Artificial Urinary Sphincter AMS Research Articles

22 - AMS800 artificial urinary sphincter: A novel modified easier technique

22 - AMS800 artificial urinary sphincter: A novel modified easier technique

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.

Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet?

Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan-Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.

Robot-assisted implantation of an artificial urinary sphincter, the AMS-800, via a posterior approach to the bladder neck in women with intrinsic sphincter deficiency.

To describe a new technique for robot-assisted AMS-800 artificial urinary sphincter (AUS) bladder neck implantation in women. We reviewed the medical files of patients who underwent robot-assisted AUS implantation between March 2017 and November 2018 at our centre. All of the implantations were performed using a posterior approach to the bladder neck in order to avoid blind dissection and the risk of vaginal and/or bladder injury. This strategy was viewed as an alternative to the anterior robot-assisted implantation recently described. The AUSs were activated 5weeks after implantation. Patients were followed up at 3, 6 and 12months, then annually. Eight patients, with a median age of 64years, underwent robot-assisted AUS implantation via a posterior approach to the bladder neck. The median preoperative pad weight was 300 g/24h. The median operating time was 244min. No peri-operative vaginal and or bladder injuries were observed. At a median of 12months of follow-up, all the AUSs were functional. Five patients required no protection (62.5%), three had day protection (37.5%), and all said they were satisfied except for one patient (12.5%) who requested treatment for persistent urge incontinence. Robot-assisted AUS implantation in women via a posterior approach to the bladder neck is a procedure that is simple, reproducible and safe. The short-term functional results are satisfactory and comparable to those obtained via an open approach. A more long-term comparison of the efficacy and longevity of AUSs implanted using this posterior approach is needed to confirm its benefit compared with the anterior robot-assisted approach and the classic open technique.

Re: Robot-Assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

Re: Robot-Assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty.

To analyze functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation in patients who had undergone buccal mucosa graft urethroplasty (BMGU) beforehand. This prospectively maintained single-center database comprises data from 236 patients from 2009 to 2015 who underwent AUS implantation. A total of 17 patients after BMGU were available for analysis. Primary endpoints consisted of continence and complication rates. Continence was defined as no use of safety pads, social continence as < 2 pads per day. Stricture recurrence was defined as a decrease in uroflowmetry, a maximum flow rate < 10ml/s or residual urine volume (> 100ml). Kaplan-Meier analysis determined explantation-free survival. Median follow-up was 24months (interquartile range [IQR] 6-31months). Indication for AUS implantation was severe urinary incontinence with a history of radical prostatectomy (RRP) in 8 (47.1%), trauma in 1 (5.9%) and TUR-P in 8 (47.1%) patients. Pelvic irradiation was reported in 13 (76.5%) cases. The median length of buccal mucosa graft for urethroplasty was 4cm (3-5cm). A double cuff was implanted in 14 patients (82.4%), 3 patients received a single cuff. Complete and social continence was achieved in 76.5% and 100% of the patients, respectively. There was no significant difference in complications and explantation-free survival (log-rank, p = 0.191) between patients who had undergone BMGU before AUS compared to patients with no history of BMGU. According to the prospective follow-up data in a homogenous cohort, AUS implantation seems to be a viable, safe and effective therapeutic strategy for incontinence treatment despite previous BMGU.

AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review.

To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.

Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

BackgroundWidespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach. ObjectiveTo describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique. Design, settings, and participantsWe retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery. Surgical procedureThe AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection. MeasurementsThe primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence. Results and limitationsForty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%). ConclusionsIn this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers. Patient summaryRobot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.

