Artificial Urinary Sphincter Removal Research Articles

MP78-18 PRESSURE REGULATING BALLOONS LOSE PRESSURE AND ELASTICITY IN A TIME-DEPENDENT MANNER

You have accessJournal of UrologyCME1 Apr 2023MP78-18 PRESSURE REGULATING BALLOONS LOSE PRESSURE AND ELASTICITY IN A TIME-DEPENDENT MANNER Kevin Krughoff, Jordan Foreman, and Andrew Peterson Kevin KrughoffKevin Krughoff More articles by this author , Jordan ForemanJordan Foreman More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Artificial Urinary Sphincter (AUS) relies on an elastic pressure regulating balloon (PRB) to generate urethral closure pressure. Reports suggest that material fatigue may be a common driver of device replacement. Our objective was to characterize the nature of material fatigue. METHODS: We compared the pressure and elasticity characteristics of new and used 61-70cmH20 PRBs extracted during AUS removal or replacement surgeries. Pressure-volume curves were generated using commercially available urodynamics equipment in a standardized fashion. PRB pressures were measured at 23cc (standard fill volume) and 30cc (overfill volume). Elastance was calculated by the slope of the tangent line at the inflection point of the pressure-volume curve. Tests were repeated 5 times per PRB and intraclass correlations were used to gauge test-retest reliability. Regression models were used for continuous variables based on data distribution. RESULTS: PRBs from 15 consecutive AUS removal or revision cases were tested. Indications included fluid leak at the cuff (7), sub-cuff atrophy (4) and erosion (4). Time to removal ranged from 0.5 to 16.5 years (mean 7.8±4.7). The mean pressure of all extracted PRBs was 62.2cmH2O (± 4.8) with 7 (46.7%) PRBs below the standard operating range (56-60cmH2O). Each year of PRB use was associated with 0.63cmH20 pressure loss on linear regression (p<0.01 CI -1.04 to -0.22). Pressures were no different whether removed for atrophy (62.8±4.4), cuff fluid leak (60.3±3.1) or erosion (65.0±7.0) (p=0.13). Loss of elastance was non-linear, declining at a rate of approximately 5% per year on Poisson regression (p<0.01, CI -0.07 to -0.03). When compared to pressures generated at standard fill volumes, PRBs less than 1 year old lost pressure when overfilled to 30cc whereas older PRBs gained pressure when overfilled in linear fashion (+1.19cmH20 per year, p<0.01, CI 0.96 to 1.422). The oldest PRB (16 years) exhibited the lowest elasticity and greatest increase in pressure when overfilled (+21cmH2O), while the youngest PRB (0.02 years) exhibited the highest elasticity and lost pressure (-3cmH2O) when overfilled. CONCLUSIONS: In this small series of PRBs tested ex-vivo for pressure-volume characteristics, increasing PRB age was associated with decreased pressure, decreased elasticity and increased pressure when overfilled. These findings have implications for single-component replacement in older devices. The relationship between loss of elasticity and recurrent stress incontinence deserves further investigation. Source of Funding: Boston Scientific Fellowship Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1139 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Krughoff More articles by this author Jordan Foreman More articles by this author Andrew Peterson More articles by this author Expand All Advertisement PDF downloadLoading ...

PD35-01 ARTIFICIAL URINARY SPHINCTER DEVICES HARBOR MICROBIAL BIOFILMS THAT RECONSTITUTE DIFFERENTIALLY IN VITRO BY STRAIN AND MEDICAL DEVICE MATERIAL TYPE

