Artificial Urethral Sphincter Research Articles

Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). Eight client-owned dogs with UD treated with an AUS. Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Manual Dexterity Predictors of Artificial Urinary Sphincter Success

ObjectiveTo determine better in-office measures for artificial urethral sphincter outcomes, we investigated the ability of preoperative timed peg-transfer, pinch strength, grip strength, and Disabilities of the Arm Shoulder and Hand Outcome questionnaire in predicting postoperative satisfaction, confidence, and ease of use of artificial urethral sphincter placement for stress urinary incontinence. Materials and MethodsA timed 9-hole peg test, pinch and grip strength assessment, and upper extremity questionnaire were administered during the preoperative visit before sphincter placement. In addition to standard preoperative workup, short form International Consultation of Incontinence Questionnaire and physician handshake were recorded. Activation occurred 6 weeks after surgery along with assessment of adequacy of pump placement. Three months from surgery a repeat incontinence questionnaire and a survey measuring satisfaction, difficulty of use, and confidence were given. Correlation between preoperative assessment variables and the postoperative questionnaire was assessed. ResultsThirty-nine patients were included. Average age and body mass index were 68.8 years and 28.8 kg/m2 respectively. Prior prostatectomy accounted for 92.3% of patients, and 46.2% had prior pelvic radiation. Postoperatively 59.0% of patients were very satisfied; 64.1% of patients reported no difficulty of use; 53.8% felt confidence within one day; and 66.7% had much better bladder control. Average pad improvement count was 5.3. Pinch test was associated with satisfaction (p= 0.011) while peg test was associated with confidence (p = 0.049). Handshake and upper extremity questionnaire were not significant. ConclusionsThe pinch and 9-hole peg transfer tests are cost-effective and easily performed adjuncts that could be used during artificial urethral sphincter evaluation for patients with unclear manual functional status.

Application of modified urethral separation method in artificial urethral sphincter implantation and its influence on intraoperative urethral pressure profilometry

Objective: To explore the application of modified urethral separation method in artificial urethral sphincter (AUS) implantation in patients with stress urinary incontinence (SUI), and its influence on the results of urethral pressure profilometry. Methods: A prospective collection of clinical data was conducted on 25 patients with stress urinary incontinence who underwent modified urethral separation method in AUS implantation and underwent urethral pressure profilometry in Beijing Hospital, Beijing Jishuitan Hospital Affiliated to Capital Medical University and the Second Hospital Affiliated to Tianjin Medical University from March 2019 to June 2023. The improved urethral separation method was to borrow part of the white membrane tissue of the cavernous body while freeing the dorsal side of the cavernous body of the urethra. The circumference of the urethra, sleeve size, and urethral pressure were recorded, the patient's autonomous urinary control before and after surgery and the changes of the international consultation on incontinence questionnaire-short form (ICI-Q-SF) score, incontinence quality of life questionnaire (I-QoL) score, urinary frequency score, nocturia score were compared. Follow-up was conducted in the clinic or by telephone at 1, 3, 6, and 12 months after activation of the device, and once a year thereafter. Local skin status and urine control were assessed, residual urine volume was measured by ultrasound and subjective score scale was completed. Results: All patients were male, aged 27-85 (65.8±15.7) years old. The circumference of the cuff used in this study was 4.0 cm in 4 patients (16.0%), 4.5 cm in 16 patients (64.0%), 5.0 cm in 4 patients (16.0%), and 5.5 cm in 1 patient (4.0%). Among them, the urethral circumference matched the cuff size in 14 cases (56.0%), the urethral circumference was smaller than the cuff size in 4 cases (16.0%), and the urethral circumference was larger than the cuff size in 7 cases (28.0%). Preoperative urodynamic examination showed that the maximum urethral pressure (MUP) was (78.0±25.9) cmH2O, (1 cmH2O=0.098 kPa) and the maximum urethral closure pressure (MUCP) was (53.4±26.6) cmH2O. The MUP of AUS device in the inactivated state was (88.0±26.5) cmH2O, which was not significantly higher than that before operation (P>0.05). The MUCP was (68.2±24.5) cmH2O, which was significantly higher than that before operation (P<0.05). The MUP and MUCP of the AUS device in the activated state were (146.6±25.2) cmH2O and (123.0±28.3) cmH2O, which were significantly higher than those before surgery and in the inactivated state (both P<0.001). All patients in the group reached the social urinary control standards at the first month of device activation. During a follow-up period of 2-50 months, 22 patients (88.0%) used the initial AUS device and all met social urinary control standards. The AUS device was replaced in 1 case. One patient died of cerebrovascular accident. One patient removed the device due to complications. The number of pads [M (Q1, Q3)] used in 25 patients before and after operation was 4.5 (3.0, 6.5) and 1 (0, 1) respectively, with statistically significant differences (P<0.001). ICI-Q-SF score, I-QoL score, urinary frequency score and nocturia score of 25 patients were significantly improved after surgery (all P<0.05). The incidence of postoperative complications was 20.0% (5/25), including 2 cases of painless hematuria, 1 case of infection, 1 case of urethral erosion, and 1 case of dysuria. Except for one patient who experienced urethral erosion and had his sleeve removed, the remaining four patients regained social urination control with active support treatment, and no symptoms recurred until the last follow-up. Conclusion: The modified urethral separation method has no significant effect on urethral pressure in patients with SUI, and can increase the volume of peri-urethral tissue in the cuff, thereby reducing the risk of intraoperative urethral injury and the incidence of postoperative urethral erosion.