V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION

You have accessJournal of UrologyED, Infertility & Male Incontinence1 Apr 2018V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION Nadim Abo Youssef, Jürgen Pannek, Kevin Horton, Marco Randazzo, and Hubert John Nadim Abo YoussefNadim Abo Youssef More articles by this author , Jürgen PannekJürgen Pannek More articles by this author , Kevin HortonKevin Horton More articles by this author , Marco RandazzoMarco Randazzo More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic lower urinary tract dysfunctions have an important impact on the quality of life in patients due to spina bifida. The artificial urinary sphincter AMS 800® has been used for years as standardized long-term therapy in patients with severe stress incontinence. A robot-assisted subprostatic cuff positioning around the membranous urethra has not yet been described in the literature. METHODS This video shows the robot-assisted AMS 800®-sphincter implantation in a 43-year-old patient with neurogenic voiding dysfunction as a result of impaired detrusor contractility due to spina bifida. In this context he underwent previous surgical interventions, namely a bulbar AMS 800®-sphincter implantation in April 2002 and a bulbar double-cuff implantation in January 2003. About 14 years later the patient now complains about progressive stress incontinence. After initiating a transperitoneal approach we performed the extraperitonealisation of the bladder and the incision of the endopelvic fascia in a first step. This was followed by the enlacement and measurement of the membranous urethral circumference. The cuff was positioned at the implant site with mesh towards the outside and «pillow» side towards the urethra. The pressure-regulating balloon was implanted through the 12 mm trocar and the connecting-tubing through another suprapubic trocar. After tunnelling through the trocar position and creating a dependent subdartos pouch in the scrotum, the control pump was placed into the scrotal pouch. The balloon was filled with 22 ml dilute Iopamiro 300 / Aqua Dest. (57 ml/60 ml) solution and the procedure was completed with the «Quick Connection» of the tubing. RESULTS The blood loss was irrelevant and there were no intra- or postoperative complications. The newly implanted membranous AMS 800®-sphincter has been activated at about 6 weeks postoperative. 6 months after surgery the patient showed a satisfying continence with a use of 1-2 pads per day (preoperative 5-6 pads/day). CONCLUSIONS The subprostatic, robot-assisted implantation of an AMS 800® around the membranous urethra is a new minimal-invasive therapeutic option. To our knowledge, this approach is described so far for the first time in the literature. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1163-e1164 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nadim Abo Youssef More articles by this author Jürgen Pannek More articles by this author Kevin Horton More articles by this author Marco Randazzo More articles by this author Hubert John More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pirmoji patirtis implantuojant dirbtinį sfinkterį „AMS 800“

TikslasPateikti pirmuosius vyrų šlapimo nelaikymo po radikalios prostatektomijos rezultatus, implantuojant „AMS 800“ dirbtinį sfinkterį. Įvertinti šio metodo efektyvumą ir pranašumą.Medžiaga ir metodai2016 m. lapkričio 4 d. VUL SK Urologijos centre 3 pacientams dėl sunkaus šlapimo nelaikymo, atsiradusio po radikalios prostatektomijos dėl prostatos karcinomos, buvo implantuoti šlapimo pūslės dirbtiniai sfinkteriai „AMS 800“. Šiems pacientams konservatyvus šlapimo nelaikymo gydymas buvo neveiksmingas. Visi pacientai prieš operaciją buvo išsamiai ištirti. Jiems prostatos vėžio progresavimo, šlaplės striktūrų, liekamojo šlapimo nebuvo, šlapimo takų infekcijos nerasta. Pacientai patikrinti praėjus mėnesiui po dirbtinio sfinkterio aktyvavimo.RezultataiIš viso buvo implantuoti 3 dirbtiniai sfinkteriai 3 pacientams. Praėjus 6 savaitėms buvo aktyvuoti 2 sfinkteriai, vieno sfinkterio aktyvuoti nepavyko dėl prietaiso techninių kliūčių, tačiau po 1 savaitės pakartotinis aktyvavimas buvo sėkmingas. Patikrinus 3 pacientus praėjus 1 mėnesiui po sfinkterio aktyvavimo, dviem visiškai nereikėjo įklotų, 1 šlapimo laikymas pagerėjo 60 proc. (anksčiau sunaudojo 6, dabar užtenka 2 įklotų).IšvadosRemdamiesi literatūra ir savo pirmuoju patyrimu galime teigti, kad „AMS 800“ dirbtinis sfinkteris yra laiko patikrintas ir laikomas auksiniu standartu gydant vidutinio ir didelio laipsnio įtampos šlapimo nelaikymą. Tinkamai ištyrus pacientą, pasiekiami geri gydymo ir paciento pasitenkinimo operacija rezultatai, labai pagerėja gyvenimo kokybė.