You have accessJournal of UrologyCME1 Apr 2023PD35-01 ARTIFICIAL URINARY SPHINCTER DEVICES HARBOR MICROBIAL BIOFILMS THAT RECONSTITUTE DIFFERENTIALLY IN VITRO BY STRAIN AND MEDICAL DEVICE MATERIAL TYPE Glenn Werneburg, Daniel Hettel, Ava Adler, Kenneth Angermeier, Hadley Wood, Sandip Vasavada, Howard Goldman, Raymond Rackley, Bradley Gill, Daniel Shoskes, and Aaron Miller Glenn WerneburgGlenn Werneburg More articles by this author , Daniel HettelDaniel Hettel More articles by this author , Ava AdlerAva Adler More articles by this author , Kenneth AngermeierKenneth Angermeier More articles by this author , Hadley WoodHadley Wood More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Howard GoldmanHoward Goldman More articles by this author , Raymond RackleyRaymond Rackley More articles by this author , Bradley GillBradley Gill More articles by this author , Daniel ShoskesDaniel Shoskes More articles by this author , and Aaron MillerAaron Miller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) is an effective surgical treatment for stress urinary incontinence, and about 9% of AUS devices require removal due to infection. We sought to determine microbial biofilm and metabolite composition on AUS devices, reconstitute biofilms from microbes isolated from indwelling AUSs in an environment mimicking human tissue, and compare their formation across strains and medical material types. We hypothesized AUSs would harbor unique bacterial and metabolite profiles, and that reconstitution of biofilms in vitro may lead to new strategies to prevent device-associated infection. METHODS: Devices from consented patients scheduled for AUS removal or revision were swabbed for biofilm. Samples and controls were subjected to next-generation sequencing, metabolomics, and culture-based approaches. Bacterial isolates were isolated from devices and grown in a continuous-flow stir-tank bioreactor designed to mimic human tissue with an indwelling medical device present, and biofilm-formation on medical device material types was assessed with plate-count assays and scanning electron microscopy. RESULTS: In the 17 analyzed devices, the most commonly detected phyla were Proteobacteria and Firmicutes. Diethanolamine (local anesthetic precursor), threonine-butyl-ester (precursor for peptide synthesis), 5-aminovaleric acid (bacterial metabolite of lysine; GABA agonist) were the most commonly detected metabolites. Microbes isolated from AUS devices consistently reconstituted biofilm in vitro, and biofilm deposition differed by both strain (Staphylococcus lugdunensis the greatest) and material type (polyurethane the greatest and titanium the least, ****p<0.0001). Micrococcus luteus, shown in the Figure 1, had intermediate biofilm overall, with silicone shown in the top micrograph and polyurethane on the bottom. CONCLUSIONS: AUS devices consistently harbored microbiota in the form of biofilms. Isolated strains reconstituted biofilm in vitro across a library of medical device materials. Biofilm formation differed by both strain and material type. Our methods and results open new avenues to screen for inhibitors of biofilm formation and novel medical device materials resistant to infection. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e974 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Glenn Werneburg More articles by this author Daniel Hettel More articles by this author Ava Adler More articles by this author Kenneth Angermeier More articles by this author Hadley Wood More articles by this author Sandip Vasavada More articles by this author Howard Goldman More articles by this author Raymond Rackley More articles by this author Bradley Gill More articles by this author Daniel Shoskes More articles by this author Aaron Miller More articles by this author Expand All Advertisement PDF downloadLoading ...

Does Medicaid cover artificial urinary sphincter and male urethral sling surgery?-a state-by-state analysis.

Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and male suburethral slings (MS) placement in the United States (US) is not readily available. In this manuscript, we seek to elucidate the state-by-state Medicaid coverage of these two procedures in the US. State Medicaid websites were utilized to access publicly available physician fee schedules for the calendar year 2020. Fee schedules were searched for current procedural terminology (CPT) codes. CPT codes representing insertion of tandem cuff, insertion of AUS, removal of AUS, removal and replacement AUS, sling operation for correction of male stress urinary incontinence (SUI), and removal or revision of sling for male SUI were utilized. Data were recorded by the procedure for each device, including the coverage status and physician fees. Of the 50 US states analyzed, 49 publish publicly accessible physician fee schedules. All 49 of these states reported coverage for removal with and without revision of the AUS, and 48 states reported coverage for insertion of an AUS, and insertion of a tandem cuff. The median reimbursement for each AUS related procedure was $624.00 ($181.84-$10,960.90) for tandem cuff, $665.54 ($199.89-$11,949.86) for AUS insertion, $528.03 ($146.90-$1,893.12) for AUS removal, and $630.29 ($208.55-$11,586.74) for AUS revision. All 49 states reported coverage for placement of MS, and 48 states reported coverage for removal or revision of MS. The median reimbursement was $652.57 ($198.00-$5,237.35) for MS placement and $554.47 ($104.27-$2,288.93) for MS revision. AUS and MS procedures in the Medicaid population are covered by nearly all states. Therefore, surgical treatment of SUI may be offered to Medicaid patients in most states without reimbursement concerns.

Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement

ObjectiveTo evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management. The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear. MethodsWe performed a retrospective review of all bulbar urethral AUS procedures at our institution. Inclusion criteria were patients with a history of prostate cancer treatment, AUS placement for SUI, and a history of CIC before and/or after AUS placement. All eligible cases were retrospectively reviewed. Surgical and continence outcomes were analyzed. ResultsA total of 57 patients were identified with a history of CIC and AUS placement under the care of two surgeons. Eighteen continued to perform CIC or first initiated CIC after AUS placement and 39 discontinued CIC prior to AUS placement. The incidence of erosion was no different amongst patients who continued or discontinued CIC after AUS placement (17.9% vs 22.2%, P = .79). There was no difference in future AUS removal or replacement (56.4% vs 44.4%, P = .41). Both groups experienced improvement in urinary incontinence after placement of an AUS. ConclusionBulbar AUS placement in the setting of continuous intermittent catheterization can be considered in patients who are not surgical candidates for definitive treatment of their outlet obstruction.

MP52-05 PRE-EXISTING DETRUSOR OVERACTIVITY LEADS TO EARLIER ARTIFICIAL URINARY SPHINCTER FAILURE AND NEED FOR REVISION

You have accessJournal of UrologyCME1 May 2022MP52-05 PRE-EXISTING DETRUSOR OVERACTIVITY LEADS TO EARLIER ARTIFICIAL URINARY SPHINCTER FAILURE AND NEED FOR REVISION Kevin Krughoff, and Andrew C. Peterson Kevin KrughoffKevin Krughoff More articles by this author , and Andrew C. PetersonAndrew C. Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) is the gold standard treatment for post-prostatectomy stress urinary incontinence. While clinical risk factors such as radiation exposure have been evaluated for erosion, bladder mechanics may play an unknown role in device longevity. We hypothesized that poor bladder mechanics such as detrusor overactivity (DO) are associated with the need for earlier surgical device revision. METHODS: A prospectively maintained, IRB approved institutional database was queried for CPT codes 53445-53449 spanning years 1997-2021. 2,243 encounters comprising 524 unique patient records were individually reviewed. Records with primary AUS removal or replacement, history of radical prostatectomy, baseline urodynamic study (UDS), voiding diary and pad weights were included for analysis. Results from cystoscopy and pelvic x-ray of the contrast-filled devices were reviewed to assess failure etiology. Multiple imputation of chained equations was performed for missing data elements. Variables with significant correlation on univariate analysis or strong theoretical association with AUS longevity were entered for Cox proportional hazards modeling. Partial correlation coefficients between variables were assessed for collinearity. RESULTS: Ninety-two records met criteria for analysis. The median time to intervention was 2070 days (823, 3442). Intervention was prompted by mechanical failure (41.8%), sub-cuff atrophy (38.8%), erosion (9.0%), infection (8.8%) or patient preference (1.5%). AUS longevity was associated with age (p=0.01), volume at strong sensation (p<0.01), capacity (p<0.01) and DO (p<0.01). On multivariate analysis, DO was significantly associated with time to intervention (HR = 2.03; 95% CI 1.24 – 3.36; p<0.01) when controlling for radiation history, BMI, diabetes and smoking status. No other clinical variables were associated with AUS longevity. CONCLUSIONS: In men with uncomplicated post-prostatectomy incontinence, the intervention rate for AUS removal or replacement is twice as high in men with pre-existing DO. Clinical characteristics typically related to tissue quality and healing potential were not significantly related to device longevity when accounting for bladder dynamics. Source of Funding: Boston Scientific Fellowship Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e887 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Krughoff More articles by this author Andrew C. Peterson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Preventing Urinary Fistulae After Artificial Urinary Sphincter Removal: Outcomes of a Standardized Protocol