(041) Pre-Operative Bilateral Pudendal Nerve Blocks can Reduce Opioid Utilization for Patients Undergoing Urologic Prosthetic Procedures

Abstract Introduction Opioid related overdoses and deaths have been increasing in recent decades, and recent studies have shown that even short courses of opioids can result in dependence and misuse. Urologic prosthetic procedures can be painful, and historically pain management has been predominantly through opioid-based analgesia. Multimodal pain management plans have been shown to help reduce exposure to opioids, and these include local nerve blockade. Objective Our study aims to assess the efficacy of bilateral pudendal nerve block in post-operative pain management and reduction of opioid use. Methods We conducted a retrospective review of all patients undergoing urologic prosthetic surgeries at a single Canadian institution between September 2020 and June 2023. Prosthetic surgeries included inflatable penile prosthesis (IPP) and artificial urethral sphincter (AUS) implants and explantation/reimplantation, but patients were only included once during the study period. Patients with chronic pain or missing pain data were excluded. Patients received bilateral pudendal nerve blocks at the discretion of the surgeon as a practice change starting in 2021 and compared to a control group (no blocks). Pain was assessed by the nursing care team using an analogue rating scale (out of 10), and all opioid and non-opioid pain medications were blindly recorded by nursing as their part of their usual documentation. Opioid utilization was converted to oral morphine equivalents (OMEs). Primary outcome was OMEs utilization in the post-operative period while in hospital, with a secondary of overall pain scores. Data was analysed using two-sample t-tests, and significance set to a p-value of 0.05. Results Our study included a total of 134 patients, with 59 patients receiving preoperative bilateral pudendal nerve blocks (54 IPP, 5 AUS), and 75 patients receiving the standard protocol (31 IPP, 44 AUS). The median age of patients receiving pudendal nerve blocks was 62.51 compared to the control group median age of 67.81. (p&amp;lt;0.05). There was no difference in ages in sub-analysis of IPP and AUS cohorts. Sub-analysis of the AUS cohort demonstrated a lower median pain score immediately post-op for those receiving blocks compared to control (0.8 vs. 2.73 respectively, p&amp;lt;0.05), with no difference in pain scores otherwise. AUS patients with pudendal nerve blocks consumed significantly less OMEs on day of surgery (median 0 vs. 6.75 OMEs, p&amp;lt;0.05). The IPP cohort with pudendal nerve blocks had no difference in pain scores compared to control, but consumed significantly less OMEs on day of surgery (9.06 vs. 12.56 OMEs respectively, p&amp;lt;0.05) and on post-operative day one (2.99 vs. 7.30 OMEs respectively, p&amp;lt;0.05). Conclusions Preoperative bilateral pudendal nerve blocks appear to reduce post-operative opioid use for patients undergoing urologic prosthetic surgery. Regular use of pudendal nerve blocks for patients undergoing prosthetic and pelvic surgeries may be an efficient means to reduce patient exposure to opioids. Bilateral pudendal nerve blockade for all genital and pelvic surgeries may be an effective opioid harm reduction strategy and warrants further investigation and patient satisfaction outcomes. Disclosure No.

(222) Simultaneous Inflatable Penile Prosthesis and Adjustable Male Sling: A Step-by-Step Surgical Technique

