Artificial Urinary Sphincter Cuff Research Articles

V331 URETHRAL RECONSTRUCTION OF COMPLICATED INTRACTABLE POSTERIOR URETHRAL STRICTURES

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V331 URETHRAL RECONSTRUCTION OF COMPLICATED INTRACTABLE POSTERIOR URETHRAL STRICTURES Polina Reyblat, Manuel S. Eisenberg, Ricardo Brandina, David A. Ginsberg, and Stuart D. Boyd Polina ReyblatPolina Reyblat Sherman Oaks, CA More articles by this author , Manuel S. EisenbergManuel S. Eisenberg Los Angeles, CA More articles by this author , Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , David A. GinsbergDavid A. Ginsberg Los Angeles, CA More articles by this author , and Stuart D. BoydStuart D. Boyd Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.396AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An innovative reconstructive technique was introduced in 1984 to address intractable posterior urethral/bladder neck strictures that can potentially develop following difficult prostate cancer treatment strategies such as salvage radical prostatectomy, radical prostatectomy followed by adjuvant radiation therapy, radiation therapy with follow up transurethral resection of obstructive prostate or marked distraction of the bladder from the urethra following radical prostatectomy. The reconstruction plan employs a safe and relatively simple urethral pull-through procedure to correct the stricture with subsequent placement of an artificial urinary sphincter (Americal Medical System, Minnetonka, MN) to resolve the associated incontinence. All patients in this study had developed refractory bladder neck contractures and after repeated incisions and dilations, had dense posterior urethral strictures involving the external sphincter. The reconstruction solution with a unique urethral pull-through procedure performed perineally and placement of artificial urinary sphincter (AUS), solved both the stricturing and the incontinence. METHODS The procedure is performed totally perineally. The urethra is mobilized from the penoscrotal junction to the point of the obstruction in the urogenital diaphragm and transected. This type of mobilization makes 3-4cm of elastic urethra available for reconstruction. The stricture zone is typically 1.5-2.5cm in length, and it is incised and dilated to a 14 Hegar up into the bladder. Ideally a suprapubic catheter has been previously placed or can be placed at this time. The urethra is fixed with chromic suture to 20F Red Robinson catheter that has been pulled through the bladder suprapubically into the perineum. The urethra is then advanced up to just inside the opened bladder neck and the catheter is fixed to the abdominal wall. An AUS cuff is placed as a space holder. The urethra is well vascularized and is allowed to heal in place secondarily. The pull-through catheter is removed in 3-4 weeks. An AUS is placed 6 weeks after the initial surgery and activated 12 weeks after initial reconstruction. RESULTS The long-term results in 56 patients have been uniformly excellent. No patient has had to be diverted. Refractory stricturing of the pull-through urethra tends to be minimal (9%) and solvable. Many of these patients had previously been told that they would never urinate, and now can expect to void with a good stream and good control. CONCLUSIONS Definitive treatment for these seemingly irreparable patients can now be offered in a more timely manner. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e131 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Polina Reyblat Sherman Oaks, CA More articles by this author Manuel S. Eisenberg Los Angeles, CA More articles by this author Ricardo Brandina Los Angeles, CA More articles by this author David A. Ginsberg Los Angeles, CA More articles by this author Stuart D. Boyd Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urethrotomy Has a Much Lower Success Rate Than Previously Reported

We evaluated the success rate of direct vision internal urethrotomy as a treatment for simple male urethral strictures. A retrospective chart review was performed on 136 patients who underwent urethrotomy from January 1994 through March 2009. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth and fifth urethrotomy. Patients with complex strictures (36) were excluded from the study for reasons including previous urethroplasty, neophallus or previous radiation, and 24 patients were lost to followup. Data were available for 76 patients. The stricture-free rate after the first urethrotomy was 8% with a median time to recurrence of 7 months. For the second urethrotomy stricture-free rate was 6% with a median time to recurrence of 9 months. For the third urethrotomy stricture-free rate was 9% with a median time to recurrence of 3 months. For procedures 4 and 5 stricture-free rate was 0% with a median time to recurrence of 20 and 8 months, respectively. Urethrotomy is a popular treatment for male urethral strictures. However, the performance characteristics are poor. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer followup and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned.

