240 PARTICULAR ASPECTS OF ARTIFICIAL URINARY SPHINCTER IMPLANTATION AFTER URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2012240 PARTICULAR ASPECTS OF ARTIFICIAL URINARY SPHINCTER IMPLANTATION AFTER URETHROPLASTY Andre Cavalcanti and Mauricio Rubinstein Andre CavalcantiAndre Cavalcanti Rio de Janeiro, Brazil More articles by this author and Mauricio RubinsteinMauricio Rubinstein Rio de Janeiro, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The artificial urinary sphincter(AUS) is the gold standard procedure to a definitive treatment of urinary incontinence associated with sphincter deficiency in male. The aim of this study is to describe our experience with the AUS implantation in a particular group: patients submitted to previously urethroplasties. METHODS The charts of 22 patients submitted to a AUS implantation after a urethroplasty were observed. The mean follow-up was 23.3 months (range from 6 to 48 months) and the mean patients age was 63 years (range from 25 to 81 years). The majority of the patients were submitted to a urethroplasty to treat an anastomotic stricture after radical prostatectomy (16 patients). 4 patients were submitted to a urethroplasty to treat a posterior stricture after a BPH surgery and 2 to treat a posterior traumatic stricture. The AUS surgical approach was transcorporal in all patients. In 7 patiens we performed a modified transcorporal approach, from the original Webester‘s technique (using two lateral tunica albugínea flaps to cover the urethra and a pericardium bovine graft to close the corporal defect). RESULTS In our initial 6 cases we used a early AUS implantation (3 months after the urethroplasty) and we observed a high urethral erosion rate (50%). In the other 16 cases we performed a late implantation (at least 6 months after the urethroplasty) and we observed an erosion rate decline to 6,2% (1 patient). 2/4 patients with AUS erosion were submitted to a suprapubic continent diversion and 2/4 patients were submitted to a AUS re-implantation with success. The final success rate of the AUS implantation (use of 1 pad per day or less), at least 6 months after the implantation was 75% (16/20 patients) with 65% complete dry (13/20). In 3/20 patients (15%) an improvement of the incontinence was observed with a reduction on the number of pads per day. 10/20 (50%) patients with AUS implanted were submitted to penile prosthesis implantation: 7 semirigid, 1 inflatable (3-pieces) e 2 inflatable (2-pieces). A delay cuff erosion was observed in all (2/2) patients after the implantation of a inflatable (2-pieces) penile prosthesis. CONCLUSIONS The AUS implantation after an urethroplasty is possible with acceptable rates of success. In our opinion the delay transcorporal implantation and the correct penile prosthesis choice (when necessary) are the best approaches to prevent complications. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e98-e99 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Cavalcanti Rio de Janeiro, Brazil More articles by this author Mauricio Rubinstein Rio de Janeiro, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...