprapubic catheter for 4 weeks in a patient with spina bifida. During the mean follow-up of 26.1 months, two treatment failures were diagnosed due to vaginal erosion and were managed with removal of the AUS. All the remaining 23 patients reported continence, either complete (in 19) or social (in four). However, this was not a randomized comparative study. CONCLUSION laparoscopic implantation of the AUS in women with genuine SUI is safe, feasible and efficient.
Collapse
Affiliation(s)
- Eric Mandron
- Department of Urology, Clinique Chirurgicale du Pre, Le Mans, France
| | | | | |
Collapse
|
14
|
Djakovic N, Huber J, Nyarangi-Dix J, Hohenfellner M. Der artifizielle Sphinkter für die Inkontinenztherapie. Urologe A 2010; 49:515-24. [DOI: 10.1007/s00120-010-2265-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Cornel EB, Elzevier HW, Putter H. Can advance transobturator sling suspension cure male urinary postoperative stress incontinence? J Urol 2010; 183:1459-63. [PMID: 20172561 DOI: 10.1016/j.juro.2009.12.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE In a prospective 2-center study we confirmed and extended published results of the positive effect on post-prostatectomy stress incontinence of transobturator sling suspension using an Advance male sling. MATERIALS AND METHODS From September 2007 to June 2008 a male sling was placed and evaluated in 36 men according to the Rehder and Gozzi method. Diagnosis was based on 24-hour urine loss measured by a pad test, a 24-hour micturition frequency volume chart and cystoscopy. A visual analog scale for continence and bother, and a pad test were used preoperatively and postoperatively to objectively evaluate operative results. RESULTS At 1-year followup cure was achieved in 9.0% of patients and improvement was achieved in 45.5%. No effect on incontinence was seen in 36.5% of patients and 9.0% experienced worsening incontinence by pad test. The mean +/- SD visual analogue scale score of 6.1 +/- 2.2 (range 0 to 10) preoperatively improved significantly to 4.6 +/- 3.0 at 3 months (p = 0.024) and not significantly to 4.9 +/- 3.1 by 1 year postoperatively (p = 0.39). Improved incontinence did not correlate with patient age or incontinence severity. Complications developed in 2 patients, including sling infection and postoperative urinary retention in 1 each. CONCLUSIONS The transobturator sling suspension operation is a minimally invasive, safe procedure for male postoperative stress incontinence. Significantly improved continence was not observed on pad test but significant improvement in continence and bother was seen on the visual analog scale at 3 months.
Collapse
Affiliation(s)
- Erik B Cornel
- Department of Urology, Ziekenhuis Groep Twente Hengelo, Hengelo, The Netherlands.
| | | | | |
Collapse
|
16
|
|