After Artificial Urinary Sphincter Research Articles

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy.

To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non-irradiated patients. This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non-RT group, respectively) who were treated with primary AUS implantation for post-radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model. In the RT and non-RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow-up of 38 months, ICIQ-SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non-RT groups. In the RT group, ICIQ-SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non-RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ-SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non-RT group (p < .001, and .015, respectively). Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.

Male Hypogonadism Does Not Affect Surgical Outcomes After Primary Artificial Urinary Sphincter Placement

Purpose: Studies suggest a link between hypogonadism and complications after artificial urinary sphincter (AUS) placement. We investigated this association and evaluated whether testosterone replacement therapy (TRT) before AUS placement attenuates this risk in hypogonadal patients. Materials and Methods: A retrospective cohort study was conducted using the TriNetX network between 2008 and 2022. We defined 2 groups undergoing primary AUS: (1) eugonadal and (2) hypogonadal patients. We further assessed the hypogonadal cohort by comparing TRT recipients with TRT-naïve patients before AUS. Propensity score matching was used to account for differences in covariates between eugonadal and hypogonadal cohorts. Outcomes included 5-year all-cause revision, erosion, mechanical failure, or device infection. Results: A total of 4308 eugonadal and 514 hypogonadal patients (95 with TRT, 409 TRT-naïve) were included. After matching, the eugonadal and hypogonadal cohorts each contained 504 patients. The median follow-up times for the eugonadal and hypogonadal cohorts were 6 and 5 years, respectively. We found no difference in 5-year all-cause revision (25% vs 28%, P = .35), erosion (1.2% vs 2.2%, P = .22), device infection (3.6% vs 4.0%, P = .74), or mechanical failure (16% vs 17%, P = .67) between eugonadal and hypogonadal patients. In the hypogonadal subanalysis, we found no difference in 5-year device outcomes between TRT recipients and TRT-naïve patients. Post-AUS, only 22 (5%) patients in the TRT-naïve arm received new TRT, suggesting minimal crossover. Conclusions: In matched cohorts of eugonadal and hypogonadal patients undergoing primary AUS placement, we observed no difference in 5-year device outcomes. TRT does not appear to affect surgical outcomes in hypogonadal patients undergoing AUS placement. These hypothesis-generating findings warrant further evaluation.

Using a stress reservoir to improve urine leakage after artificial urinary sphincter implantation.

Although the longest efficacy record, some patients report about urinary leakage during higher intra-abdominal pressure after Artificial Urinary Sphincter (AUS) implantation. To improve the continent results, we placed in addition to the occluding cuff and the pressure regulating balloon, in a second procedure a stress-relief reservoir in lower abdomen, for additional passive pressure transmission to the occluding cuff. In this retrospective monocentric data analysis between 2011 and 2018, 80 patients with persistence incontinence after AUS implantation were included. Stress-relief reservoir was indicated in 12 patients with involuntary leakage of urine, that occurred when intra-abdominal pressure raised. In all 12 cases, the stress reservoir was easily implanted and there were no intraoperative complications. In a mean follow-up time of 53months, the pad per day usage (p/d) improved from 3 (± 1.2) to 1.7 (± 1.5) (p = 0.001). Two patients with multiple previous abdominal surgeries used an equal number of pads after SRR; however, an improvement during physical exertion was reported. Continence situation was evaluated with a questionnaire and was rated as "excellent", "good", or "satisfactory" by 11 (92%) patients. The persistence of urinary incontinence after AUS is a challenging topic. Implantation of a stress reservoir in carefully selected patients with urinary leakage during higher intra-abdominal pressure is minimally invasive and offers new options to improve the proven long-term record of AUS. Certainly, more investigations are needed to determine the clinical relevance of this approach.

Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery.

