Artificial Urinary Sphincter Explantation Research Articles

Novel Utilization of a Penrose Drain as a Spacer During Temporary Artificial Urinary Sphincter Explantation and Rectourethral Fistula Repair

Novel Utilization of a Penrose Drain as a Spacer During Temporary Artificial Urinary Sphincter Explantation and Rectourethral Fistula Repair

Risk Factors for Artificial Urinary Sphincter Explantation and Erosion in Male Nonneurological Patients.

This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort. We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components. The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039). In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.

Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

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.

V06-06 ROBOTIC ARTIFICIAL URINARY SPHINCTER EXPLANTATION AND CONCOMITANT FASCIAL SING INSERTION IN CASE OF BLADDER NECK CUFF EXTRUSION FOR FEMALE PATIENTS

You have accessJournal of UrologyCME1 May 2022V06-06 ROBOTIC ARTIFICIAL URINARY SPHINCTER EXPLANTATION AND CONCOMITANT FASCIAL SING INSERTION IN CASE OF BLADDER NECK CUFF EXTRUSION FOR FEMALE PATIENTS Camille Haudebert, Juliette Hascoet, Lucas Freton, Claire Richard, Karim Bensalah, Gregory Verhoest, Zine Eddine Khene, Romain Mathieu, Andrea Manunta, and Benoit Peyronnet Camille HaudebertCamille Haudebert More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Lucas FretonLucas Freton More articles by this author , Claire RichardClaire Richard More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Zine Eddine KheneZine Eddine Khene More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female stress urinary incontinence (SUI) is highly prevalent. Artificial urinary sphincter is an option for severe or complex female SUI cases. In case of bladder neck cuff extrusion, AUS explantation is required and further SUI treatment can be challenging. In the present video, we report and describe a new surgical technique aiming both to treat AUS bladder neck extrusion and to prevent recurrence of SUI. METHODS: We present the case of a 43-year-old female patient with a history of urethrovaginal fistula. After the repair with a Martius flap interposition she reported severe SUI. She reported SUI with 350 g on 24h pad weigh test, massive leakage on cough stress test with a fixed urethra. She underwent robotic AUS implantation with complete resolution of SUI. Six months after, she had a recurrence of the SUI and urethral pain. Bladder neck extrusion of the AUS cuff was diagnosed on cystoscopy. A robotic AUS explantation was planned. We offered to place a fascial sling at the bladder neck during the explantation to minimize the risk of SUI and urethrovaginal fistula recurrence. RESULTS: Five ports are placed. The bladder is dropped down from the abdominal wall. Opening the fibrotic tissue surrounding the bladder neck, the cuff is found, dissected and opened. The anterior aspect of the bladder is opened longitudinally to repair the bladder neck defect transvesically. The edges of the bladder incision are sutured on each side to the abdominal wall to improve the transvesical bladder neck exposure. The inflammatory/necrotic tissues surrounding the extrusion orifice are excised. The orifice is then closed transversally in two layers (detrusor and mucosa individually) using interrupted 4/0 Vicryl suturesWe harvest a 10x1.5 cm rectus fascial sling. The fascial sling is inserted in the abdomen and placed around the bladder neck. The sling is pulled towards the rectus fascia using two permanent 2/0 monofilament stitches inserted into the abdomen with a Reverdun needle and placed at each end of the sling. We tightened the sling above the rectus fascia moderately. The operative time was 280 minutes. There was no postoperative complications. The urethral catheter was removed at day 15 and the patient resumed spontaneous voiding. CONCLUSIONS: Robotic artificial urinary sphincter explantation and concomitant fascial sing insertion in case of bladder neck cuff extrusion appears feasible and may be an interesting salvage option to prevent SUI recurrence and avoid further anti-incontinence surgical procedures likely to be highly challenging. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e566 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Haudebert More articles by this author Juliette Hascoet More articles by this author Lucas Freton More articles by this author Claire Richard More articles by this author Karim Bensalah More articles by this author Gregory Verhoest More articles by this author Zine Eddine Khene More articles by this author Romain Mathieu More articles by this author Andrea Manunta More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach.

ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.