Abstract Introduction Erectile dysfunction (ED) and urinary incontinence (UI) are common complications following radical prostatectomy (1). At twenty-four months post-surgery, approximately 43% of men experience some degree of ED, while UI affects around 15% of patients between twelve to twenty-four months (2, 3). Notably, nearly 20% of patients experience both ED and UI complications (4). Initial conservative management strategies include the use of PDE-5 inhibitors, intercavernosal injections, or a vacuum erectile device for ED and pelvic floor muscle training for UI (5). However, symptoms that persist or worsen beyond six months can be considered for surgical intervention (6). Surgical options include penile prosthesis implantation for ED and diverse techniques such as the Artificial Urinary Sphincter (AUS) or adjustable male urethral sling, depending on symptom severity, for UI management. Limited evidence suggests that a simultaneous surgical approach addressing both conditions can be a cost-effective and a safe alternative to separate surgeries (7, 8). Objective In this context, the objective of this video presentation is to illustrate a detailed, step-by-step technique for the simultaneous implantation of an inflatable penile prosthesis (IPP) and an adjustable male sling (AMS), while also discussing its feasibility, safety, and functional outcomes. Methods The combined IPP and AMS surgery is a safe, viable, and cost-effective option for patients who need to address both ED and UI. Rhee (2005) initially described the concurrent placement of a penile prosthesis (PP) and male sling (MS) in a series of four post-prostatectomy patients. Results The results demonstrated successful restoration of erections and complete continence in all patients, with no postoperative complications. Our previous systematic review, comparing the outcomes of simultaneous surgical placement of PP and MS versus PP and artificial urethral sphincter (AUS), found no clinically significant differences in outcomes between the two groups (Raheem 2021). Therefore, the simultaneous placement of IPP and AMS should be considered an option for patients, as it shows comparable effectiveness to other concurrent surgical interventions. Dual implantation of PP and male sling have also demonstrated cost savings of approximately $9,000 for patients, further enhancing its advantages in managing both ED and UI (Gorbatiy 2010). Ultimately, a collaborative discussion between patients and their urologist is crucial in determining the most suitable approach for patient individual needs. Conclusions The simultaneous surgical placement of an inflatable penile prosthesis (IPP) and adjustable male sling (AMS) presents a favorable and viable solution for managing erectile dysfunction (ED) and urinary incontinence (UI) in patients who exhibit an inadequate response to conservative management following prostatectomy. Disclosure No.

Placement of an artificial urethral sphincter for treatment of passive urinary incontinence after inadvertent prostatectomy and balloon dilation treatment for stricture formation in a 5-month-old dog.

Describe the management of incontinence with several therapies, culminating with the apparently successful treatment utilizing artificial sphincter placement following an inadvertent prostatectomy. 5-month-old 7.5-kg male neutered Miniature Schnauzer. The patient was referred for dysuria and persistent stranguria following an iatrogenic total prostatectomy and urethrectomy. An extra pelvic urethral anastomosis was performed, followed by hospitalization for 2 weeks with a urinary catheter. The patient was further investigated for persistent stranguria, and a contrast urethrogram revealed a urethral stricture at the anastomosis site, which was treated with fluoroscopic balloon dilation. The stranguria resolved, but an acute nocturnal grade 3 passive urinary incontinence occurred, which was nonresponsive to medical management of phenylpropanolamine hydrochloride and estriol. An artificial urethral sphincter was placed, leading to continence after 5 top-ups to a total volume of 0.9 mL. The patient remained continent for 5.5 weeks before abrupt incontinence recurred, which was resolved by another 0.1-mL top-up. No further signs of incontinence occurred in the 11 months following. The placement of an artificial urethral sphincter successfully managed urinary incontinence in this patient. Continence was achieved with no significant complications other than a transient loss of continence. Long-term follow-up 14 months after sphincter placement revealed that the patient had remained continent since the final sphincter top-up. The owner reported a significant improvement in the patient's quality of life following successful incontinence management. This case highlighted the benefits of placing an artificial urethral sphincter in managing urinary incontinence after select cases of prostatectomy in dogs that are unresponsive to medical management.

Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review.

Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.

Magnetically controlled artificial urinary sphincter: An overview from existing devices to future developments.

Urinary incontinence is a common clinical problem in the world today. Artificial urinary sphincter is a good treatment approach for severe urinary incontinence, which is designed to mimic the action of the human urinary sphincter and assist patients to regain urinary function. There are many control methods based on artificial urinary sphincter, such as hydraulic control, electromechanical control, magnetic control, and shape memory alloy control. In this paper, the literature was first searched and documented based on PRISMA search strategy for selected specific subject terms. Then, a comparison of artificial urethral sphincters based on different control methods was conducted, and the research progress of magnetically controlled artificial urethral sphincters was reviewed, and their advantages and disadvantages were summarized. Finally, the design factors for the clinical application of magnetically controlled artificial urinary sphincter are discussed. As magnetic control allows for non-contact force transfer and does not generate heat, it is proposed that magnetic control may be one of the more promising control methods. The design of future magnetically controlled artificial urinary sphincters will need a variety of considerations, including the structural design of the device, manufacturing materials, manufacturing costs, and convenience. In addition, validation of the safety and effectiveness of the device and device management are equally important. The design of an ideal magnetically controlled artificial urinary sphincter is of great importance to enhance patient treatment outcomes. However, there are still great challenges to be faced for the clinical application of such devices.

