2303 ULTRASOUND IMAGING OF ARTIFICIAL SPHINCTER PRESSURE REGULATING BALLOON

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112303 ULTRASOUND IMAGING OF ARTIFICIAL SPHINCTER PRESSURE REGULATING BALLOON Benjamin Brucker, Abdullah Demirtas, Eva Fong, Chris Kelly, and Victor Nitti Benjamin BruckerBenjamin Brucker New York, NY More articles by this author , Abdullah DemirtasAbdullah Demirtas New York, NY More articles by this author , Eva FongEva Fong New York, NY More articles by this author , Chris KellyChris Kelly New York, NY More articles by this author , and Victor NittiVictor Nitti New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2549AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditionally, plain radiography has been used to assess artificial urinary sphincter (AUS) integrity when there is failure or a change is patient continence status to determine if fluid has leaked from the system. This requires that the pressure regulating balloon (PRB) is filled with a contrast medium at the time of implantation. We propose that the device can be filled with injectable saline and office based abdominal ultrasound (US) can be used to determine the volume in the PRB when needed. The aim of this study was to assess the sensitivity and specificity of US in identifying PRB fluid status. METHODS A retrospective review was carried out on patient identified by a CPT 53447 (removal/replacement Urinary Sphincter)(R/R) limited to service dates 4/1/07–4/1/10. Data regarding clinical scenario, imaging, and intra-operative findings were recorded. US were all done in an office setting by a radiology technologist and reviewed by a Urologist. A Seimen's ACUSON Sequoia C512 was used with an 8C4(4–8 mHz) or a 9L4 probe (4–9 mHz) in all studies. The AMS 800 AUS was utilized in all cases. Sensitivity and specificity were calculated with a 2x2 table. In cases of under filled PRB, the point of leakage was determined, and the device was R/R. In cases of a full PRB, patients had a cuff downsizing or total R/R. RESULTS 27 patients were identified as having had a R/R of an AUS in the 3 year period analyzed. 14 patients underwent an US as part of their work-up prior to the R/R. Reasons for not obtaining an US included the following: advanced age of device (4), cuff erosion (2), confirmation of volume status on other imaging modality (2), cuff site pain (1), isolated pump malfunctions (1), other (3). Of the 14 patient, an AUS was placed after radical prostatectomy in 10, benign prostectomy in 1, TURP in 2 and neobladder 1 patients. 43% (n=6) of the US were read as the PRB being full (21–23 ml) and 57% (n=8) were noted to be empty/under filled (0-6 ml). By comparing these results to intra-operative findings US was 100% sensitive and 100% specific for determining fluid status of the PRB. AUS noted to be full on US were managed with downsizing of cuff (3), transcorporal cuff placement (1) and total removal/replacement (2). The devices that were empty were all entirely R/R. 50% (4/8) of leaks identified at the cuff site and the remaining AUS, though empty, did not have a leak sites identified. CONCLUSIONS Office based abdominal US is an effective and accurate way of determining the fluid status of the AMS 800 AUS. Given the accuracy of this modality, the system can be filled with saline solution without losing the ability to diagnose a fluid leak in the system. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e923-e924 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Brucker New York, NY More articles by this author Abdullah Demirtas New York, NY More articles by this author Eva Fong New York, NY More articles by this author Chris Kelly New York, NY More articles by this author Victor Nitti New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...