PD06-06 IMPACT OF ROBOTIC ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS ON QUALITY OF LIFE AND PATIENTS-REPORTED OUTCOMES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (PD06)1 Sep 2021PD06-06 IMPACT OF ROBOTIC ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN FEMALE PATIENTS ON QUALITY OF LIFE AND PATIENTS-REPORTED OUTCOMES Benoit Peyronnet, Valentine Lethuillier, Louis-Paul Berthelot, Claire Richard, Camille Haudebert, Caroline Voiry, Lucas Freton, Juliette Hascoet, and Andrea Manunta Benoit PeyronnetBenoit Peyronnet More articles by this author , Valentine LethuillierValentine Lethuillier More articles by this author , Louis-Paul BerthelotLouis-Paul Berthelot More articles by this author , Claire RichardClaire Richard More articles by this author , Camille HaudebertCamille Haudebert More articles by this author , Caroline VoiryCaroline Voiry More articles by this author , Lucas FretonLucas Freton More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , and Andrea ManuntaAndrea Manunta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001974.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincter (AUS) is commonly used in France in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, female AUS has never been assessed using validated questionnaires so far. The aim of the present study was to assess the functional outcomes of robotic artificial urinary sphincter implantation using validated questionnaires METHODS: The data of all female patients undergoing a robotic AUS implantation at a single academic center between 2014 and 2019 were collected prospectively. Preoperativley, all patients underwent urodynamics and filled out an Urinary Symptoms Profile (USP) questionnaire (SUI subscore /9; overactive bladder subscore /21 ; voiding symptoms subscore /9), a ICIQ-SF questionnaire and a Patient Global Impression of Improvement (PGII). The same questionnaires were filled out at 3 months postoperatively. RESULTS: Over the study period, 57 robotic female AUS implantations were performed by two surgeons. Eight patients had neurogenic SUI (14%). The median patients’ age was 66 years and 84.2% had a history of previous SUI surgery. The median cuff size was 75 mm. There were ten intraoperative complications (5 bladder neck injuries and 5 vaginal injuries ; 17.5%) and 16 postoperative complications (28.1%) all Clavien grades 1 or 2 except three Clavien 3B: two early vaginal erosion with AUS explantation and one suspicion of AUS infection with surgical exploration (major complications rate: 5.3%). The median length of stay was 3 days. All patient-reported outcomes were significantly improved at 3 months. The USP SUI subscore decreased from 7.4/9 preoperatively to 0.7/9 at 3 months (p<0.0001), the USP OAB subscore dwindled from 12.6 to 5.2 (p<0.0001) and the ICIQ-SF from 16.3 to 3.1 (p<0.0001). The AUS implantation improved patients’ quality of life with the ICIQ-qol decreasing from 8.4 preoperatively to 1.3 at 3 months (p<0.0001). The 3-month PGII was 1/7 (very much improved) in 41 patients (74.5%), 2/7 (improved) in 5 patients (9.1%), 3/7 in four patients (7.3%) and 4/7 (unchanged) in five patients (9.1%). CONCLUSIONS: Robot-assisted AUS implantation in female patients has a low morbidity and improves the patients-reported outcomes and quality of life of female patients with SUI due to ISD. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e101-e102 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet More articles by this author Valentine Lethuillier More articles by this author Louis-Paul Berthelot More articles by this author Claire Richard More articles by this author Camille Haudebert More articles by this author Caroline Voiry More articles by this author Lucas Freton More articles by this author Juliette Hascoet More articles by this author Andrea Manunta More articles by this author Expand All Advertisement Loading ...