MP71-06 MANUAL DEXTERITY PREDICTORS OF ARTIFICIAL URETHRAL SPHINCTER SUCCESS

You have accessJournal of UrologyCME1 Apr 2023MP71-06 MANUAL DEXTERITY PREDICTORS OF ARTIFICIAL URETHRAL SPHINCTER SUCCESS Kendrick Campbell, Joel Vetter, Shellee Ogawa, Baas Wesley, Aleksandra Klim, Alethea Paradis, Deborah Ksiazek, Diana Wolff, Henry Lai, and Gregory Murphy Kendrick CampbellKendrick Campbell More articles by this author , Joel VetterJoel Vetter More articles by this author , Shellee OgawaShellee Ogawa More articles by this author , Baas WesleyBaas Wesley More articles by this author , Aleksandra KlimAleksandra Klim More articles by this author , Alethea ParadisAlethea Paradis More articles by this author , Deborah KsiazekDeborah Ksiazek More articles by this author , Diana WolffDiana Wolff More articles by this author , Henry LaiHenry Lai More articles by this author , and Gregory MurphyGregory Murphy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urethral sphincters (AUS) remain the gold standard for treatment of stress urinary incontinence in men. Dexterity diminishes with age and some men can have difficulty operating the device. There is scarce information on effective preoperative screening for this issue. Here we investigate the ability of pinch and grip strength, peg-transfer, and Disabilities of the Arm Shoulder and Hand Outcome questionnaire (DASH) to predict postoperative success. We hypothesize that strength and dexterity as measured by these tests will correlate with patient satisfaction. METHODS: A timed 9-hole peg test, pinch and grip strength assessment, and DASH questionnaire were administered during the pre-operative visit before AUS placement. In addition to standard pre-operative workup, incontinence questionnaire (ICIQ-SF) and physician handshake were recorded. Activation occurred 6 weeks after surgery along with assessment of adequacy of pump placement. 3 months from surgery a repeat ICIQ-SF and a survey measuring satisfaction, difficulty of use, and confidence were given. Correlation between pre-operative assessment variables and the post-operative questionnaire was assessed. RESULTS: 39 patients were included. Average age and BMI were 68.8 years and 28.8 kg/m2 respectively. 92.3% had prior prostatectomy, and 46.2% had prior pelvic radiation. Postoperatively 59.0% of patients were very satisfied; 64.1% of patients reported no difficulty of use; 53.8% felt confidence within one day; and 66.7% had much better bladder control. Average pad improvement count was 5.3. Pinch test was associated with satisfaction (p=0.011) while peg test was associated with confidence (p=0.049). Handshake and DASH were not significant. CONCLUSIONS: Pinch and 9-hole peg transfer test could be useful adjuncts during AUS evaluation for patients whose manual functional status is unclear. Additionally, these tests are cheap and easy to perform in clinic.2 Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1015 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kendrick Campbell More articles by this author Joel Vetter More articles by this author Shellee Ogawa More articles by this author Baas Wesley More articles by this author Aleksandra Klim More articles by this author Alethea Paradis More articles by this author Deborah Ksiazek More articles by this author Diana Wolff More articles by this author Henry Lai More articles by this author Gregory Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-16 RETROSPECTIVE MULTICENTER OBSERVATIONAL STUDY OF IMMEDIATE VOIDING AT END OF CONTINENCE SURGERY [REMOVE

You have accessJournal of UrologyCME1 Apr 2023MP71-16 RETROSPECTIVE MULTICENTER OBSERVATIONAL STUDY OF IMMEDIATE VOIDING AT END OF CONTINENCE SURGERY [REMOVE] Thomas Kozar, John Michael Kaylor, Cynthia Hinderscheid, Jamee Schoephoerster, Albert Holler, Edward Wright, Joseph Pariser, William Boysen, Lucas Wiegand, Patrick Selph, and Andrew Cohen Thomas KozarThomas Kozar More articles by this author , John Michael KaylorJohn Michael Kaylor More articles by this author , Cynthia HinderscheidCynthia Hinderscheid More articles by this author , Jamee SchoephoersterJamee Schoephoerster More articles by this author , Albert HollerAlbert Holler More articles by this author , Edward WrightEdward Wright More articles by this author , Joseph PariserJoseph Pariser More articles by this author , William BoysenWilliam Boysen More articles by this author , Lucas WiegandLucas Wiegand More articles by this author , Patrick SelphPatrick Selph More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Placement of an artificial urethral sphincter (AUS) for stress urinary incontinence may result in postoperative urinary retention. Therefore, patients often remain catheterized for a 23-hour period, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in rate of urinary retention or post-operative complications. METHODS: We conducted an IRB-approved retrospective review of patients undergoing first-time AUS placement from 2009-2021. Patients were stratified by postoperative catheter status into either immediate decatheterization — leaving the procedure without a catheter — or controls — placement of an indwelling catheter for 23 hours. Data were collected on demographic and surgical variables from five institutions. The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented PVR over 250 mL. Analyses were performed using STATA with p<0.05 considered significant. RESULTS: Our study identified 302 controls and 123 immediate decatheterization. Twenty (6.6%) historic controls and nine (7.3%) immediate decatheterization patients developed urinary retention requiring short term catheterization (p=0.80). The immediate decatheterization cohort had a higher rate of complication (19.2% vs 33.3%), but there was no difference in the rate of urinary tract infections (UTI) (2.6% vs 2.4%, p=0.90), surgical site infections (SSI) (1.3% vs 2.4%, p=0.41), or device erosions between groups (1.7% vs 0.8%, p=0.51). Kaplan-Meier survival analysis revealed no significant difference in the rate of revision surgery (Figure 1). CONCLUSIONS: In our cohort, there was no difference in urinary retention, device erosion, UTI, and SSI rates between immediate intraoperative catheter removal and those catheterized for 23 hours. Early decatheterization enables outpatient incontinence surgery without altering reoperation over medium-term follow up. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1021 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Kozar More articles by this author John Michael Kaylor More articles by this author Cynthia Hinderscheid More articles by this author Jamee Schoephoerster More articles by this author Albert Holler More articles by this author Edward Wright More articles by this author Joseph Pariser More articles by this author William Boysen More articles by this author Lucas Wiegand More articles by this author Patrick Selph More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