Perioperative antimicrobial prophylaxis is crucial for prevention of prosthesis and patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for many urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) Best Practice guidelines. The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, revision/removal, and associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. AUS-related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline-adherent antibiotics was done via chi-squared and Kruskal-Wallis tests. A multivariable logistic mixed effects model was used to assess factors related to the odds of complication, specifically the use of guideline-adherent versus nonadherent regimens. Of 9775 patients with primary AUS surgery, 4310 (44.1%) received guideline-adherent antibiotics. The odds of guideline-adherent regimen use increased 7.7% per year with 53.0% (830/1565) receiving guideline-adherent antibiotics by the end of the study period. Patients with guideline-adherent regimens had a decreased risk of any complication (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.74-0.93) and surgical revision (OR: 0.85, 95% CI: 0.74-0.96) within 3 months; however, no significant difference in infection within was noted (OR: 0.89, 95% CI: 0.68-1.17) within 3 months. Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over the last two decades. While guideline-adherent regimens were associated with decreased risk of any complication and surgical intervention, no significant association was found with risk of infection. Surgeons appear to be increasingly following AUA recommendations for antimicrobial prophylaxis for AUS surgery, however, further level 1 evidence should be obtained to demonstrate conclusive benefit of these regimens.

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

MP71-08 TRENDS OVER 20 YEARS OF ANTIMICROBIAL PROPHYLAXIS FOR ARTIFICIAL URINARY SPHINCTER SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP71-08 TRENDS OVER 20 YEARS OF ANTIMICROBIAL PROPHYLAXIS FOR ARTIFICIAL URINARY SPHINCTER SURGERY Helen Sun, Michael Callegari, Eric Zhou, Stephen Rhodes, Aaron Brant, Erin Jesse, Megan Prunty, Jonathan Shoag, Kyle Scarberry, and Shubham Gupta Helen SunHelen Sun More articles by this author , Michael CallegariMichael Callegari More articles by this author , Eric ZhouEric Zhou More articles by this author , Stephen RhodesStephen Rhodes More articles by this author , Aaron BrantAaron Brant More articles by this author , Erin JesseErin Jesse More articles by this author , Megan PruntyMegan Prunty More articles by this author , Jonathan ShoagJonathan Shoag More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Shubham GuptaShubham Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Perioperative antimicrobial prophylaxis is crucial for prevention of patient morbidity after artificial urinary sphincter (AUS) placement. While antibiotic guidelines exist for urologic procedures, adoption patterns for AUS surgery are unclear. We aimed to assess trends in antibiotic prophylaxis for AUS and outcomes relative to American Urological Association (AUA) best practice statements. METHODS: The Premier Healthcare Database was queried from 2000 to 2020. Encounters involving AUS insertion, removal, and/or associated complications were identified via ICD and CPT codes. Premier charge codes were used to identify antibiotics used during the insertion encounter. Guideline-based regimens were defined as 1) aminoglycoside (AG) + 1st/2nd generation cephalosporin (CEP), 2) AG+vancomycin, 3) aztreonam and CEP, 4) aztreonam and vancomycin, 5) aminopenicillin, or 6) beta-lactamase inhibitor. AUS-related complication events were found using patient hospital identifiers. Univariable analysis between hospital/patient characteristics and use of guideline-based antibiotics was done via chi-squared and Kruskal Wallis tests. A logistic regression model was used to determine the odds ratio (OR) of complications. RESULTS: Of 9794 patients with primary AUS surgery, 4318 (44%) received guideline-based antibiotics. Probability of guideline-based regimen use increased 7.5% per year. Patients with guideline-based regimens had lower odds of any complication within 3 months vs. non-guideline regimens (OR 0.76, 95% CI 0.67-0.86); however, no significant difference in repair/removal was noted (OR 0.99, 95% CI 0.86-1.14). Each decade increase in age was associated with a 17% increase in complications (95% CI 1.11-1.24). No significant difference was noted with Charlson comorbidity index, region, or hospital size. CONCLUSIONS: Adherence to AUA antimicrobial guidelines for AUS surgery appears to have increased over time. Use of guideline-based regimens was associated with lower likelihood of complications, however they did not appear to lower surgical revision rates. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1016 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helen Sun More articles by this author Michael Callegari More articles by this author Eric Zhou More articles by this author Stephen Rhodes More articles by this author Aaron Brant More articles by this author Erin Jesse More articles by this author Megan Prunty More articles by this author Jonathan Shoag More articles by this author Kyle Scarberry More articles by this author Shubham Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