Correlation of Penile and Bulbospongiosus Measurements: Implications for Artificial Urinary Sphincter Cuff Placement

We assessed penile and bulbospongiosus measurements to develop a quantitative guide to select the surgical approach (perineal vs transscrotal vs transcorporeal) to artificial urinary sphincter cuff placement. We retrospectively reviewed the intraoperative records of 100 men who underwent artificial urinary sphincter placement (43) or anastomotic urethroplasty (57) from February 2008 to June 2009. Correlations between penile (stretched length and circumference at the shaft base) and bulbospongiosus (distal and proximal circumference) measurements were assessed. Cases were analyzed according to 2 penile circumference groups, including group 1-8.0 cm or less and group 2-8.5 or more. Mean proximal bulbospongiosus circumference was uniformly larger than distal bulbospongiosus circumference (4.5 vs 3.9 cm). It was about 50% of the penile shaft circumference (mean 8.9 cm, r = 0.70). In group 1 men the average distal bulbospongiosus circumference was 3.4 cm. They were more likely to undergo transcorporeal artificial urinary sphincter cuff placement than those in group 2, who had an average distal bulbospongiosus circumference of 4.1 cm (8 of 22 or 36% vs 1 of 21 or 5%, OR 11.4). Penile length correlated less robustly with distal and proximal bulbospongiosus circumference (r = 0.39 and 0.43, respectively). Patients with urethroplasty had significantly larger urethral measurements than those with the artificial urinary sphincter (proximal and distal bulbospongiosus circumference 4.9 vs 3.7 and 4.1 vs 3.2, respectively) but were significantly younger (47 vs 67 years), and less likely to have erectile dysfunction (11 of 57 vs 34 of 43) or to have undergone radical prostatectomy (0 of 57 vs 37 of 43). Bulbospongiosus circumference appears to be proportional to penile circumference. The distal bulbospongiosus is uniformly smaller than the proximal bulbospongiosus. The potential need for a perineal or transcorporeal approach to artificial urinary sphincter placement can be anticipated by penile circumference measurements and a combination of clinical factors, such as older patient age, history of radical prostatectomy and impotence.

A Multicenter Study on the Perineal Versus Penoscrotal Approach for Implantation of an Artificial Urinary Sphincter: Cuff Size and Control of Male Stress Urinary Incontinence

In a single center retrospective study we previously reported superior dry rates and fewer artificial urinary sphincter revisions when the sphincter cuff was placed via the traditional perineal approach compared with a penoscrotal approach. A multicenter study was performed to compare the approaches further and explain the disparity in outcomes. We performed a retrospective review of 158 patients who underwent these procedures from April 1987 to October 2007 at 4 centers. During 184 surgeries in 158 patients 201 artificial urinary sphincter cuffs were placed (90 penoscrotal and 111 perineal). Among patients with known followup the completely dry rate for single cuff artificial urinary sphincters was 17 of 62 (27.4%) in the penoscrotal group and 41 of 93 (44.1%) in the perineal group (p = 0.04). Continued incontinence necessitated subsequent tandem cuff in 7 of the 62 (11.3%) penoscrotal cases compared to only 5 of the 93 (5.4%) perineal cases. Cuff size in the penoscrotal group was 5.0 cm in 1 patient (1.1%), 4.5 cm in 11 (12.2%) and 4.0 cm in 78 (86.7%). Cuff size in the perineal group was 5.5 cm in 1 patient (0.9%), 5.0 cm in 8 (7.2%), 4.5 cm in 30 (27.0%) and 4.0 cm in 72 (64.9%). There appears to be a higher completely dry rate with fewer subsequent tandem cuff additions with the perineal approach compared to the penoscrotal approach. This disparity may be explained by a more proximal artificial urinary sphincter cuff placement in the perineal group as evidenced by a larger cuff size.