Vyrų šlapimo nelaikymo gydymas implantuojant dirbtinį sfinkterį AMS 800

Darbo tikslasRemiantis literatūros duomenimis, apžvelgti dirbtinio šlapimo pūslės sfinkterio AMS 800 implantavimo rezultatus gydant įtampos (streso) šlapimo nelaikymą. Įvertinti prietaiso implantavimo indikacijas, kontraindikacijas, paciento paruošimą ope­racijai, operacijos techniką, komplikacijas.Medžiaga ir metodaiApžvalga buvo atlikta remiantis naujausia literatūra, pateikiama PubMed duomenų bazėje.RezultataiLiteratūros duomenimis, dirbtinio šlapimo pūslės sfinkterio AMS 800 efektyvumas įvairuoja nuo 61 % iki 100 %. 80–90 % ope­ruotų pacientų pagerėja gyvenimo kokybė, jie yra patenkinti operacija ir ją rekomenduotų kitiems. Komplikacijos yra palygin­ti retos, pasitaiko nuo 1 % iki 31 % atvejų. Tikimybė, kad AMS 800 dirbtinis sfinkteris garantuotai veiks 5 metus, yra 59–79 %.IšvadosAMS 800 dirbtinis sfinkteris yra laiko patikrintas ir laikomas auksiniu standartu gydant vidutinio ir didelio laipsnio įtampos šlapimo nelaikymą. Tinkamai ištyrus pacientą, pasiekiami puikūs gydymo ir paciento pasitenkinimo operacija rezultatai, labai pagerėja gyvenimo kokybė.

1157 Tissue atrophy after artificial urinary sphincter AMS 800: Options of management and outcome

1157 Tissue atrophy after artificial urinary sphincter AMS 800: Options of management and outcome

192 Impact of antibiotic coating (InhibiZone®) on infection and explantation rates of the artificial urinary sphincter AMS 800®

192 Impact of antibiotic coating (InhibiZone®) on infection and explantation rates of the artificial urinary sphincter AMS 800®

Esfíncter urinário artificial AMS 800 - análise retrospectiva de seis anos

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

High revision rate following artificial urethral sphincter implantation

Objective. In severe cases of stress urinary incontinence (SUI), with sphincter dysfunction, the artificial urinary sphincter AMS 800™ may be the last solution. The purpose of this study was to evaluate the outcome of surgical intervention for SUI with the AMS 800 in patients who were treated at Sahlgrenska University Hospital, Gothenburg. The primary aim of the study was to determine the complications related to the operation. Material and methods. A retrospective follow-up was done by reviewing medical records. The material comprised 97 men, who underwent their first AMS 800 implantation between May 1997 and June 2010 at Sahlgrenska University Hospital. Results. The revision rate was 28%, including an infection rate of 3% and an erosion rate of 7%. The mean follow-up for revised patients was 3 years. The median time until revision was 1 year. Seventy-five per cent of all patients were satisfied with the operation at 6 months’ follow-up. Radical prostatectomy was the reason behind incontinence in 84% of patients in this series. Conclusion. The results clearly demonstrate a need for revision procedures in a considerable proportion of patients implanted with an AMS 800 device. Patient satisfaction was high, but although this operation has extremely low mortality it has its complications and the system will need to be replaced in time.

Long-term functional results of artificial urinary sphincter AMS 800® in neurological patients

Long-term functional results of artificial urinary sphincter AMS 800® in neurological patients

Artificial Urinary Sphincter AMS 800™ in Males—Can We Explain Residual Leaks When Sitting?

Some patients fitted with an AMS 800™ type artificial urinary sphincter report urinary leaks in the sitting position whose mechanism remains unclear. In this experimental study we explain these residual leaks by characterizing fluid transfer and pressure variations in the device during cuff compression. Two complete sets of AMS 800 devices were tested on an original test bench. A qualitative study using methylene blue dye was performed to assess fluid transfer within the device during manual cuff compression. After estimating the pressures exerted on the perineal floor in the sitting position, pressure variations in the AMS 800 components were measured in real time using the pressure sensors of a urodynamic workstation. When the AMS 800 cuff was compressed between 2 fingers, reflux of the blue dye into the balloon through the pump resistor was observed. After the cuff was compressed for 5, 10, 15 and 20 seconds at a pressure of 150 cm H2O, the minimal pressure measurements in the cuff were 37, 25, 14 and 12 cm H2O, respectively. Furthermore, the time required for cuff re-pressurization was 68, 87, 101 and 117 seconds, respectively. Urinary leaks reported in sitting position by patients fitted with an AMS 800 may be explained by compression of the urethral cuff between the pelvic floor and the chair, which causes emptying of the cuff into the balloon. Patients should be reassured that there is no implant dysfunction and may adopt simple lifestyle strategies to circumvent these leaks.