PD04-05 SURVIVAL OF ARTIFICIAL URINARY SPHINCTER IN SIMULTANEOUS VS STAGED ARTIFICIAL URINARY SPHINCTER AND PENILE PROSTHESIS IMPLANTATION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-05 SURVIVAL OF ARTIFICIAL URINARY SPHINCTER IN SIMULTANEOUS VS STAGED ARTIFICIAL URINARY SPHINCTER AND PENILE PROSTHESIS IMPLANTATION Nathan Cheng, Nickolas Dalbec, Dongfeng Qi, Guanghui Liu, and David Shin Nathan ChengNathan Cheng More articles by this author , Nickolas DalbecNickolas Dalbec More articles by this author , Dongfeng QiDongfeng Qi More articles by this author , Guanghui LiuGuanghui Liu More articles by this author , and David ShinDavid Shin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) and erectile dysfunction (ED) are important quality-of-life measures especially after prostate cancer treatment. When both conditions are present, simultaneous artificial urinary sphincter (AUS) and penile prosthesis (PP) implantation can be performed to treat UI and ED, respectively. We sought to evaluate device survival outcomes in men who underwent simultaneous vs. staged AUS and PP implantation for UI and ED. METHODS: Analysis of 21 years of a national prospectively maintained Boston Scientific database was performed (1995-2016). Patients were placed into three subgroups based on timeline of implantation: AUS first then PP (AUS1), PP first then AUS (AUS2), and simultaneous AUS and PP (SIMAUS). Patients were stratified by surgical approaches for AUS and PP implantation. Implant survival (time to revision or explantation) analysis was performed using log-rank test. RESULTS: 6770 patients were included in the study. AUS survival from revision showed AUS1>SIMAUS>AUS2 at 5-years (89.1% vs 84.3% vs 79.5%), 10-years (84.3% vs 80.1% vs 75.2%), 15-years (82.2% vs 78.5% vs 74.0%), and 20-years (81.3% vs 77.8% vs 74.0%) after initial device implantation, all p<0.001. AUS survival from explantation showed AUS1>SIMAUS>AUS2 at 5-years (90.8% vs 85.6% vs 82.0%) and 10-years (77.7% vs 75.0% vs 72.0%), but SIMAUS>AUS1 or AUS2 at 15-years (70.4% vs 66.3% vs 65.0%) and 20-years (69.7% vs 58.2% vs 65.0%), all p≤0.003. In a subgroup of 1119 men undergoing perineal AUS and penoscrotal IPP approach, AUS revision survival showed AUS1>SIMAUS>AUS2 at 5-years (93.1% vs 83.9% vs 79.7%, p<0.001) and 10-years (92.4% vs 80.7% vs 79.7%, p<0.001). AUS explantation survival also showed AUS1>SIMAUS>AUS2 at 5-years (93.5% vs 86.6% vs 79.8%, p<0.001) and 10-years (72.6% vs 68.7% vs 65.4%, p=0.002). CONCLUSIONS: For dual UI and ED diagnosis, AUS survival from revision up to 20 years or explantation up to 10 years is best seen in patients who undergo staged placement of AUS first followed by PP, as highlighted by perineal AUS and penoscrotal PP surgical approach. However, simultaneous AUS and PP implantation offers better long term (>10 years) AUS survival from explantation. Source of Funding: Boston Scientific © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e51-e51 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Cheng More articles by this author Nickolas Dalbec More articles by this author Dongfeng Qi More articles by this author Guanghui Liu More articles by this author David Shin More articles by this author Expand All Advertisement Loading ...

Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success

Introduction: After implantation of an artificial urinary sphincter (AUS) due to stress urinary incontinence, in some cases revision procedures may be necessary. This is mostly due to device infection or cuff erosion in the long term. The aim of this study was to evaluate the impact of early revision procedures (prior to or immediately after AUS activation) on the long-term outcome. Methods: We retrospectively evaluated patients who underwent primary AUS implantation between 2006 and 2019. Patients with previous radiotherapy, urethroplasty, urethral stent placement, or repeat AUS implantation were excluded. Early revision was defined as prior to or immediately after AUS activation and comprised pump repositioning or cuff size adaptation due to difficulties in using the pump, persistent urinary incontinence, or urinary retention. Patients were compared with regard to complication rates, functional outcome, and patient satisfaction. Univariable and multivariable logistic regression analyses were performed to analyze risk factors for early AUS revision. Kaplan-Meier analysis evaluated explantation-free survival. Results: A total of 250 patients were included. Twenty patients (8%) required early revision (pump repositioning in 15 cases [75%], cuff downsizing in 3 cases [15%], and cuff upsizing in 2 cases [10%]). Mean follow-up was 78.6 months. 96.4% of all patients were objectively continent at the time of last follow-up without differences between both groups, and patient satisfaction was high in both groups. No differences with regard to mechanical implant failure, tissue atrophy, and AUS explantation due to cuff erosion or implant infection were observed. Explantation-free survival was comparable in both groups. On univariable logistic regression analysis, coronary artery disease and transcorporal cuff placement were associated with early AUS revision. Conclusion: Early revision after AUS implantation can be performed without negative impact on the long-term outcome.

Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence.

Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. Over a span of 26years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.

Robot-assisted artificial urinary sphincter implantation.

The aim of the present manuscript was to provide an overview on the current state of robotic artificial urinary sphincter (AUS) implantation in male and female patients. Over the past few years, several series have been reported, with promising outcomes for the most part. This has contributed to expand the use of bladder neck AUS, especially in female patients, which was, until then, hampered by its perioperative morbidity. Robotic AUS has been developed to overcome the technical challenge of bladder neck implantation in female patients and in specific male subgroups, especially self-catheterizing neurological patients. All the series of robotic AUS implantation published in the past few years reported much lower rates of cuff erosion and AUS explantation than the historical open cohorts suggesting that the robotic approach might become the standard for female AUS implantation. This less morbid approach along with technological improvement of the AUS device may contribute to make it a more popular option in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency. There are much less data available on robotic bladder neck AUS implantation in male patients.

Long-term outcomes of artificial urinary sphincter in female patients with spina bifida.

To report the long-term functional outcomes of artificial urinary sphincter (AUS) implantation in female patients with spinal dysraphism and stress urinary incontinence (SUI) related to intrinsic sphincter deficiency (ISD). The charts of all spina bifida female patients with SUI due to ISD who underwent AUS (AMS 800) implantation between 2005 and 2019 at three academic departments of urology were retrospectively reviewed. Reoperation was defined as either revision or explantation of the AUS device. Reoperation-free survival of the AUS device was estimated using the Kaplan-Meier method. Continence status as per patients' subjective assessment was categorized as follows: complete continence (no pads), improved continence, unchanged SUI or worsened SUI. Twenty-three patients were included, 69.6% were self-catheterizing. The median follow-up was 14 years. Median time to first reoperation was 10 years. Survival rates without reoperation were 85.9%, 41.8%, 34.6%, and 20.9% at 5, 10, 15, 20 years, respectively. Survival rates without AUS explantation were 90.7%, 66.3%, 55.2%, and 41.4% at 5, 10, 15, 20 years, respectively. None of the patients who underwent device explantation had a new AUS implanted. The only predictive factor of reoperation-free survival was the type of spinal dysraphism (hazards ratio = 3.60 for closed vs. open dysraphism; p = .04). At last follow-up, 17 of the 23 patients were fully continent (73.9%). AUS in female patients with spina bifida may be associated with satisfactory long-term functional outcomes and a high reoperation rate. The median time to first reoperation was similar to what is reported in the male AUS literature (10 years).

370 - Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence

370 - Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence

Female neurogenic stress urinary incontinence

The aim of this article is to look into recent updates on the management of neurogenic stress urinary incontinence (NSUI) in adult females. Recently, a small number of studies have investigated different surgical modalities in treatment of NSUI in adult females including artificial urinary sphincter (AUS), suburethral tapes (SUT) and adjustable slings and urethral bulking agents. Up to 70% of neurogenic patients who received AUS implants are continent and have not required surgical revision over a 20-year follow-up period. However, the risk for explantation of AUS may be twice as high in neurogenic patients compared with nonneurogenic patients. SUT have success and improvement in quality of life rates of up to 52 and 68%, respectively. However, complications may be as high as 24%. Early data on adjustable slings may suggest up to 80% continence with low complication rates. AUS can provide satisfactory continence levels with acceptable rates of revision and explantation. SUT are effective but more than half of patients may require additional procedures. Adjustable slings could be a promising option. Further high-quality studies with careful attention to methodology and standardization of both definitions used and outcome reporting are required to help us reach safe conclusions.