S41 A multicenter study on perineal versus penoscrotal approach for implantation of an artificial urinary sphincter: cuff size and control of male stress urinary incontinence

In a single center retrospective study we previously reported superior dry rates and fewer artificial urinary sphincter revisions when the sphincter cuff was placed via the traditional perineal approach compared with a penoscrotal approach. A multicenter study was performed to compare the approaches further and explain the disparity in outcomes.We performed a retrospective review of 158 patients who underwent these procedures from April 1987 to October 2007 at 4 centers.During 184 surgeries in 158 patients 201 artificial urinary sphincter cuffs were placed (90 penoscrotal and 111 perineal). Among patients with known followup the completely dry rate for single cuff artificial urinary sphincters was 17 of 62 (27.4%) in the penoscrotal group and 41 of 93 (44.1%) in the perineal group (p = 0.04). Continued incontinence necessitated subsequent tandem cuff in 7 of the 62 (11.3%) penoscrotal cases compared to only 5 of the 93 (5.4%) perineal cases. Cuff size in the penoscrotal group was 5.0 cm in 1 patient (1.1%), 4.5 cm in 11 (12.2%) and 4.0 cm in 78 (86.7%). Cuff size in the perineal group was 5.5 cm in 1 patient (0.9%), 5.0 cm in 8 (7.2%), 4.5 cm in 30 (27.0%) and 4.0 cm in 72 (64.9%).There appears to be a higher completely dry rate with fewer subsequent tandem cuff additions with the perineal approach compared to the penoscrotal approach. This disparity may be explained by a more proximal artificial urinary sphincter cuff placement in the perineal group as evidenced by a larger cuff size.

COMPARISON OF PERINEAL AND PENOSCROTAL APPROACHES FOR ARTIFICIAL URINARY SPHINCTER PLACEMENT

La prostatectomie radicale a beaucoup évolué durant les 20 dernières années avec, d’une part, une connaissance approfondie de l’anatomie de la prostate, et d’autre part, l’avènement de nouvelles techniques de conservation des bandelettes neuro-vasculaires. Malgré ces progrès, le taux de dysfonction érectile post-prostatectomie varie entre 30 et 90 % selon les séries et c’est l’élément impactant la qualité de vie le plus souvent altérée après prostatectomie radicale. L’objectif de ce travail était d’effectuer une revue de la littérature évaluant les différents protocoles de rééducation érectile post-prostatectomie radicale.Une revue systématique de la littérature à partir de la base de recherche PubMed a été effectuée de 1995 à 2013 en utilisant les mots clés suivants : therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection.L’analyse critique des études sélectionnées met en évidence l’absence de protocole standard établi de rééducation érectile précoce post-prostatectomie radicale. Ces études ont démontré qu’une prise en charge précoce, par injections intra-caverneuses ou par IPDE5, améliorait la récupération des érections tel que le recommande l’Association française d’urologie.La prise en charge des troubles de la sexualité post-prostatectomie radicale est essentielle, elle doit s’organiser dans un protocole bien établi alliant l’aide pharmacologique et l’éducation thérapeutique délivrée par des praticiens ou des infirmières formées. Il serait nécessaire d’élaborer au sein d’un essai clinique un protocole standard de prise en charge.Radical prostatectomy has evolved considerably during the last 20 years, with one hand, a thorough knowledge of the anatomy of the prostate, and secondly, the introduction of new conservation techniques of neurovascular bundles. Despite this progress, the rate of post-prostatectomy erectile dysfunction varies between 30 and 90% depending on the series and this element impacts the quality of life after radical prostatectomy. The objective of this work was to conduct a review of the literature in order to evaluate the various protocols of post-radical prostatectomy erectile rehabilitation.A systematic review of the literature from the basic PubMed search was performed using the following keywords. Therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection.The critical analysis of selected studies highlights the lack of standard protocol that established erectile rehabilitation early after radical prostatectomy. These studies have shown that early treatment, injections or intracavernous PDE5 inhibitors improved recovery of erections as recommended by the French Association of Urology.Management of disorders of post-radical prostatectomy sexuality is essential, it must be organized in a well-established protocol combining pharmacological and therapeutic education assistances delivered by practitioners or nurses. It would need to develop in a clinical trial a standard protocol.

