MP40-13 ECTOPIC RESERVOIR PLACEMENT IN THE LATERAL RETROPERITONEUM DURING ARTIFICIAL URINARY SPHINCTER PLACEMENT: A REVIEW OF 729 CASES

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (MP40)1 Apr 2020MP40-13 ECTOPIC RESERVOIR PLACEMENT IN THE LATERAL RETROPERITONEUM DURING ARTIFICIAL URINARY SPHINCTER PLACEMENT: A REVIEW OF 729 CASES Jeffrey Loh-Doyle*, Azadeh Nazemi, Akbar Ashrafi, Eli Thompson, Mukul Patil, David Ginsberg, and Stuart Boyd Jeffrey Loh-Doyle*Jeffrey Loh-Doyle* More articles by this author , Azadeh NazemiAzadeh Nazemi More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Eli ThompsonEli Thompson More articles by this author , Mukul PatilMukul Patil More articles by this author , David GinsbergDavid Ginsberg More articles by this author , and Stuart BoydStuart Boyd More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000889.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) remains the gold standard treatment for male stress urinary incontinence (SUI).Conventionally, the pressure regulating balloon (PRB) is placed in the retropubic space. After extirpative pelvic surgery or radiotherapy, this space can be scarred and placing the reservoir in this space can lead to complications during initial placement and subsequent extraction, including significant vascular injury. To prevent this, several strategies for placing prosthetic reservoirs in alternate locations have been devised. We describe our technique that facilitates safe placement, simplifies subsequent interrogation and exchange, and avoids the reservoir-related complications associated with other locations. METHODS: We retrospectively reviewed an institutional review board approved prosthetic database of male patients that underwent placement of an AUS (AMS 800TM, Boston Scientific, Marlborough, MA) from 2005 to 2019. Patients with follow-up duration less than 6 months were excluded. All patients underwent ectopic placement of the PRB in the lateral retroperitoneum. The medical record of each patient was then specifically queried for reservoir-related complications including bladder and bowel injury, erosion into adjacent structures, vascular injury, herniation, palpability, leak, and tubing torsion during initial implantation and subsequent follow-up. RESULTS: From 2005-2019, 729 male patients with stress incontinence underwent implantation of an AUS. A total of 11 (1.5%) PRB-related complications were identified. No injuries to bowel or major vasculature occurred during placement or removal of the reservoir during subsequent revision. There were no instances of erosion into adjacent structures. Two patients had herniation of the reservoir into the subcutaneous space. 3 other patients were noted to have a palpable reservoir. There were no cases of mechanical failure attributed to torsion or twisting of tubing. 7 patients experienced failure of the device due to an identified leak that in the PRB. All patients underwent successful reservoir replacement without complication. One patient developed an infection of the PRB. The patient underwent immediate salvage removal and replacement of the entire device. CONCLUSIONS: Ectopic placement of the PRB in the lateral retroperitoneum during AUS placement is quick, safe, and avoids reservoir-related complications during implantation and future exchange. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e591-e591 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Loh-Doyle* More articles by this author Azadeh Nazemi More articles by this author Akbar Ashrafi More articles by this author Eli Thompson More articles by this author Mukul Patil More articles by this author David Ginsberg More articles by this author Stuart Boyd More articles by this author Expand All Advertisement PDF downloadLoading ...