ABSTRACT Introduction The artificial urinary sphincter (AUS) is the standard treatment for moderate to severe stress urinary incontinence in male patients. Despite their efficacy, the AUS is not without risk. Patients with an AUS are susceptible to complications such as mechanical failure, device infection, and urethral erosion. Erosion of the urethra can result in negative sequelae such as urethral stricture disease and urinary fistulae. Objective While there is no debate that patients presenting with urethral erosion require removal of the AUS, there is a lack of consensus on how to manage the patient in the perioperative period. We present our experience using a standardized surgical technique and perioperative protocol used at our institution to manage patients with an AUS presenting with urethral erosion. Methods Using an IRB-approved prosthetic database we completed a retrospective review of 97 patients who underwent AUS explantation between 2009 and 2020. Indications for removal, patient demographics, AUS component characteristics, and post-operative outcomes were analyzed. Patients undergoing AUS removal in the setting of urethral erosion were treated with a standardized protocol. Upon presentation, cystourethroscopy is performed to confirm erosion and to facilitate safe passage of a urethral catheter. With the urethral catheter in place, all AUS components are removed. After urethral cuff removal, urethrorraphy is performed. A 10-French surgical drain is placed through a separate stab incision and made to lie in the perineum and the wounds are closed in multiple layers. The urethral catheter is left in place for 4 weeks. After 4 weeks, physical examination and cystourethroscopy is performed to confirm repair of the urethra and the absence of fistula. Patients are seen monthly and are deemed eligible for reimplantation only after a minimum of 3 months have elapsed after explantation and the patient is deemed to have sufficient healthy urethra. Results No intraoperative complications occurred during AUS explantation. 117 patients underwent AUS removal during the study period. 94 (80.3%) patients had AUS removal due to urethral erosion. After median follow-up of 18.1 months (IQR 6.5 – 48.2) after AUS removal, there were a total 6 (4.0%) patients who developed a urethrocutaneous fistula with median time from AUS removal to fistula resolution of 6.5 months. Each patient with fistulae had presented with erosion of the urethra as indication for AUS removal. 67 (57.3%) patients underwent successful AUS reimplantation after removal with median time between explant and reimplant of 3.5 months (IQR3-4.8). Risk factors for urinary fistulae include urethral erosion, prior treatment with pelvic radiotherapy, and increasing age at time of AUS removal. Conclusions Urinary fistula can be prevented after urethral erosion with standardized surgical technique and peri-operative management in patients with an AUS. Disclosure No

325 Does Urethral Repair Prevent Complications from AUS Cuff Erosions? A Decade of Experience

Artificial Urinary Sphincter (AUS) cuff erosion occurs in 8.5% of cases and requires removal of the device.1 Management options include urethral catheter placement alone or in situ urethroplasty (ISU) at the time of explant. It has previously been reported that stricture rates are higher in patients managed with catheter placement alone versus ISU (85% v 35% respectively)2. To determine the stricture rate in patients who undergo ISU after AUS cuff erosion in a large tertiary referral practice. We performed a retrospective cohort study of patients who underwent AUS removal by a single surgeon, secondary to erosion, from January 2006 to June 2019. We identified those who were managed with ISU at the time of explant. The electronic medical records were reviewed for patient demographics, operative details, and development of stricture at follow up. The degree of urethral erosion was defined by percent of urethral circumferential defect noted intra-operatively or on pre-operative cystoscopy. Urethral patency was studied at follow up with voiding cystourethrogram, retrograde urethrogram or cystoscopy.