Modifications in artificial urinary sphincter placement

Although the male sling procedure is becoming increasingly popular, the artificial urinary sphincter (AUS) remains the gold standard due to its favorable outcome, long-term durability, and ability to treat mild, moderate, and severe urinary incontinence caused by intrinsic sphincter deficiency. However, AUS mechanical failure and the small but predictable occurrence of infection, erosion, and sub-cuff atrophy make it imperative that prosthetic urologists be familiar with salvage techniques. Secondary techniques to manage common complications are Mulcahy AUS salvage for infection, Webster’s transcorporal AUS cuff placement to prevent urethral erosion, and tandem cuff placement for urethral atrophy. Recent design modifications have introduced antibiotic-impregnated urinary sphincters that may decrease infections in primary and secondary AUS implants. Innovations in AUS placement, such as Mulcahy immediate AUS salvage and Webster’s transcorporal cuff placement, have allowed restoration of continence in men who previously had conditions considered untreatable.

Long-Term Durability and Functional Outcomes Among Patients With Artificial Urinary Sphincters: A 10-Year Retrospective Review From the University of Michigan

The artificial urinary sphincter continues to be one of the most effective and commonly used surgical treatments for severe urinary incontinence. The long-term durability and functional outcome remains unclear. This study sought to report the artificial urinary sphincter complication rates, associated risk factors with complications, and long-term quality of life and durability. This single institution study reports the outcomes of 124 consecutive index cases of artificial urinary sphincter from 1996 to 2006 for complications (infection, erosion, and mechanical failure). Bivariate statistics and multivariable logistic models were used to identify patient and artificial urinary sphincter characteristics associated with complications. Functional outcomes and long-term durability were assessed using a cross sectional analysis of a validated health related quality of life survey and a product limit estimates, respectively. Among the 124 male patients median followup was 6.8 years. The overall complication rate for patients undergoing an artificial urinary sphincter was 37.0%, with mechanical failure the most common cause (29), followed by erosion (10) and then infection (7). Significant differences between complications and specific patient and artificial urinary sphincter characteristics risk factors were not found. Functional outcomes appeared stable with similar mild-moderate urinary incontinence severity and 0 to 1 daily pad use at intervals of 0 to 4 years, 4 to 8 years and more than 8 years. Long-term durability was notable with 36% having complications (requiring surgical revision or removal) within 10 years and most events occurring within the first 48 months. Long-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure and infection in the first 48 months from implantation.

Perineal Approach for Artificial Urinary Sphincter Implantation Appears to Control Male Stress Incontinence Better Than the Transscrotal Approach