Therapieoptionen der rezidivierenden oder persistierenden Belastungsharninkontinenz

After synthetic sling procedures, up to 16 % of women and 45.5 % of men complain about a persistent or recurrent stress urinary incontinence (SUI). Currently, randomized studies comparing the different treatment modalities of persistent or recurrent SUI are lacking. There are data of retrospective studies investigating the efficiency of synthetic slings and the artificial urinary sphincter AMS 800® in men. Synthetic slings can be applied in patients with mild SUI and without prior radiation of the pelvic region. The AMS 800® is the treatment of choice in patients with severe SUI or previous radiation.In women with persistent and recurrent SUI, the efficiency of colposuspensions, autologous and synthetic slings as well as the AMS 800® has been investigated in retrospective studies. Due to comparable cure rates and a faster postoperative recovery, synthetic slings are now superseding colposuspensions and autologous slings. Excellent success rates after AMS 800® implantation have been described for both genders; nonetheless, postoperative complications and revisions as well as the requirement of dexterity of the patients should be taken into account. Data about the efficiency of adjustable slings, the ACT® and newer artificial urinary sphincter devices like Flow-Secure® and Zephyr® ZSI 375 in the treatment of persistent and recurrent SUI is lacking.

Implantation de sphincter artificiel urinaire par voie laparoscopique chez des femmes avec incontinence urinaire d’effort sévère

To evaluate, feasibility, efficacy and morbidity of laparoscopic artificial urinary sphincter (AUS) implantation in women with severe stress urinary incontinence. Twenty-six women with severe stress urinary incontinence were treated between October 2007 and January 2012 by laparoscopic implantation of an AUS AMS 800 (American medical Systems, Inc., Minnetonka, Minnesota). For 18 patients AUS was primary implanted and, for eight, AUS was revised for a mechanical failure. Three patients had a concomitant laparoscopic vaginal prolapse repair. Mean value was for age 64 years, BMI 27.8kg/m2, and mean maximal urethral closure pressure was 26.75cm of water. Most of the patients (88%) had a history of pelvic or incontinence surgery. The study was a retrospective analysis of operative parameters, complications and functional results. Three conversions in open surgery and five bladder injuries were described. Mean operative time was 149 minutes. Bladder catheter was removed at a mean of day 3.8. Mean post-operative stay was 5 days. Early postoperative complications consist in eight acute transient urinary retentions, two pump migrations, and one vaginal injury. Late post-operative complications consist in one vaginal erosion. Explantation of AUS was performed for these last two patients. Mean follow-up was 20 months. Sixteen patients are totally continent, five have a social continence (1 pad/day) and three need more than one pad/day. Our results compare favorably to literature either for laparoscopic or conventional approach with a limited learning curve. Laparoscopic implantation of AUS in women with severe stress urinary incontinence was feasible and efficient.

Management of Male Voiding Dysfunction after Radical Cystectomy and Neobladder Reconstruction

At centers orthotopic bladder substitution (OBS) is the preferred method of urinary diversion following radical cystectomy (RC). Daytime and nighttime incontinence (UI) are reported in up to 13 % and 28 % of cases, respectively. SUI is the most common reason for daytime leakage, while an absent vesicourethral reflex with reduced external sphincter tone is associated with nighttime UI. A PubMed search disclosed a paucity of data for any treatment modality, the absence of prospective randomized trials and the existence of few retrospective case reports or small case series with limited follow up. Conservative management has limited value. Pharmacologic treatment for enuresis is effective in select OBS patients, while the off label use of Duloxetine for SUI seems promising. Surgical approaches include adjustable and nonadjustable slings as well as the ProACT system in mild stress UI. The need of intermittent self catheterisation (ISC) after slings seems to be very high. Implantation of the artificial urinary sphincter AMS 800 (AUS) is the standard treatment for severe stress (UI). AUS is a relatively safe, effective continence procedure for patients with OBS and severe SUI. Complication rate, urinary symptoms, and quality of life of these patients as determined by validated questionnaires are acceptable.