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

Sphincter urinaire artificiel robot chez la femme : début d’expérience

To analyze the medium-term results and complications of the artificial urinary sphincter (AUS) AMS 800 implanted using laparoscopic robot surgery in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). We conducted a prospective cohort study, which included all procedures done in the CHU of Nîmes from July 2015 to January 2017. Patients with SUI by ISD needing an AUS or patients with a malfunctioning AUS needing to be changed were included. We collected data on intraoperative complications, length of hospitalization, postoperative complications, continence rate at twelve months and satisfaction of patients. Nineteen patients were included, 10 for primo-implantation and 9 for AUS revision. There were 4 postoperative bladder injuries, of which 2 led to laparoconversions. The mean length of hospitalization was 4.1days. Three patients had postoperative complications, which needed an intervention without AUS removal. One patient with persisting SUI due to bladder weakness preferred AUS ablation rather than having a cuff change. There was a median follow-up of 22months (12 to 33months). Sixteen patients out of 19 were completely continent and were satisfied of their intervention and the improvement of their quality of life. The laparoscopic robot surgery for AUS implantation is safe and reproducible with good medium-term results. 4.

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

ObjectiveTo determine whether frailty is associated with increased odds of 30-day surgical complications among men undergoing both artificial urinary sphincter (AUS) placement and removal procedures and to determine whether frailty was associated with increased odds of having an AUS removal procedure. MethodsThis is a retrospective cohort study of men undergoing AUS placement and removal procedures using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2006 to 2013. Frailty was quantified using the NSQIP-FI (frailty index) and was applied to logistic regression models predicting 30-day complications (overall, major, and minor) and the odds of having an AUS removal procedure (over an AUS placement procedure). ResultsWe identified a total of 624 and 147 men undergoing AUS placement and removal procedures, respectively. NSQIP-FI of ≥0.27, but not age, was associated with major complications (aOR 3.5, 95% confidence interval 1.2-9.9), while age ≥85 years, but not NSQIP-FI, was associated with minor complications (aOR 7.9, 95% confidence interval 1.4-45.6). Men undergoing AUS removal procedures tended to be more frail compared to men undergoing AUS placement procedures (12.9% vs 6.1% had NSQIP-FI of ≥0.27, P<.01). ConclusionMen undergoing AUS removal procedures are, on average, more frail compared to men undergoing AUS placement procedures. Frailty is associated with increased odds of major complications and with having an AUS removal procedure. These findings highlight the importance of incorporating measures of frailty, instead of age alone, into the perioperative decision-making process for adults considering these types of procedures.

Review of Single-surgeon 10-Year Experience With Artificial Urinary Sphincter With Report of Sterile Cuff Erosion Managed Nonsurgically

To review our experience with artificial urinary sphincter (AUS) and to consider the role of nonsurgical management of sterile AUS cuff erosion. We retrospectively reviewed our 10-year experience with AUS implantation, including complication rates. We focus on the outcomes of eroded sphincters including 2 unique patients who were managed nonsurgically for sterile cuff erosion. Between 2002 and 2012, 126 AUS units were implanted in 79 adult male patients by single surgeon (A.K.S.). Twenty-five patients (31.6%) required at least 1 additional procedure because of urethral atrophy (22.8%) or erosion or infection (8.9%). In addition, 2 patients with congenital anomalies underwent AUS implantation at bladder neck and were followed up nonsurgically for several years after cuff erosion. Both refused surgical management and have since remained continent and infection-free despite chronic erosion for 15 years' duration in 1 patient and for 5 years' duration in the other. Of note, the patient with the longer duration of erosion developed bladder stones requiring surgical removal. Our AUS complication rates are consistent with those of prior series. Our unique experience with 2 patients suggests that immediate removal of AUS after sterile cuff erosion may occasionally be instituted only in difficult cases where repeat AUS implantation is not possible. To our knowledge, this is the first report of nonsurgical management of eroded AUS cuff in the literature. Larger prospective series concerning patient selection for salvaging eroded AUS may be warranted.