MP52-07 IMPACT OF FRAILTY ON ADVERSE COMPLICATIONS FOLLOWING ARTIFICIAL URINARY SPHINCTER IMPLANTATION

You have accessJournal of UrologyCME1 May 2022MP52-07 IMPACT OF FRAILTY ON ADVERSE COMPLICATIONS FOLLOWING ARTIFICIAL URINARY SPHINCTER IMPLANTATION Rohan Bhalla, Jackson Cabo, Tanya Marvi, Abimbola Ayangbesan, George Koch, Stephen Hill, Douglas Milam, Melissa Kaufman, and Niels Johnsen Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Tanya MarviTanya Marvi More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Stephen HillStephen Hill More articles by this author , Douglas MilamDouglas Milam More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is a well-established predictor of postoperative outcomes. We aimed to investigate the association between the modified Frailty Index (mFI) and postoperative complications after artificial urinary sphincter (AUS) surgery. METHODS: Men who underwent AUS surgery at a single institution (1/1/13 – 7/31/2020) were identified and electronic medical records were reviewed. The mFI is a validated measure of predicting patient morbidity and mortality that consists of 11 patient co-morbidities. Each variable is given 1 point with composite scores ranging from 0 (no frailty) to 11 (highest degree of frailty). Operative and non-operative complications were categorized as: mechanical failure, cuff erosion, infection, intractable pain, urinary retention, or other. Multivariable logistic regression was used to identify an association between mFI and postoperative complications. RESULTS: 203 AUS patients met inclusion criteria. The median age was 69.8 years (IQR 65.1-75.0) with 33% (n=67) of patients having a history of radiation and 29.1% (n=59) of patients with a history of diabetes mellitus. The median time from surgery to data collection was 73.4 months (IQR 54.4-89.2). The median cuff size was 4.5cm (IQR 4-5). The complication rate was 26.6% with 18.7% of men requiring a surgical intervention (mechanical failure: n=11, cuff erosion: n=16, infection: n=7, other n=4). The median mFI was 2 (IQR 1-4) for patients with a complication and 2 (IQR 1-3) for those with no complication (Table 1). Multivariable analysis demonstrated no association between mFI and overall complication (OR 1.04, 95% CI 0.83-1.29; p=0.75) or surgical complication (OR 1.04, 95% CI 0.81-1.34; p=0.75). Prior radiation and time since surgery were significantly associated with postoperative complications (Table 2). CONCLUSIONS: The mFI was not associated with an increased risk of AUS complications. However, a prior history of radiation and extended time from surgery were independently associated with complications and the need for surgical intervention. Source of Funding: N/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e888 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Tanya Marvi More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Stephen Hill More articles by this author Douglas Milam More articles by this author Melissa Kaufman More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF DownloadLoading ...

Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence

ABSTRACT Introduction Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown. Objective We sought to examine the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion. Methods We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS. Results We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of + 1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p &amp;lt; 0.01, duration 26.0 ± 21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p = 0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p &amp;lt; 0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p = 0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p = 0.04). Conclusions PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Reconstruction of AUS Cuff Erosion: Defect Size Predicts Prognosis

ABSTRACT Introduction In-situ urethroplasty (ISU) has been proposed in conjunction with device explant as an acute management strategy after artificial urinary sphincter (AUS) cuff erosion. Previous studies have not shown a clear relationship between extent of erosion and long-term prognosis. Objective We hypothesize that more extensive erosions are associated with higher rates of lower urinary tract complications (LUTC) and increased need for urinary diversion (UD). Methods We performed a retrospective study of patients who underwent ISU for AUS cuff erosion from June 2007 to December 2020 with a minimum of 90-day follow up. Patients were stratified into two groups based on the degree of urethral erosion determined endoscopically at the time of device explant - mild erosions (&amp;lt;33% circumferential defect) and major erosions (&amp;gt; 33%). Outcomes included LUTC, AUS reimplantation, and UD. LUTC was defined as urethral strictures, diverticulum, fistulas, and erosions of a secondary AUS. UD was defined as suprapubic tube placement with or without urethral ligation or ileal conduit creation. Kaplan-Meier curves were created to compare outcomes between groups. Results A total of 40 patients underwent ISU for urethral cuff erosion and met the follow-up criteria. Median patient age was 76 years old with median erosion defect size of 46% (IQR: 20-50%); 15 men (37.5%) had mild erosions and 25 (62.5%) had major erosions. The overall LUTC rate was 53.5% with significantly fewer complications noted with mild erosions (28.6% vs 65.4%, p = 0.002) (Figure 1). Ultimately, 35.0% of patients required permanent UD with decreased rates in the case of mild erosions (13.3% vs 48.0%, p = 0.04) (Figure 2). On Kaplan-Meier analysis, mild erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. Conclusions Prognosis after AUS cuff erosion is associated with size of the urethral defect. Patients with extensive cuff erosion are at high risk for LUTCs and permanent UD. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Risk Factors for Revision After Artificial Urinary Sphincter Implantation in Male Patients With Stress Urinary Incontinence: A 10-Year Retrospective Study.