Anterior urethral erosion: report of a malfunctioned and infected artificial urinary sphincter

Background: Since its introduction in less than a century, artificial urinary sphincter (AUS) remains the gold standard in the treatment of severe male sphincter weakness incontinence. It is an extremely reliable prosthesis and patient's satisfaction rate is high after successful implantation. However, complications can occur following implantation and one of the most feared complications is anterior urethral erosion from sphincter malfunction and failure. As patients embark on medical tourism, Urologists in our environment may be challenged with complications resulting from various interventions not readily available in our environment.Case Summary: A 15 year old male student presented to our facility with fever of one week duration and painful scrotal swelling which ruptured spontaneously discharging purulent foulsmelling fluid two (2) months following successful implantation of AUS at a hospital in India. He was febrile with temperature of 38.70C, respiratory rate 32 cycles/minute, pulse rate 110 beat per minutes and blood pressure of 100/60mmHg. His packed cell volume was 34 % other laboratory parameters were not remarkable. He was managed for urosepsis with intravenous infusion, parenteral antibiotics, and initial wound debridement and subsequent AUS ex-plantation and perineal urethrostomy. Patient did well and he is awaiting urethroplasty and AUS placement.Conclusion: Artificial urinary sphincter removal and perineal urethrostomy is a viable option for the emergency management of anterior urethral erosion due to malfunctioned infected artificial sphincter.Keywords: Anterior urethral erosion, artificial urinary sphincter, Urosepsis, perineal urethrostomy, urethroplastySavannah Journal of Medical Research and Practice 2018;7(1):23-27

Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation.

To evaluate the impact of previous urethroplasty on complication rates and postoperative continence after primary artificial urinary sphincter (AUS) implantation in male patients with severe stress urinary incontinence. A prospective evaluation of patients undergoing primary AUS implantation was conducted. Patients with previous radiotherapy, AUS implantation or urethral stent placement were excluded. Main endpoints were postoperative continence and complication rates including necessity of AUS explantation. Kaplan-Meier analysis evaluated explantation-free survival. Logistic regression analyses were performed to identify potential predictors for AUS explantation. 105 patients were included with a mean follow-up of 76.6months (SD 15.9). 30 of these patients had a history of urethroplasty. Postoperatively, 96.2% of all patients were objectively continent (≤ 1 pad/day). No differences in postoperative continence and early complication rates were observed. Concerning long-term complications, infection, mechanical implant failure, and tissue atrophy were also comparable. Overall sphincter erosion rate was 12.3%, but significantly higher in urethroplasty patients (23.3% vs. 8.0%, p = 0.038) and sphincter explantation rate was threefold higher (p = 0.016) in the urethroplasty group. Furthermore, explantation-free survival was reduced compared to the non-urethroplasty group (p = 0.044). On logistic regression analysis, the previous urethroplasty was the only significant predictor for AUS explantation (p = 0.016). AUS implantation in patients with former urethroplasty can provide satisfying results. Compared to patients without the previous urethroplasty, the higher risk of cuff erosion and AUS explantation has to be addressed during preoperative consultation. Patients with the previous urethroplasty with grafting, long strictures and previous visual internal urethrotomy might be at highest risk.

Stress urinary incontinence in female neurological patients: long-term functional outcomes after artificial urinary sphincter (AMS 800TM ) implantation.

To report the long-term functional outcomes of artificial urinary sphincter (AUS) implantation in female adult neurological patients suffering from stress urinary incontinence (SUI) due to sphincter deficiency. Female patients with neurological disease suffering from SUI due to sphincter deficiency who underwent AUS (AMS 800TM ) implantation between 1984 and 2011 were included. Continence rate defined as no need for pads and survival rates of the device without needing explantation or revision using Kaplan-Meier curves were reported. Overall, 26 patients, median age 49.2 years (IQR 28.5-59.7) were included. The median follow-up time was 7.5 years (IQR 3.9-23.8). At the end of follow-up period, 15 patients (57.7%) still had their primary AUS. The AUS was explanted in five women because of infection or erosion. Survival rates, without AUS explantation were 90%, 84%, 84%, and 74% at 5, 10, 15, 20 years, respectively. Survival rates without AUS revision were 75%, 51%, 51%, and 51% at 5, 10, 15, 20 years, respectively. 71.4% of patients with AUS were continent. When considering the 26 initial patients, including the patients in whom the AUS was explanted, the continence rate was 57.7%. For treating neurogenic sphincter deficiency in the long term, the AMS 800TM can offer a satisfying rate of continence to female patients, with a tolerable rate of explantation and revision. Neurourol. Urodynam. 36:764-769, 2017. © 2016 Wiley Periodicals, Inc.