Editorial Comment

This is an unusual case study of 2 patients with cuff erosion who were managed conservatively despite artificial urinary sphincter (AUS) cuff erosion for 5-15 years. As the author points out, these patients are quite unique, and most likely this case study would not be applicable to the general population of AUS patients. Both patients had congenital anomalies with placement of the sphincters at the bladder neck for continence. In addition, they had difficult surgical anatomy, and AUS removal would potentially be devastating to their quality of life as they may not be able to undergo another surgery and be rendered incontinent. The majority of patients seen by urologists do not have medical problems of this severity and would be candidates for repeat AUS placement in the future. The author also notes that 1 patient did have a complication of bladder stone formation on the eroded sphincter requiring several operations to remove the stones, including 1 open stone removal. Nevertheless, the patient continued to refuse AUS removal despite these complications. Review of Single-surgeon 10-Year Experience With Artificial Urinary Sphincter With Report of Sterile Cuff Erosion Managed NonsurgicallyUrologyVol. 85Issue 1PreviewTo review our experience with artificial urinary sphincter (AUS) and to consider the role of nonsurgical management of sterile AUS cuff erosion. Full-Text PDF ReplyUrologyVol. 85Issue 1PreviewWe reviewed our longitudinal experience and complications with artificial urinary sphincter (AUS) implantation over a 10-year time frame in a relatively large cohort of patients. We focused on the unique and unusual experience of 2 patients who developed sterile cuff erosion, yet opted to avoid surgical explantation despite our recommendations otherwise. They continued to remain continent and free of infection for several years despite chronic AUS cuff erosion, prompting us to query the need for uniformly explanting the AUS after sterile cuff erosion. Full-Text PDF

Transcorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer

To investigate the transcorporal (TC) vs standard (ST) approach of artificial urinary sphincter (AUS) placement for incontinence after treatment of prostate adenocarcinoma (PCa) with radiotherapy or surgery, or both. A database was created to include the data from all patients who had undergone AUS placement from January 2000 to August 2005 at the University of California, San Francisco, Medical Center. We noted the demographic features, comorbidities, PCa therapy, technique for AUS placement, and postoperative outcome. The continence and failure rates were recorded for TC AUS placement in patients previously treated for PCa. A total of 30 patients underwent aus surgery during the study period: 26 for incontinence after PCa treatment. Of the 26 patients, 18 had undergone ST (ST group) and 8 had undergone TC (TC group) AUS placement, with a minimal follow-up of 12 months and a mean follow-up of 31 and 28 months, respectively. The 2 groups did not differ widely in age or comorbidities. Of the patients in the ST and TC groups, 44% and 50% had undergone external beam radiotherapy or brachytherapy and 78% and 100% had undergone radical prostatectomy, respectively. Of the patients in the ST and TC groups, 22% and 89% had undergone >or=2 types of urethral surgery before AUS placement, respectively. A total of 50% of TC group underwent TC placement without having undergone a previous sling or ST AUS procedure. The AUS removal rates were equivalent between the 2 groups at 2 years. Finally, the success rate for social continence was 69% and 81% for ST and TC group, respectively. The results of our study, with 2 years of follow-up, have shown that TC AUS placement is an effective salvage or primary incontinence treatment for high-risk patients after PCa therapy.

The outcome of artificial urinary sphincter placement after a mean 15-year follow-up in a paediatric population.

To evaluate the long-term outcome in children who had an artificial urinary sphincter (AUS) placed, after a minimum of 10 years of follow-up. The medical records of patients who had an AUS placed at the Children's Hospital of Michigan were reviewed and a telephone questionnaire was then completed by all patients with an AUS currently in place. Forty-seven children initially had an AUS placed between October 1978 and August 1986; medical records and follow-up were available for 32. After a mean follow-up of 15.4 years, 13 patients had had the AUS removed and 19 currently have an intact AUS. Erosion or infection was responsible for all AUS removals. Possible risk factors for AUS removal were prior AUS erosion, prior bladder neck surgery and a balloon pressure of >70 cmH2O. Eighteen of 19 patients with an intact AUS are dry and seven void volitionally. Revision was the most common reason for additional surgery, but the revision rate has decreased with the most current AS-800 model, to 0.03 revisions per patient-year. Of the 13 patients with an AS-800 model placed after 1987, nine have not required revision. Upper tract changes were mild and uncommon. The AUS is a durable and effective surgical option in the management of neurogenic urinary incontinence, and is the only reliable technique that can preserve volitional voiding. With technical improvements to the AUS and a longer follow-up, the revision rate has decreased. Causes of AUS removal may be preventable with improvements in surgical technique and patient selection. AUS placement should be considered as a first choice for the surgical management of neurogenic sphincteric incompetence.