Traditionally cuff placement of an artificial urinary sphincter is done through a perineal approach. A new approach through a penoscrotal incision or transscrotal approach is reportedly more rapid and easier than the traditional incision. These 2 approaches were evaluated to determine which one controlled male stress urinary incontinence better. We performed a retrospective chart review of 94 patients who underwent artificial urinary sphincter placement procedures from April 1987 to March 2004. A total of 126 artificial urinary sphincter cuffs (120 procedures, including double cuff placement in 6) were placed in 94 patients with 63 placed penoscrotally and 63 placed perineally. Of the double cuff placements 1 was perineal and 5 were transscrotal. In patients with a single initial or revision cuff the self-reported completely dry rate was 28.6% with the penoscrotal approach and 56.5% with the perineal approach (p = 0.01), while for initial cuffs only the dry rate was 28.0% and 56.7% for the penoscrotal and perineal approach, respectively (p = 0.03). Five of 28 patients (17.9%) with initial penoscrotal placement later underwent tandem cuff placement for continued incontinence, whereas only 1 of 32 (3.1%) with initial perineal placement later had a tandem cuff added (p = 0.06). There was no difference in the estimated failure-free survival (failure for any reason) of the device. When the artificial urinary sphincter cuff is placed through a perineal approach, there appears to be a higher completely dry rate and fewer subsequent tandem cuff additions than when the artificial urinary sphincter cuff is placed through a penoscrotal incision.

Long-term Follow-up of Single Versus Double Cuff Artificial Urinary Sphincter Insertion for the Treatment of Severe Postprostatectomy Stress Urinary Incontinence

To assess the long-term effectiveness and complications associated with single and double cuff artificial urinary sphincter (AUS) implantation for the treatment of severe postprostatectomy stress urinary incontinence (SUI). We updated the outcomes of 56 men with postprostatectomy SUI who underwent single (28 patients) or double (28 patients) cuff AUS placement. Originally patients in each cohort were matched according to preoperative pad usage, risk factors for complications, and age. Continence, quality of life, and complications were assessed according to the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad usage, chart review, and patient/family interview. Updated data were available for 47 men (25 single cuff and 22 double cuff patients). Mean pre-AUS implant age was 67 years for each group. Average follow-up was 74.1 months and 58.0 months for single and double cuff patients, respectively. No statistically significant difference in continence improvement was noted between the two groups according to daily pad usage and overall dry rate. IIQ-7 scores improved from 14.8 to 4.1 after single cuff implants and from 16.3 to 6.4 after double cuff placement (P = 0.34). Men receiving a single cuff AUS reported seven complications requiring further operative intervention. Double cuff patients underwent 12 additional surgeries secondary to complications. Despite our earlier findings, no significant difference in dry rate, overall continence, or quality of life was seen with long-term follow-up of single versus double cuff AUS patients. Furthermore, men receiving double cuff implants may be at higher risk of complications requiring additional surgery.

Urethral support with PelviSoft™ after artificial urinary sphincter erosion at revision procedures

An artificial urinary sphincter cuff (AMS 800) is regarded the gold standard for surgically treating urinary incontinence without residual sphincter function. After erosion of an AMS 800 into the urethral lumen the whole system has to be explanted. When the urethral wall is supported and covered after healing with a porcine dermal acellular collagen matrix BioMesh (PelviSoft), a new artificial urinary sphincter may be implanted. The follow-up of up to two years seems promising in preventing erosion of the new cuff through the strengthened urethra wall, without compromising the functionality of the artificial urinary sphincter.

1493: Management of Large Volume Post Prostatectomy Urinary Incontinence Using a Single Cuff Artificial Urinary Sphincter

You have accessJournal of UrologyModerated Poster 46, Tuesday, May 22, 2007, 1:00 - 3:00 pm1 Apr 20071493: Management of Large Volume Post Prostatectomy Urinary Incontinence Using a Single Cuff Artificial Urinary Sphincter Kristy M. Borawski, Neil H. Grafstein, and George D. Webster Kristy M. BorawskiKristy M. Borawski More articles by this author , Neil H. GrafsteinNeil H. Grafstein More articles by this author , and George D. WebsterGeorge D. Webster More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31694-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1493: Management of Large Volume Post Prostatectomy Urinary Incontinence Using a Single Cuff Artificial Urinary Sphincter." The Journal of Urology, 177(4S), pp. 492–493 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 492-493 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Kristy M. Borawski More articles by this author Neil H. Grafstein More articles by this author George D. Webster More articles by this author Expand All Advertisement PDF downloadLoading ...