PD42-07 OUTCOMES RELATED TO INFLATABLE PENILE PROSTHESIS (IPP) RESERVOIR REMOVAL: A 7-YEAR MULTI-CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023PD42-07 OUTCOMES RELATED TO INFLATABLE PENILE PROSTHESIS (IPP) RESERVOIR REMOVAL: A 7-YEAR MULTI-CENTER EXPERIENCE Javier Piraino, Ian Madison, Matthew Ziegelmann, Run Wang, Tobias Kohler, Aram Loeb, Gerard Henry, Robert Cornell, Dylan Supak, Landon Trost, and Jonathan Clavell Javier PirainoJavier Piraino More articles by this author , Ian MadisonIan Madison More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Run WangRun Wang More articles by this author , Tobias KohlerTobias Kohler More articles by this author , Aram LoebAram Loeb More articles by this author , Gerard HenryGerard Henry More articles by this author , Robert CornellRobert Cornell More articles by this author , Dylan SupakDylan Supak More articles by this author , Landon TrostLandon Trost More articles by this author , and Jonathan ClavellJonathan Clavell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 3-piece IPP is the most widely used device for erectile dysfunction refractory to medications, containing a reservoir inserted into the Space of Retzius (SOR) or an alternative/ectopic space (AES). Indications for removal of the reservoir include malfunction, malposition or infection. In revision cases without infection, reservoir removal is sometimes optional. We review outcomes and complications specifically related to reservoir removal from a large multi-institutional series. METHODS: We retrospectively reviewed databases at 6 institutions over 7 years. Patients with artificial urethral sphincter, urethral sling or Mini-jupette were excluded. Outcomes and complications related to IPP reservoir removal were analyzed. Data were collected but only reservoir-related complications at surgery were included. Data were compared between SOR and AES cohorts to evaluate differences with χ2, with significance at p<0.05. RESULTS: Of 215 cases, there were 172 SOR (80%) and 43 AES (20%) reservoirs. Mean patient age was 65.3 years old. 131 (60.9%) procedures were due to malfunction, 49 (22.8%) were due to malposition of an IPP component, and 35 (16.3%) were secondary to infection. Among those retained (N=44, 20.5%), reasons included reuse, avoiding surrounding structure damage, unspecified, and difficult dissection. Among those removed (N=171), 15 (8.8%) required a counter-incision (6 in SOR and 9 in AES). χ2 to determine statistical difference between those removed from SOR and AES found a p=0.00059, indicating significant difference in the need for a counter-incision those groups. Complications included bladder perforation (N=1) in the SOR group, and an avulsion of the epigastric vessels requiring abdominal exploration (N=1) in the AES group. χ2 to determine statistical difference when comparing SOR and AES complications was p=0.365, indicating no significant difference between groups. CONCLUSIONS: Removal of an IPP reservoir remains safe with few complications. Surgeons should be aware of the inferior epigastric vessels during removal in an AES or be willing to perform a counter incision to avoid injury to surrounding structures. Surgeons should obtain preoperative imaging to identify the specific location of the reservoir and adjacent anatomy. This is the first and largest multi-institutional study reviewing outcomes related to reservoir removal during IPP revision or removal surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1113 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Piraino More articles by this author Ian Madison More articles by this author Matthew Ziegelmann More articles by this author Run Wang More articles by this author Tobias Kohler More articles by this author Aram Loeb More articles by this author Gerard Henry More articles by this author Robert Cornell More articles by this author Dylan Supak More articles by this author Landon Trost More articles by this author Jonathan Clavell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY Ghazal Ameli, Peter Weibl, Michael Rutkowski, and Wilhelm Huebner Ghazal AmeliGhazal Ameli More articles by this author , Peter WeiblPeter Weibl More articles by this author , Michael RutkowskiMichael Rutkowski More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Victo is an adjustable artificial urinary sphincter (AUS), consisting of three parts which are preconnected. A pressure regulating balloon, a cuff, and a pump, which includes a self-sealing port for adjustment. The objective of the present study is to test the efficiency and practicality of VICTO in the control of stress urinary incontinence (SUI) and to evaluate the short- and long-term complications. METHODS: A total of 32 patients were included between 1/2020 and 4/2022, the trial is still ongoing and estimated end of the clinical trial is May 2025.41% of the patients in this cohort has undergone prior procedures for SUI: sling n=4, ProACT n=4, AMS 800=1, 3 patients had multiple SUI surgeries. 38% of the patients had undergone secondary irradiation therapy. Additionally, 9 patients had undergone procedures for bladder neck pathologies or urethral strictures.All patients underwent artificial urethral sphincter (AUS) implant “VICTO” according to established technique. The mean age was 71.9 years, 41% of the patients had systemic arterial hypertension and 19% diabetes mellitus.Functional urinary outcomes were assessed according to daily pad use and a standardized questionnaire. Data were collected as part of the follow up care of these patients. RESULTS: The reduction in number of pads compared between baseline and Follow-Up was significant (p<0,001). Cure of urinary incontinence was defined as using either 0 or 1 p/d. All the index patients in this cohort (n=7) were cured. In total 64.5% of the patients reported to be dry and were cured by definition. Additionally, 19.4% patients reported improvement of ≥50 % according the PGI-I (Patients Global Impression of Improvement).Two erosions were reported over the FU-period (mean 4.6 months). One infection occurred after traumatic catheterization without deactivation of the device followed by urethral erosion, infection and explantation of the device. Both patients with erosion had previous pelvic irradiation.One explantation was reported at day 2 after implantation, the presumable cause of explantation was unrecognized intra-operative urethral injury and consequently urethral erosion and was excluded from the study. CONCLUSIONS: In this complex group with mostly high-risk patients, all men with uncomplicated SUI (no previous surgeries and no history of irradiation) were cured after device implantation. The overall treatment success was 84 % according PGI-I and 65% according to pad per day usage. Despite the above average number of patients with risk factors for failure in this cohort, the results of the current trial are consistent with the evidence in literature. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli More articles by this author Peter Weibl More articles by this author Michael Rutkowski More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