PD16-08 FOLEY OR FIX: COMPARATIVE ANALYSIS OF FOLEY, ABBREVIATED URETHROPLASTY, AND MOBILIZATION WITH PRIMARY URETHRAL ANASTOMOSIS AT THE TIME OF AUS EXPLANTATION FOR CUFF EROSION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-08 FOLEY OR FIX: COMPARATIVE ANALYSIS OF FOLEY, ABBREVIATED URETHROPLASTY, AND MOBILIZATION WITH PRIMARY URETHRAL ANASTOMOSIS AT THE TIME OF AUS EXPLANTATION FOR CUFF EROSION Nathan Chertack, Hemant Chaparala, Kenneth Angermeier, Drogo Montague, and Hadley Wood Nathan ChertackNathan Chertack More articles by this author , Hemant ChaparalaHemant Chaparala More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , Drogo MontagueDrogo Montague More articles by this author , and Hadley WoodHadley Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Artificial urinary sphincter (AUS) cuff erosion requires explantation and the resulting urethral defect may be managed with Foley catheter placement, abbreviated urethroplasty (AU), or mobilization with primary urethral anastomosis (PA). We reviewed these treatment options to compare post- operative results, complications and probability of AUS reimplantation. METHODS Medical records of patients treated for AUS cuff erosion from 2005-2015 were reviewed. Patients were divided into three groups based on management of the urethra: Foley catheter only, abbreviated urethroplasty, or mobilization with primary urethral anastomosis. Patient characteristics, operative times, outcomes, complications, and factors impacting AUS reimplantation were recorded and analyzed. RESULTS Seventy-five patients with a median age of 77 years (72-83) were treated for AUS cuff erosion from 2005-2015. Fifty-two underwent Foley catheter placement, 8 AU, and 15 PA. The mean follow-up was 13 months (0-106). Operative times for AUS explant-only procedures were longer for PA than Foley or AU (120 vs. 90, 120 vs. 76, p=0.033, p=0.012, respectively). Severe erosions were more common in the PA treatment group than Foley or AU (100% vs. 37%, 100% vs. 38%, p<0.001, p<0.001, respectively). Patients treated with AU were found to have a higher number of prior explants per patient than either Foley or PA (1 vs. 0.4, 1 vs. 0.2, p<0.029, p<0.017, respectively). Severe erosions treated with a Foley were significantly more likely to develop a stricture than mild erosions (38% vs. 5%, p=0.009). Tandem cuff patients treated with a Foley were more likely to develop a diverticulum than single cuff patients (33% vs. 4%, p=0.016). There was no difference in probability of AUS reimplantation between PA and Foley or AU (63% vs. 69%, 63% vs. 33%, 0.748, 0.438, respectively). CONCLUSIONS Foley catheter placement alone may represent suboptimal management for severe or tandem cuff erosions, due to the increased risk of subsequent urethral stricture or diverticulum. Overall, the likelihood of AUS reimplantation does not appear to be affected by severity of erosion using the reported techniques for urethral management. At the time of AUS explantation for cuff erosion, management of the urethral defect should be determined by individual patient characteristics and surgeon experience. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e397 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nathan Chertack More articles by this author Hemant Chaparala More articles by this author Kenneth Angermeier More articles by this author Drogo Montague More articles by this author Hadley Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Foley or Fix: A Comparative Analysis of Reparative Procedures at the Time of Explantation of Artificial Urinary Sphincter for Cuff Erosion