1494: De Novo Double Cuff Artificial Urinary Sphincter (DCAUS), for Post- Prostatectomy Urinary Incontinence: Long-Term Subjective Results

1494: De Novo Double Cuff Artificial Urinary Sphincter (DCAUS), for Post- Prostatectomy Urinary Incontinence: Long-Term Subjective Results

Tandem Transcorporal Artificial Urinary Sphincter Cuff Salvage Technique: Surgical Description and Results

Complications associated with placement of artificial urinary sphincter may make reoperation necessary. We present a surgical description and outcome data for tandem transcorporal artificial urinary sphincter salvage technique for nonmechanical artificial urinary sphincter failure. A retrospective analysis from July 2002 to December 2005 identified 198 consecutive men who underwent artificial urinary sphincter placement by a single surgeon (DSE) for postoperative stress urinary incontinence. Tandem transcorporal salvage artificial urinary sphincter surgery was performed in 18 patients with 1 (10 of 18) or both (8 of 18) cuffs placed transcorporally. Etiology of previous artificial urinary sphincter failure leading to the insertion of both cuffs in the transcorporal position included 3 infections, 2 erosions, 2 impending erosions, and 1 failed male sling. A self-administered standardized questionnaire was used to assess continence and quality of life outcomes. At a median followup of 26 months (IQR 14 to 30), pad use decreased from a median of 5.0 (IQR 3.5 to 5) to 2.0 (IQR 1 to 3) (p<0.001). Two patients experienced explantation of the device (1 erosion, 1 infection) without reimplantation and, thus, were excluded from outcome analysis. Eleven (69%) required 2 or fewer pads daily, and 5 (31%) required 3 pads daily. Eleven (69%) reported being very or extremely improved. Of the 5 patients reporting some or no improvement 4 were also on androgen deprivation therapy, suggesting that the transcorporal technique may be less durable in this group of patients. Tandem transcorporal artificial urinary sphincter placement is an effective approach to salvage cases with a high risk of repeat erosion or infection after failed artificial urinary sphincter placement.

V1675: Advancement in Salvage Procedure following Failed Artificial Urinary Sphincter: Tandem Transcorporal Artificial Urinary Sphincter Cuff Technique

You have accessJournal of UrologyVideo Session, Wednesday, May 24, 2006, 1:00 - 3:00 pm1 Apr 2006V1675: Advancement in Salvage Procedure following Failed Artificial Urinary Sphincter: Tandem Transcorporal Artificial Urinary Sphincter Cuff Technique James S. Magera, and Daniel S. Elliott James S. MageraJames S. Magera More articles by this author , and Daniel S. ElliottDaniel S. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33990-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "V1675: Advancement in Salvage Procedure following Failed Artificial Urinary Sphincter: Tandem Transcorporal Artificial Urinary Sphincter Cuff Technique." The Journal of Urology, 175(4S), pp. 539–540 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 539-540 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information James S. Magera More articles by this author Daniel S. Elliott More articles by this author Expand All Advertisement PDF DownloadLoading ...

359: Multicenter Experience with Tandem Cuff Artificial Urinary Sphincter as Primary and Salvage Treatment for Male Urinary Incontinence