PurposeTo evaluate the preoperative and intraoperative risk factors for revision after artificial urinary sphincter (AUS) implantation in male patients with stress urinary incontinence (SUI).MethodsA retrospective analysis from a prospectively maintained database was performed. Male patients, with moderate-tosevere SUI, undergoing AUS implantation were included. All patients underwent placement of AMS 800. Cause of revision, type of revision, and time to revision were recorded. Multivariable analyzes were performed using a logistic regression to investigate the risk factors. Competing risk analysis according to Fine-Gray model was used to study time to event data.ResultsA total of 70 patients were included. Revision surgery was performed in 22 of 70 patients (31.4%), after a median (interquartile range) time of 26.5 months (6.5–39.3 months). Overall, 19 of 22 repairs (86.4%) and 3 of 22 explants (13.6%) were recorded. Mechanical dysfunction, urethral erosion, urethral atrophy, and device infection were the causes of revision in 11 of 22 (50.0%), 6 of 22 (27.3%), 3 of 22 (13.6%), and 2 of 22 patients (9.1%). Vesicourethral anastomosis stenosis (P=0.02), urethral cuff size of 3.5 cm (P=0.029), and dual implantation (P=0.048) were independent predictors for revision. Vesicourethral anastomosis stenosis (P=0.01) and urethral cuff size of 3.5 cm (P=0.029) predicted a lower survival of the AUS.ConclusionsThe vesicourethral anastomosis stenosis, urethral cuff size of 3.5 cm, and dual implantation are independent predictors for revision after AUS implantation. However, only the vesicourethral anastomosis stenosis and urethral cuff size of 3.5 cm predict a lower survival of AUS.

Lower Urinary Tract Symptoms are Common After Artificial Urinary Sphincter Implantation

ObjectiveTo investigate lower urinary tract symptoms (LUTS) observed after artificial urinary sphincter (AUS) implantation for post-radical prostatectomy urinary incontinence (PRPUI). Materials and MethodsCases of AUS for PRPUI were evaluated. Stress urinary incontinence (SUI) was assessed using the Sandvik-incontinence severity index. Other LUTS were evaluated using the overactive bladder symptom score and international prostate symptom score. The prevalence and predictive risk factors for post-AUS LUTS were analyzed. ResultsOf 129 patients evaluated (mean follow-up = 42.3 months, mean age = 76.7 years), 8.5% had very severe SUI, 78.4% had moderately to severely symptomatic LUTS (IPSS = 8-35 points), and 45.2% were dissatisfied with their urinary condition. Nocturia was the most prevalent (48.0%). Maximum cystometric capacity (rho = –0.236, P = .007) and involuntary detrusor contraction (P = .002) were significantly related to the severity of post-AUS urgency urinary incontinence (UUI). Multivariable linear regression analysis indicated that involuntary detrusor contraction was more associated with post-AUS urgency (P <.001) and UUI (P = .006) than any other preoperative parameter. Age significantly correlated with the severity of post-AUS urgency (rho = 0.309, P <.001), UUI (rho = 0.196, P = .026), and the need for straining to void (rho = 0.240, P = .007). ConclusionEven after successful placement of an AUS, many patients were dissatisfied with various LUTS, ranging from the most frequent nocturia to the need for straining to void. Attention should be paid not only to SUI but also to non-SUI LUTS, which are observed in the general population in this age group and change over time. Counseling to educate patients about expected outcomes and continuous monitoring and treatment for LUTS should be provided for the PRPUI-AUS population.