Intravesical Injection of Botulinum Toxin Type A in Men without Bladder Outlet Obstruction and Post-Deobstructive Prostate Surgery.

A significant proportion of men without bladder outlet obstruction (BOO) have been reported to have overactive bladders (OAB). This article aimed to review the specific group of reports on the use of botulinum toxin type A (BTX-A) injections into the bladder wall. Original articles reporting men with small prostates without BOO were identified through a literature search using the PubMed and EMBASE databases. Finally, we included 18 articles that reviewed the efficacy and adverse effects of BTX-A injections in men. Of the 18 articles screened, 13 demonstrated the therapeutic efficacy and adverse effects of BTX-A injections in men. Three studies compared BTX-A injection response between patients without prior prostate surgery and those undergoing prior prostate surgery, including transurethral resection of the prostate and radical prostatectomy (RP). Patients with prior RP experienced better efficacy and had a low risk of side effects. Two studies focused on patients who had undergone prior surgery for stress urinary incontinence, including male sling and artificial urethral sphincter surgery. The BTX-A injection was a safe and effective procedure for this specific group. OAB in men was found to have a different pathophysiology mechanism from that in female patients, which may decrease the efficacy of BTX-A injection in men. However, patients with small prostates and low prostate-specific antigen levels demonstrated better efficacy and tolerability after BTX-A injection. Although intravesical injection of BTX-A was a good option for controlling refractory OAB in men, the evidence-based guidelines are still limited. Further research is necessary to better understand the role of BTX-A injections on various aspects and histories. Therefore, treating patients using strategies tailored to their individual conditions is important.

Efficacy of surgical treatment for post-prostatectomy urinary incontinence: a systematic review and network meta-analysis.