You have accessJournal of UrologyDiscussed Poster, Sunday, May 21, 2006, 1:00 - 4:00 pm1 Apr 2006359: Multicenter Experience with Tandem Cuff Artificial Urinary Sphincter as Primary and Salvage Treatment for Male Urinary Incontinence Liann N. Handel, Seetharaman Ashok, Andrew M. Shapiro, Ouida L. Westney, Allen F. Morey, Carl Klutke, Steven B. Brandes, and Kennon S. Miller Liann N. HandelLiann N. Handel More articles by this author , Seetharaman AshokSeetharaman Ashok More articles by this author , Andrew M. ShapiroAndrew M. Shapiro More articles by this author , Ouida L. WestneyOuida L. Westney More articles by this author , Allen F. MoreyAllen F. Morey More articles by this author , Carl KlutkeCarl Klutke More articles by this author , Steven B. BrandesSteven B. Brandes More articles by this author , and Kennon S. MillerKennon S. Miller More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32615-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "359: Multicenter Experience with Tandem Cuff Artificial Urinary Sphincter as Primary and Salvage Treatment for Male Urinary Incontinence." The Journal of Urology, 175(4S), pp. 117–118 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 117-118 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Liann N. Handel More articles by this author Seetharaman Ashok More articles by this author Andrew M. Shapiro More articles by this author Ouida L. Westney More articles by this author Allen F. Morey More articles by this author Carl Klutke More articles by this author Steven B. Brandes More articles by this author Kennon S. Miller More articles by this author Expand All Advertisement PDF downloadLoading ...

Salvage procedure for infected noneroded artificial urinary sphincters.

We report our experience with removal, antiseptic irrigation and immediate reimplantation of infected noneroded artificial urinary sphincters. From April 1996 to October 2000, 8 patients with an infected artificial urinary sphincter underwent a total of 9 salvage operations. All patients underwent cystoscopy before salvage to ensure nonerosion of the sphincter cuff. All previously implanted material was removed, the wounds were copiously irrigated according to a 7 solution protocol and an identical new system was implanted. All patients were discharged home the following morning on oral antibiotics. Followup was 5 to 66 months (mean 33). The predominant organisms cultured at salvage were gram-positive cocci. Time from implantation to salvage was from 2 weeks to 64 months (mean 13.7 months). Prostatectomy was the etiology of incontinence in all except 1 case. In 5 of the 8 men a double cuff system was placed and 3 underwent concurrent 3-piece inflatable penile prosthesis salvage. The salvage procedure was done twice in 1 patient 5 months apart. The system was removed 16 months later secondary to urethral erosion. At the most recent followup the other 7 patients were free of infection with a functioning artificial urinary sphincter. Salvage and immediate reimplantation of an infected, noneroded single or double cuff artificial urinary sphincter appears to be a valid option. Our overall success rate was 87%. The usual offending organisms are gram-positive skin flora. An associated inflatable penile prosthesis does not prohibit simultaneous salvage of the 2 devices.

Tandem Cuff Artificial Urinary Sphincter as a Salvage Procedure Following Failed Primary Sphincter Placement for the Treatment of Post-Prostatectomy Incontinence

Management of post-artificial urinary sphincter (AUS) urethral atrophy can be difficult for the treating physician, yielding unsatisfactory results for the patient. As with many incontinence procedures, initial results are generally encouraging. We determined the durability and success of tandem cuff placement for urethral atrophy following AUS placement. We reviewed the records of 18 patients with a mean age 74 years who underwent tandem AUS placement from 1994 to 2001. Mean followup was 3.3 years. All patients originally underwent AUS placement for post-prostatectomy stress urinary incontinence and they had subsequent incontinence secondary to urethral atrophy. Adjuvant radiation in 3 cases, hormone therapy in 3, cuff size and pressure, and multiple continence procedures prior to tandem cuff placement in 5 were evaluated as risk factors for cuff erosion. Long-term followup was obtained through office examination and telephone interview using a standardized questionnaire regarding voiding habits and satisfaction. Following tandem cuff placement mean +/- SD pad use daily decreased from 4.3 +/- 0.35 (median 3) to 1.6 +/- 0.42 (median 1) (p <0.0001). Overall 10 of the 18 patients (56%) needed 1 pad or less daily, 16 (88%) would have the tandem cuff placed again and 17 (94%) would recommend the procedure. Median subjective improvement and satisfaction was 4.7 and 4.0, respectively, on a scale of 0 to 5. Reoperation was required for cuff leakage in 1 case and cuff erosion in 2. One patient with erosion had 3 prior AUS revisions, including placement of a 71 to 80 cc balloon reservoir. Placement of tandem urethral cuff as a salvage procedure for recurrent stress urinary incontinence provides marked sustained improvement in leakage and overall high patient satisfaction in the difficult setting of urethral atrophy.