Long-term lower urinary tract sequelae following AUS cuff erosion.

To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.

PD22-12 COMPARISON OF OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN POST-RADIATION PATIENTS WITH AND WITHOUT HYPERBARIC OXYGEN THERAPY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-12 COMPARISON OF OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN POST-RADIATION PATIENTS WITH AND WITHOUT HYPERBARIC OXYGEN THERAPY Samantha Nealon, Joseph Balbona, and Lucas Wiegand Samantha NealonSamantha Nealon More articles by this author , Joseph BalbonaJoseph Balbona More articles by this author , and Lucas WiegandLucas Wiegand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior radiation therapy is a well-documented risk factor for postoperative complications after artificial urinary sphincter (AUS) placement. Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue quality in patients with prior radiation. However, no previous study has investigated the role of HBOT in reducing complications following AUS surgery in patients with pelvic radiation. METHODS: Patients identified had a radiation history and underwent primary AUS insertion by a single surgeon August 2015 - March 2019. Demographics, comorbidities, continence, and postoperative complications were analyzed. Surgical outcomes in patients who had received HBOT prior to AUS insertion were compared to those who had not. RESULTS: 31 patients underwent AUS placement. 10 patients (median age 73.4) underwent HBOT while 21 patients (median age 69.3) did not receive HBOT. More patients in the non-HBOT group received EBRT (94.7%), compared to the HBOT group in which 55.6% received EBRT while the remaining received either EBRT plus brachytherapy or brachytherapy alone (p=0.03). Average time since radiation therapy was 9.3 years in the HBOT group and 7.6 years in the non-HBOT group. Average follow up was not significantly different between groups (p=0.5). Pads per day preoperatively were 6.6 and 7.2 in the HBOT and non-HBOT groups. Postoperative pads per day were 1.0 and 2.2 in the HBOT and non-HBOT groups. Preoperative and postoperative pads per day were not statistically different between the two groups. No statistically significant difference was seen in postoperative complications between the HBOT and non-HBOT groups (50% vs. 57.1%, p<0.70). Patients treated with HBOT had an overall lower rate of erosions and revisions than patients without HBOT, however neither difference reached significance (p=0.52 and p=0.31, respectively). CONCLUSIONS: HBOT has been shown to improve post-radiation tissue damage. In our current series, rates of AUS erosion were lower in patients treated with HBOT prior to AUS placement, but this did not reach statistical significance. While our study was not powered to be statistically significant, these results indicate that an additional higher-powered study is needed to determine whether HBOT can prevent complications related to AUS placement. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e384-e385 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Nealon More articles by this author Joseph Balbona More articles by this author Lucas Wiegand More articles by this author Expand All Advertisement Loading ...

PD04-06 ARTIFICIAL URINARY SPHINCTER REVERSES WEIGHT GAIN ASSOCIATED WITH POST-PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-06 ARTIFICIAL URINARY SPHINCTER REVERSES WEIGHT GAIN ASSOCIATED WITH POST-PROSTATECTOMY INCONTINENCE Raj Bhanvadia, Benjamin Dropkin, Avery Wolfe, Linley Diao, Sarah Sanders, Gregory Joice, Claus Roehrborn, Steven Hudak, and Allen Morey Raj BhanvadiaRaj Bhanvadia More articles by this author , Benjamin DropkinBenjamin Dropkin More articles by this author , Avery WolfeAvery Wolfe More articles by this author , Linley DiaoLinley Diao More articles by this author , Sarah SandersSarah Sanders More articles by this author , Gregory JoiceGregory Joice More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Steven HudakSteven Hudak More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown. We examined the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion. METHODS: We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS. RESULTS: We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of +1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p<0.01, duration 26.0 +21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p=0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p<0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p=0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p=0.04). CONCLUSIONS: PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e51-e52 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raj Bhanvadia More articles by this author Benjamin Dropkin More articles by this author Avery Wolfe More articles by this author Linley Diao More articles by this author Sarah Sanders More articles by this author Gregory Joice More articles by this author Claus Roehrborn More articles by this author Steven Hudak More articles by this author Allen Morey More articles by this author Expand All Advertisement Loading ...