Post-prostatectomy urinary incontinence (PPUI) is a major complication that reduces the quality of life in patients undergoing prostatectomy for benign prostatic hyperplasia and prostate cancer. However, there are currently limited guidelines on which surgical techniques are preferred after conservative treatment for PPUI. In this study, a systematic review and network meta-analysis (NMA) that can help determine the priority for the selection of surgical methods were performed. We retrieved data from electronic literature searches of PubMed and the Cochrane Library through August 2021. We searched for randomized controlled trials studies on the surgical treatment of PPUI after surgery for benign prostatic hyperplasia or prostate cancer and included the terms artificial urethral sphincter (AUS), adjustable sling, nonadjustable sling, and injection of the bulking agent.The NMA pooled the odds ratios and 95% credible intervals (CrIs) using the number of patients achieving urinary continence, weight of pads used per day, number of pads used per day, and the International Consultation on Incontinence Questionnaire score. The therapeutic effect of each intervention on PPUI was compared and ranked using the surface under the cumulative ranking curve. A final 11 studies, including 1116 participants, were included in our NMA. The pooled overall odds ratios of patients achieving urinary continence compared with no treatment was 3.31 (95% CrI: 0.749, 15.710) in AUS, 2.97 (95% CrI: 0.412, 16.000) in adjustable sling, 2.33 (95% CrI: 0.559, 8.290) in nonadjustable sling, and 0.26 (95% CrI: 0.025, 2.500) in injection of bulking agent. In addition, this study shows the surface under the cumulative ranking curve values of ranking probabilities for each treatment performance, which indicated that AUS ranked first in terms of continence rate, International Consultation on Incontinence Questionnaire, pad weight, and pad use count. The results of this study suggested that only AUS had a statistically significant effect compared to the nontreatment group and the highest PPUI treatment effect ranking among other surgical treatments.

Biomechanical study of the male lower urinary tract: Simulation of internal and external sphincters dyssynergia

Urethral sphincter dysfunction is an important cause of stress urinary incontinence (SUI). The most effective treatment is the insertion of an artificial urethral sphincter (AUS), which relies to a large extent on the surgeon’s experience. However, there is no quantitative standard for cuff tightness, resulting in frequent postoperative complications. This study aimed to investigate the effect of internal and external sphincter dyssynergia on urodynamic parameters in the lower urinary tract. A geometric model of male lower urinary tract tissue was constructed from collodion slices, accounting for the active behavior of the internal and external sphincters. Normal and dyssynergic internal and external sphincters (active sphincter behavior was individually injured by 25%, 50%, 75%, or 100%) were simulated with fluid–structure interactions and changes in urethral stress, displacement, and urine flow rate were detected. We found that when the internal sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the internal sphincter decreased by 8.3%, 15.6%, 24.3%, and 35.7%, respectively. Additionally, when the external sphincter was injured by 25%, 50%, 75%, and 100%, urethral stress near the external sphincter was reduced by 13.3%, 24.3%, 38.6%, and 46.6%, respectively. Internal sphincter injury primarily affects positions near the internal sphincter and prostate, while external sphincter injury affects the area between the prostate and urethral outlet. These data could facilitate the standardized evaluation of internal and external sphincter dysfunction and lead to novel methods of preoperative assessment for AUS surgery.

Urethral management after artificial urinary sphincter explantation due to cuff erosion.

The artificial urethral sphincter (AUS) is the gold standard treatment in cases of moderate-to-severe stress urinary incontinence in males. Cuff erosions are one of the most important distant complications of AUS implantation. The optimal urethral management has still not been established. Search terms related to 'urethral stricture', 'artificial urinary sphincter', and 'cuff erosion' were used in the PubMed database to identify relevant articles. In this mini review we identified 6 original articles that assessed the urethral management after AUS explantation due to cuff erosion and included urinary diversion by transurethral and/or suprapubic catheterization, urethrorrhaphy, and in situ urethroplasty. We summarized the results of different management methods and their efficacy in terms of preventing urethral stricture formation. We highlight the need for better-quality evidence on this topic. The available data do not provide a clear answer to the question of optimal urethral management during AUS explantation. There is a great need to provide higher-quality evidence on this topic.

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury.

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.

Cystoscopic-guided scissor transection of intramural ectopic ureters as a novel alternate minimally invasive treatment option to laser ablation in female dogs: 8 cases (2011–2020)

To evaluate the safety and efficacy of cystoscopic-guided scissor transection of ectopic ureters (CST-EU) in female dogs. 8 incontinent female dogs with intramural ectopic ureters. For this retrospective case series, data were collected from medical records of dogs that underwent CST-EU to relocate the ectopic ureteral orifice to an anatomically normal trigonal location between June 2011 and December 2020. Outcome after hospital discharge was determined using owner telephone questionnaires. Ectopic ureters were bilateral in 4 of the 8 dogs, and all dogs had other urogenital tract anomalies. Owner questionnaire follow-up was available for 7 dogs, and results indicated 6 dogs had improved urinary continence immediately following the procedure. At the last follow-up (44 to 3,384 days after CST-EU), 3 of the 7 dogs were completely continent with CST-EU alone, 3 others became continent or were markedly improved with the addition of medications for urethral sphincter mechanism incompetence, and 1 required ureteroneocystostomy, colposuspension, and an artificial urethral sphincter to become fully continent. Owners of 5 of the 7 dogs reported that they considered the outcome of CST-EU as good to excellent, and all owners reported that they would consider having CST-EU performed again should they have another incontinent dog. Complications were minor, and only 3 dogs showed transient lower urinary tract signs after CST-EU. Results indicated CST-EU could provide a safe, effective, minimally invasive alternative in the absence of laser technology for the treatment of intramural ectopic ureters in female dogs.