Salvage Procedure For Infected Noneroded Artificial Urinary Sphincters

We report our experience with removal, antiseptic irrigation and immediate reimplantation of infected noneroded artificial urinary sphincters. From April 1996 to October 2000, 8 patients with an infected artificial urinary sphincter underwent a total of 9 salvage operations. All patients underwent cystoscopy before salvage to ensure nonerosion of the sphincter cuff. All previously implanted material was removed, the wounds were copiously irrigated according to a 7 solution protocol and an identical new system was implanted. All patients were discharged home the following morning on oral antibiotics. Followup was 5 to 66 months (mean 33). The predominant organisms cultured at salvage were gram-positive cocci. Time from implantation to salvage was from 2 weeks to 64 months (mean 13.7 months). Prostatectomy was the etiology of incontinence in all except 1 case. In 5 of the 8 men a double cuff system was placed and 3 underwent concurrent 3-piece inflatable penile prosthesis salvage. The salvage procedure was done twice in 1 patient 5 months apart. The system was removed 16 months later secondary to urethral erosion. At the most recent followup the other 7 patients were free of infection with a functioning artificial urinary sphincter. Salvage and immediate reimplantation of an infected, noneroded single or double cuff artificial urinary sphincter appears to be a valid option. Our overall success rate was 87%. The usual offending organisms are gram-positive skin flora. An associated inflatable penile prosthesis does not prohibit simultaneous salvage of the 2 devices.

Transcorporal Artificial Urinary Sphincter Cuff Placement in Cases Requiring Revision for Erosion and Urethral Atrophy

A distal cuff location is often required in patients undergoing artificial urinary sphincter reimplantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small that a 4 cm. cuff is too large. We present a novel technique for distal cuff placement using transcorporal dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. We reviewed the charts of 31 men who underwent this technique and contacted 26 by telephone. The indications for distal transcorporal cuff placement varied. In 7 men with inadequate urethral coaptation with a 4 cm. proximal cuff at initial implantation a primary transcorporal tandem cuff was implanted distal. In 8 men persistent or recurrent incontinence despite a 4 cm. proximal cuff led to secondary distal reimplantation. Previous artificial urinary sphincter erosion and/or infection in 10 cases, previous urethral surgery at the optimal cuff site in 5 and radiation changes at the optimal cuff site in 1 led to selection of the more distal site and technique. Of the transcorporally placed cuffs 18 were 4 cm. and 13 were 4.5 cm. Preoperatively 5.2 pads were used daily. Of the 31 patients 27 were impotent preoperatively, 1 had normal erections, 1 had partial erections with the MUSE drug delivery system (Vivus, Inc., Menlo Park, California) and 2 had a previously placed penile prosthesis. At a mean followup of 17 months 26 of the 31 patients (84%) had occasional or no stress incontinence requiring 0 to 1 pad daily, 2 with pure urge incontinence used 1 to 2 pads daily and 3 had mixed incontinence requiring 0 to 3 pads daily. Of the 26 men surveyed 25 were very satisfied with the postoperative level of incontinence. Postoperatively erectile function deteriorated in 1 patient and was unchanged in the remainder. There was no erosion or infection of the transcorporally placed cuffs, although 3 were replaced for malfunction. This technique offers significant advantages in cases of revision. The technique protects the urethra from intraoperative dissection injury and decreases the risk of erosion because the urethra is buttressed at its vulnerable location. In addition, bulk is added to the urethra, allowing for better cuff sizing, which is usually a problem at this location where the urethra is small, thereby, improving continence in revised cases. Our success has recently led us to abandon tandem cuff placement altogether. There is a potential for deteriorating erectile function in potent men who undergo implantation in this fashion.