PD04-03 RECONSTRUCTION OF ARTIFICIAL URINARY SPHINCTER CUFF EROSION: DEFECT SIZE PREDICTS PROGNOSIS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-03 RECONSTRUCTION OF ARTIFICIAL URINARY SPHINCTER CUFF EROSION: DEFECT SIZE PREDICTS PROGNOSIS Nathan Chertack, Gregory Joice, Kelly Caldwell, Mehraban Kavoussi, Benjamin Dropkin, Nicolas Ortiz, Adam Baumgarten, Nabeel Shakir, Sarah Sanders, Steven Hudak, and Allen Morey Nathan ChertackNathan Chertack More articles by this author , Gregory JoiceGregory Joice More articles by this author , Kelly CaldwellKelly Caldwell More articles by this author , Mehraban KavoussiMehraban Kavoussi More articles by this author , Benjamin DropkinBenjamin Dropkin More articles by this author , Nicolas OrtizNicolas Ortiz More articles by this author , Adam BaumgartenAdam Baumgarten More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Sarah SandersSarah Sanders More articles by this author , Steven HudakSteven Hudak More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In-situ urethroplasty (ISU) has been proposed in conjunction with device explant as an acute management strategy after artificial urinary sphincter (AUS) cuff erosion. Previous studies have not shown a clear relationship between extent of erosion and long-term prognosis. We hypothesize that more extensive erosions are associated with higher rates of lower urinary tract complications (LUTC) and increased need for urinary diversion (UD). METHODS: We performed a retrospective study of patients who underwent ISU for AUS cuff erosion from June 2007 to December 2020 with a minimum of 90-day follow up. Patients were stratified into two groups based on the degree of urethral erosion determined endoscopically at the time of device explant - mild erosions (<33% circumferential defect) and major erosions ( >33%). Outcomes included LUTC, AUS reimplantation, and UD. LUTC was defined as urethral strictures, diverticulum, fistulas, and erosions of a secondary AUS. UD was defined as suprapubic tube placement with or without urethral ligation or ileal conduit creation. Kaplan-Meier curves were created to compare outcomes between groups. RESULTS: A total of 40 patients underwent ISU for urethral cuff erosion and met the follow-up criteria. Median patient age was 76 years old with median erosion defect size of 46% (IQR: 20-50%); 15 men (37.5%) had mild erosions and 25 (62.5%) had major erosions. The overall LUTC rate was 53.5% with significantly fewer complications noted with mild erosions (28.6% vs 65.4%, p=0.002). Ultimately, 35.0% of patients required permanent UD with decreased rates in the case of mild erosions (13.3% vs 48.0%, p=0.04). On Kaplan-Meier analysis, mild erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS: Prognosis after AUS cuff erosion is associated with size of the urethral defect. Patients with extensive cuff erosion are at high risk for LUTCs and permanent UD. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e50-e50 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Chertack More articles by this author Gregory Joice More articles by this author Kelly Caldwell More articles by this author Mehraban Kavoussi More articles by this author Benjamin Dropkin More articles by this author Nicolas Ortiz More articles by this author Adam Baumgarten More articles by this author Nabeel Shakir More articles by this author Sarah Sanders More articles by this author Steven Hudak More articles by this author Allen Morey More articles by this author Expand All Advertisement Loading ...

Evaluation of the 24-h pad weight test as continence rate assessment tool after artificial urinary sphincter implantation for postprostatectomy urinary incontinence: A Swedish retrospective cohort study.