To examine artificial urinary sphincter (AUS) cuff erosion intraoperative management methods: Foley catheter placement, abbreviated urethroplasty (AU), or mobilization with primary urethral anastomosis (PA). We reviewed these options to compare postoperative complications and probability of AUS reimplantation. Medical records of patients treated for AUS cuff erosion from 2005 to 2015 were retrospectively reviewed. We divided patients into 3 groups based on intraoperative management of the urethra: Foley only, AU, or PA. Patient characteristics, operative times, outcomes, complications, and reimplantation factors were recorded and analyzed. Seventy-five patients with a median age of 77 years (72-83) were treated for AUS cuff erosion. Fifty-two underwent Foley placement, 8 AU, and 15 PA. Mean follow-up was 13 months (0-106). Severe erosions were more common in the PA group than Foley or AU (100% vs 37%, 100% vs 38%, P <.001, P <.001, respectively). Severe erosions treated with Foley were more likely to develop strictures than mild erosions (38% vs 5%, P = .009). Tandem cuff patients treated with Foley were more likely to develop diverticuli than single cuff patients (33% vs 4%, P = .016). There was no difference in probability of reimplantation between PA and Foley or AU (63% vs 69%, 63% vs 33%, P = .748, P = .438, respectively). Foley catheter placement alone may represent suboptimal management for severe or tandem cuff erosions due to increased risk of urethral complications. Urethral defect management should be determined at the time of explantation by individual patient characteristics and surgeon experience.

PD10-11 LONG-TERM FUNCTIONAL OUTCOMES AFTER ARTIFICIAL URINARY SPHINCTER (AMS 800®) IMPLANTATION IN FEMALE NEUROGENIC PATIENTS WITH STRESS URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-11 LONG-TERM FUNCTIONAL OUTCOMES AFTER ARTIFICIAL URINARY SPHINCTER (AMS 800®) IMPLANTATION IN FEMALE NEUROGENIC PATIENTS WITH STRESS URINARY INCONTINENCE Véronique Phé, Priscilla Léon, Benjamin Granger, Morgan Rouprêt, Pierre Denys, Marc-Olivier Bitker, and Emmanuel Charttier-Kastler Véronique PhéVéronique Phé More articles by this author , Priscilla LéonPriscilla Léon More articles by this author , Benjamin GrangerBenjamin Granger More articles by this author , Morgan RouprêtMorgan Rouprêt More articles by this author , Pierre DenysPierre Denys More articles by this author , Marc-Olivier BitkerMarc-Olivier Bitker More articles by this author , and Emmanuel Charttier-KastlerEmmanuel Charttier-Kastler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment of stress urinary incontinence (SUI) due to sphincter deficiency in neurogenic patients remains a real therapeutic challenge. There is no other treatment except surgery. Artificial urinary sphincter (AUS) is the last resort treatment of female SUI due to sphincter deficiency. Data are scarce regarding the long-term functional outcomes of AUS among female neurogenic patients. Our objective was to report the long-term functional outcomes of AUS implanted in female neurogenic patients suffering from SUI due to sphincter deficiency. METHODS Female neurogenic patients suffering from SUI due to sphincter deficiency and undergoing AUS (AMS 800®) implantation between 1986 and 2010 were included. Continence defined as no need for pads was assessed at the end of the follow-up. Kaplan–Meier survival curves estimated the survival rate of the device without needing explantation or revision. RESULTS Overall, 26 consecutive patients were included with a median age at surgery of 49.2 years (IQR 28.5-59.7). Among them, 23 had a spinal cord injury (all paraplegic) and 3 were spina bifida. Patients' baseline characteristics, types of devices implanted and postoperative complications are shown in table 1. The median follow-up was 7.5 years (IQR 3.9-23.8). The flowchart in figure 1 shows outcomes of the implanted devices. At the end of follow-up, 15 patients (57.7%) still had their primary AUS. The AUS was explanted in four women because of infection. Survival rates, without AUS explantation were 90%, 84%, 84% and 74% at 5, 10, 15, 20 years respectively. Survival rates without AUS revision were 75%, 51%, 51% and 51% at 5, 10, 15, 20 years respectively. At last follow-up, 71% of patients were continent. CONCLUSIONS In the long term, the AMS 800® can offer a high rate of continence to female neurogenic patients with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e204-e205 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Véronique Phé More articles by this author Priscilla Léon More articles by this author Benjamin Granger More articles by this author Morgan Rouprêt More articles by this author Pierre Denys More articles by this author Marc-Olivier Bitker More articles by this author Emmanuel Charttier-Kastler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...