Abstract
ABSTRACTPurpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients.Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires.Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients.Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.
Highlights
Urinary incontinence (UI) is a serious adverse effect due to radical prostatectomy [1]
Cuff placement may be difficult in a compromised urethra due to prior artificial urinary sphincter (AUS) placement, radiation or urethral surgery leading to a high risk of failure [4]
Quality of life and satisfaction were assessed based on two validated questionnaires in 33 patients who completed an Incontinence Quality of Life scale (I-QoL) and Patient Global Impression of Improvement (PGI-I) respectively
Summary
Urinary incontinence (UI) is a serious adverse effect due to radical prostatectomy [1]. After failure of conservative treatment, an artificial urinary sphincter (AUS) is considered the gold standard treatment for mild to severe incontinence from intrinsic sphincter deficiency [2]. It provides a high continence rate and patient satisfaction, despite a reoperation rate that may reach 62.7%. In men the AUS cuff is implanted directly around the bulbar urethra. Cuff placement may be difficult in a compromised urethra due to prior AUS placement, radiation or urethral surgery leading to a high risk of failure [4]. The transcorporal approach to AUS placement was created to protect the urethral wall in AUS revision for urethral atrophy and erosion [5] that protects the posterior wall of urethra during dissection, which may be critical
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