Patient-reported pad-count as continence rate assessment tool after artificial urinary sphincter (AUS) implantation is common. However, lack of standardized continence definition using this method results in heterogeneous published efficacy outcomes. Data on 24-h pad weight tests (PWT) after primary AUS implantation for postprostatectomy urinary incontinence (PPUI) is scarce. Our aim was to evaluate the 24-h PWT as an efficacy assessment tool and correlate it to qualitative outcomes using validated questionnaires. This retrospective, single center, follow-up cohort study, evaluated 180 patients who underwent primary AUS implantation for PPUI from 2005 to 2018. Voiding diaries, 24-h PWT, validated patient satisfaction and quality of life (QoL) questionnaires were collected pre-operatively and at 3-6 months postactivation, using the institution's Electronic Medical Records. The median preoperative and postoperative 24-h PWT values were 494 (interquartile range [IQR]: 304-780) and 7 (IQR: 0-25) g respectively with a significant improvement in urinary leakage of 489.5 g 99.1% (p < 0.001). Median preoperative and postoperative I-QoL results increased from 33.5 (IQR: 19.3-63.6) to 86.4 (IQR: 73.9-94.3) points, with a significant 52.9 points improvement in QoL (p < 0.001). Similarly, the median preoperative and postoperative ICIQ-SF values decreased from 20 (IQR: 17-21) to 5 (IQR: 3-9) points, showing a significant improvement of 15 points (p < 0.001). We also found a significant correlation between PWT and patient satisfaction. The 24-h PWT provides a reliable and objective assessment of continence rates, with a strong correlation to qualitative outcomes, after primary AUS implantation for PPUI. Its use could help reduce reported outcome heterogeneity across studies.

Impact of preoperative factors on recovery of continence after artificial urinary sphincter implantation in postprostatectomy incontinence.

BackgroundThe purpose of this study was to determine the influence of preoperative factors on the recovery of continence after artificial urinary sphincter (AUS) implantation in postprostatectomy incontinence.Materials and methodsSeventy-two patients who underwent AUS implantation between April 2006 and March 2020 were analyzed. The clinical features and preoperative urodynamic parameters were correlated with the postoperative continence rate using linear and logistic regression analysis. The recovery of continence was defined by the patient requiring no use of a protective urine pad during the 24 hours.ResultsOf the 72 patients, 57 (79.2%) recovered continence (dry group), while 15 (20.8%) were wearing more than 1 pad per day (wet group) on the last follow-up visit. In the clinical characteristics, only the interval between radical prostatectomy and AUS (in months) showed a statistically significant difference (35.4 ± 26.2 in the dry group, 22.7 ± 12.2 in the wet group, p = 0.009). Other preoperative clinical features such as the underlying disease, surgical methods, size of prostate, tumor stage, and radio nor hormonal therapy did not present statistically significant differences.Of the preoperative urodynamic parameters, only the abdominal leak point pressure (ALPP) showed statistical significance when related to surgical outcomes by 88.6 ± 33.6 in the dry group and 66.1 ± 29.6 in wet the group (P = 0.024). The number of patients for whom ALPP was higher than 80 cm H2O was 61.4% in the dry group and 20% in the wet group (95% confidence interval: 1.612-25.11). Other preoperative UDS features including detrusor underactivity, maximum urethral closure pressure, and others were not statistically significant.ConclusionsThe interval between RP and AUS, as well as the preoperative ALPP, can be possible predictive factors for the surgical outcomes of AUS implantation. In addition, an ALPP of >80 cm H2O has a high degree of predictability for success of AUS surgical outcomes in post-RP incontinence.

Long-term functional outcomes of artificial urinary sphincter (AMS 800™) implantation in women aged over 75years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency.

To assess the outcomes after artificial urinary sphincter (AUS) implantation in older women aged over 75years. A monocentric retrospective study included all non-neurological women aged over 75years suffering from stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and undergoing an AUS placement between 1991 and 2015. Early postoperative complications were reported according to Clavien-Dindo classification. Continence, defined as no pad use, was assessed at the end of follow-up. Explantation, revision and deactivation rates of the AUS were reported. A Kaplan-Meier survival curve was generated to evaluate the survival rate of the device without revision or explantation. Among 393 AUS implantations, a total of 45 patients, median age 77years (IQR 75-79), were included. Twenty-six early postoperative complications occurred in 18 patients (40%) patients. All were minor Clavien grades (I-II) except one (grade IVa). Median follow-up was 36months (IQR 16-96). Overall, 32 women (71.1%) still had their AUS in place at the end of the follow-up, without revision or explantation. The AUS was definitively removed in four (8.9%). The AUS required revisions in nine (20%) women. The 5- and 10-year survival rates of the device without revision or explantation were 78 and 50%, respectively. Three patients (6.7%) had their AUS deactivated. At last follow-up, in an intention-to-treat analysis, the continence rate was 68.9%. In women aged over 75-years-old, suffering from SUI, the AUS provides satisfactory functional results comparable to the general population.

