Esfíncter urinário artificial AMS 800 - análise retrospectiva de seis anos

Abstract

Introduction: The artificial urinary sphincter (AUS) is the gold standard for surgical treatment of male stress urinary incontinence.Objective: Evaluate the results of the artificial urinary sphincter placement of AMS 800 in the Department of Urology of São João Hospital Center in a 6-year period (January 2007/December 2012).Material and methods: 30 male patients with urinary incontinence (UI) underwent placement of AUS AMS 800 through penoscrotal approach, with an average age of 69years. 25 patients had severe incontinence and 5 moderate. With regard to etiology, UI secondary to radical prostatectomy (RP) in 26 patients, mixed incontinence (detrusor overactivity and PR) in 1 patient; prostatectomy for BPH in 1 patient; neurogenic UI in 2. 9 patients have a prior history of unsuccessful sling Invance, 14 a prior history of external pelvic radiotherapy and 8 a prior history of internal urethrotomy for stricture of vesico-urethral anastomosis. The mean postoperative follow-up was 22.1months. Mean pads/day before surgery: 5.73.Results: 20 patients (67%) are fully continent (no protection); 5 patients (17%) partially improved or continents (1-2 pads per day or reduction of > 50% of the number of pads), 5 patients (17%) without improvement (≥ 3 pads/day). Adding cured and improved patients, we obtain an overall success rate of approximately 84%. The variation of pads/day before and after surgery (respectively 5.7 and 0.8) is statistically significant (p < 0.05 - Wilcoxon test).Prior history of urethral sling, adjuvant pelvic radiotherapy and anastomotic VU stricture previously treated by urethrotomy do not compromise the continence rates.Regarding complications, mechanical failure occurred in one case (3%), infection in 3 (10%) and urethral erosion also in 3 (10%). The rate of re-operation (revision or removal of the AUS) was 23%.Conclusions: The AUS is an effective treatment for moderate to severe male stress urinary incontinence. Our success rates and complications are consistent with the literature. It has relevant success rate in peculiar groups: patients with sling, RT and anastomotic VU stricture previously treated by urethrotomy. The main limitations remain: the need for the patient to have satisfactory cognitive function and manual dexterity to handle the sphincter; present a non-negligible rate of re-intervention due to mechanical and non-mechanical complications.© 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.