V02-08 ARTIFICIAL URINARY SPHINCTER CUFF MODIFICATION AND OTHER “TRICKS OF THE TRADE”

You have accessJournal of UrologyCME1 May 2022V02-08 ARTIFICIAL URINARY SPHINCTER CUFF MODIFICATION AND OTHER “TRICKS OF THE TRADE” Jane Kurtzman, Preston Kerr, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Preston KerrPreston Kerr More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Artificial Urethral Sphincter (AUS) is the gold standard for stress urinary incontinence (SUI). The AMS 800 AUS is the most widely used device and has well over a 30-year track record of excellent efficacy and durability. We describe tips for AUS placement and advanced troubleshooting for when you run into problems. METHODS: Proper placement of an AUS requires no bulbospongiosus muscle on the urethra. We utilize a split and roll to ensure a 2cm plane for the AUS. Prior to pump placement we cycle the AUS pump 5-10x for easier activation. We create a “Fuse Box” for future troubleshooting. in cases of mis-sizing an AUS cuff, we modify our cuff via a incision into the cuff and a carefully placed 4-0 prolene. Our technique for troubleshooting an AUS starts with assessing for pressure regulating balloon (PRB) fatigue. RESULTS: Use of our techniques has resulted in an excellent success record for AUS placement. Use of our cuff modification technique has shown no difference in survival or adverse events as a result of the modification. CONCLUSIONS: A properly placed and sized AUS is the gold standard for SUI. Principles for a successful placement of an AUS includes use of the Split and Roll technique, cycling the pump 5-10x prior to placement, creation of a “Fuse Box,” and salvaging an improperly sized cuff through use of our modification technique. During troubleshooting always check the PRB first. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e113 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Preston Kerr More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF DownloadLoading ...

V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES

You have accessJournal of UrologyCME1 May 2022V04-06 TRANSPERINEAL BULBOVESICAL ANASTOMOSIS AND STAGED ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR EXTENSIVE POSTERIOR URETHRAL STENOSES Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Yusuke Hirano, Ryuichi Azuma, and Keiichi Ito Akio HoriguchiAkio Horiguchi More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Yusuke HiranoYusuke Hirano More articles by this author , Ryuichi AzumaRyuichi Azuma More articles by this author , and Keiichi ItoKeiichi Ito More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral stenosis is a complication occurring secondary to transurethral prostate surgery and prostate cancer treatment, and its management remains a significant reconstructive challenge. We herein report our surgical technique of transperineal bulbovesical anastomosis and staged artificial urinary sphincter implantation for extensive posterior urethral stenoses. METHODS: Two male patients aged 77 and 76 years were referred to us for definitive management for posterior urethral stenosis (brachytherapy for prostate cancer, and repeat transurethral surgery for benign prostatic hyperplasia, respectively). A suprapubic tube was placed in both patients due to urinary retention after exhaustive urethrotomies and dilatations. Both patients had normal bladder capacity and extensive posterior urethral stenoses extending from the bulbomembranous junction to the entire prostatic urethra. After making a midline perineal incision, the bulbar urethra was fully mobilized up to the penoscrotal junction distally and transected at the obstruction site. The corpora cavernosa was separated, and a wedge of the inferior pubic bone was excised to expose the ventral side of the bladder neck in the same manner as the repair of pelvic fracture urethral injury. The scarred prostatic tissue was meticulously excised, and the bladder neck was opened. The bladder mucosa was everted and fixed to the surrounding tissue to create an anastomosis site. Eight interrupted 4-0 PDS sutures were placed to reapproximate the bulbar urethra and bladder neck. After confirming the absence of recurrent stenosis at the anastomosis site at 6 months postoperatively, an artificial urethral sphincter was implanted using a transcorporeal approach. We followed up the patients every 6 months, performed uroflowmetry, flexible cystoscopy, and examined the amount of daily pad use. RESULTS: The operative time and blood loss during bulbovesical anastomosis was 163 minutes and 201 ml in case 1 and 193 minutes and 66 ml in case 2, respectively. No Clavien grade 2 or greater perioperative complications were observed. No recurrent stenosis on cystoscopy was found after 20 and 26 months in cases 1 and 2, respectively. The maximum flow rate and the amount of daily pad use at the last recorded follow up was 32 ml/s and no pad in case 1 and 44 ml/s and one pad in case 2. CONCLUSIONS: A bulbovesical anastomosis combined with staged artificial urethral sphincter placement could effectively manage extensive posterior urethral stenoses. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e368 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akio Horiguchi More articles by this author Masayuki Shinchi More articles by this author Kenichiro Ojima More articles by this author Yusuke Hirano More articles by this author Ryuichi Azuma More articles by this author Keiichi Ito More articles by this author Expand All Advertisement PDF downloadLoading ...