Longitudinal changes in patient-reported outcomes after artificial urinary sphincter implantation.

To evaluate the time course of lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation based on individual longitudinal changes of patient-reported outcomes. This retrospective study included 66 male patients with severe urinary incontinence who were treated with primary AUS implantation between 2009 and 2019. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and International Prostate Symptom Score (IPSS) questionnaires were used to evaluate continence status and LUTS preoperatively, 1, 3, and 12 months after activation, and then annually. The annual changes in scores were calculated with a linear mixed model. Of the 66 patients, 63 (95%) achieved complete or social continence (number of pads used ≤1/d) at 1 month after activation. Mean preoperative ICIQ-SF, IPSS, and IPSS-quality of life (QOL) score were 18.9, 14.9, and 5.4, respectively; the corresponding scores at 1 month after activation were 4.5, 9.0, and 1.7 (all P < .001), respectively. During the mean follow-up period of 36 months, the annual changes in the scores from 1 month after activation were 0.51 (P = .002), -0.30 (P = .184), and 0.19 (P < .001), respectively. As for individual IPSS items, while incomplete emptying, frequency, urgency, and weak stream improved significantly 1 month after activation, no significant changes from 1 month after activation were observed except for longitudinal deterioration of incomplete emptying score (0.08/y, P = .029). Continence status and QOL score markedly improved by AUS implantation immediately, but deteriorated over time. Improved LUTS were maintained without a worsening trend, however.

PD26-07 EXPOSING THE MYTH OF URETHRAL ATROPHY AS ETIOLOGY OF RECURRENT INCONTINENCE AFTER ARTIFICIAL URINARY SPHINCTER: THE ROLE OF CAPSULOTOMY WITH INTRAOPERATIVE PRESSURE PROFILING OF THE PRESSURE REGULATING BALLOON.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-07 EXPOSING THE MYTH OF URETHRAL ATROPHY AS ETIOLOGY OF RECURRENT INCONTINENCE AFTER ARTIFICIAL URINARY SPHINCTER: THE ROLE OF CAPSULOTOMY WITH INTRAOPERATIVE PRESSURE PROFILING OF THE PRESSURE REGULATING BALLOON. Amy Pearlman, Alison Rasper, and Ryan Terlecki Amy PearlmanAmy Pearlman More articles by this author , Alison RasperAlison Rasper More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent stress urinary incontinence (rSUI) after artificial urinary sphincter (AUS) placement can be vexing for patients and prosthetic urologists. In absence of malfunction, the etiology is often assumed to be urethral atrophy. Urethral constriction by subcuff encapsulation, however, may preclude proper coaptation. Our technique involves incision of the subcuff capsule with intraoperative observation for urethral recovery and pressure profiling of the pressure regulating balloon (PRB). We aimed to characterize the incidence and extent of both urethral recovery following capsulotomy and that of PRB material fatigue in men undergoing AUS revision for rSUI. METHODS Retrospective review of a prospectively collected, IRB-approved single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessment (via transducer) were identified. Urethral circumference was measured before and after capsulotomy. PRB profiles were recorded and compared to initial manufacturer ratings. RESULTS The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75. Mean time between original AUS placement and AUS revision surgery was 103 months. 6 patients underwent prior prostatectomy and the remaining patient underwent prior transurethral resection of his prostate followed by brachytherapy. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1cm; range 0.5-2.5cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Of the 2 patients whose cuff size decreased, 1 was a prior transcorporally placed cuff and both cuff sizes decreased by only 0.5cm. 6 of the 7 patients underwent PRB interrogation. 66.7, 16.7, and 16.7% of PRBs demonstrated pressures in a category below, at the same, or higher than the original manufacturer rating. Mean follow up between AUS revision surgery and last encounter was 6.7 months. CONCLUSIONS Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and morbidity. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e554 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amy Pearlman More articles by this author Alison Rasper More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...