Double Cuff Artificial Urinary Sphincter Research Articles

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort. Methods: 467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perineal double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal-Wallis rank sum test, and a multiple logistic regression model were used (p < 0.05). Results: Compared to perineal single-cuff AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perineal) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single-cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single-cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation. Conclusions: Providing data from a large contemporary multi-institutional patient cohort from high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates.

191 Complications and short-term explantation rate following single-cuff vs double-cuff artificial urinary sphincter implantation

191 Complications and short-term explantation rate following single-cuff vs double-cuff artificial urinary sphincter implantation

Impact of 3.5 cm Artificial Urinary Sphincter Cuff on Primary and Revision Surgery for Male Stress Urinary Incontinence

We report our initial clinical experience with the new 3.5 cm artificial urinary sphincter cuff. We reviewed the records of all men who underwent artificial urinary sphincter placement done by a single surgeon since September 2009. A perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement with a redesigned measuring tape. Clinical factors and cuff sizes were analyzed. During the 14-month study period 45 of 67 patients (67%) with an artificial urinary sphincter received the 3.5 cm cuff with no difference between primary and revision surgery (73% vs 58%, p = 0.29). Transcorporal cuff placement was reserved for 8 select patients (12%) after prior artificial urinary sphincter cuff erosion or complex urethroplasty. A tandem cuff artificial urinary sphincter was not used. Erectile dysfunction (89% vs 77%, p = 0.28) and prior radiation (47% vs 27%, p = 0.12) were more common in men who received a 3.5 vs a 4.0 cm or greater cuff. A similar proportion of men with a 3.5 cm vs a larger cuff (4 of 45 or 9% vs 2 of 22 or 9%) required explantation for infection and/or erosion. At our center the 3.5 cm cuff has become the predominant size used for primary and revision artificial urinary sphincter placement. Liberal use of the 3.5 cm cuff has simplified and improved artificial urinary sphincter placement without additional morbidity.

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.

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

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.

Comparison of outcomes after single or DOUBLE-CUFF artificial urinary sphincter insertion

Objectives To assess the effectiveness and complications associated with single and double-cuff artificial urinary sphincter (AUS) implantation for postprostatectomy stress urinary incontinence. Methods A retrospective study of 56 men with postprostatectomy stress urinary incontinence who underwent either single (28 patients) or double (28 patients) cuff AUS placement was performed. Patients in each cohort were matched on the basis of preoperative pad use, risk factors for complications, and age. Patient selection was blinded relative to outcome. Continence, quality of life, and complications were assessed using the Incontinence Impact Questionnaire Short Form (IIQ-7), postoperative pad use, and chart review. Results The mean age was 67 years for each group. Daily pad use decreased from 7.7 to 1.1 in patients treated with a single-cuff AUS and from 7.8 to 0.7 in patients with a double-cuff AUS ( P = 0.25). Complete continence (0 pads daily) was reported in 3 (11%) of 28 men with single-cuff and 12 (43%) of 28 men with double-cuff sphincters ( P = 0.008). The IIQ-7 scores improved from 14.8 to 3.1 after single-cuff placement and from 16.3 to 2.5 after double-cuff placement ( P = 0.03). With an average follow-up of 41.3 and 21.2 months for the single and double-cuff cohorts, respectively, five complications were reported in the single-cuff recipients and four in the double-cuff patients. Conclusions A significantly greater rate of complete continence and improvement in the IIQ-7 were seen in men with double-cuff AUS compared with single-cuff devices. Additional study is needed to confirm the relative advantages of double-cuff insertion.

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.

MANAGEMENT OF CUFF EROSION OF THE DOUBLE CUFF ARTIFICIAL URINARY SPHINCTER

We report on a series of patients with erosion of 1 cuff of an AMS800 double cuff artificial urinary sphincter and determine the success rate of removing the eroded cuff, leaving the other components behind and converting the device to a single cuff system. In 9 patients with a double cuff artificial sphincter 1 eroded cuff was removed and the system was converted to a single cuff sphincter. Followup was based on an incontinence scoring system. In 1 patient the remaining cuff was removed because it also eroded. In another patient a wound infection developed 5 months after placement and the entire device was removed. The remaining 7 patients had better continence scores than before artificial sphincter placement but each remarked that continence was better with 2 cuffs. An eroded cuff of a double cuff artificial urinary sphincter system can be successfully removed and the device can be converted to a single cuff system.

Addition of a Second Urethral Cuff to Enhance Performance of the Artificial Urinary Sphincter

Purpose Stress urinary incontinence may persist in approximately 15 percent of men following implantation of a standard artificial urinary sphincter. The ability of a second urethral cuff to provide satisfactory continence without additional operative complications was investigated. Materials and Methods A second urethral cuff was placed to enhance performance of the artificial urinary sphincter in 5 men with stress urinary incontinence following radical prostatectomy. A stainless steel 3-way tubing connector allowed for addition of a second cuff to the standard artificial urinary sphincter without the kinking problems previously observed with a flexible 3-way connector. In 4 consecutive men a second cuff was added at operative revision of an existing artificial urinary sphincter that had failed to produce satisfactory continence. A double cuff artificial sphincter was placed initially in 1 man. Results Of 5 men 4 had satisfactory and 1 had improved continence with the double cuff artificial urinary sphincter. The stainless steel 3-way tubing connector eliminated kinking complications. Conclusions Implantation of a second urethral cuff can provide satisfactory urinary continence in men with an artificial urinary sphincter and persistent incontinence. Placement of a double cuff artificial urinary sphincter may also represent appropriate initial intervention in men with significant stress urinary incontinence.

Erosion Rate of the Double Cuff AMS800 Artificial Urinary Sphincter: Long-Term Followup

Purpose We reviewed the erosion rate of the double cuff artificial urinary sphincter. Materials and Methods Charts of 95 patients were evaluated for erosions and underlying etiology. Results Ten patients had erosion of the cuffs, for an erosion rate of 10.5 percent. Of the 10 erosions 4 (40 percent) were secondary to iatrogenic injuries. Conclusions Addition of a second cuff to the artificial urinary sphincter remains a safe alternative for patients with severe urinary stress incontinence.

Long-term experience with the double-cuff AMS 800 artificial urinary sphincter

Objectives To assess the efficacy and safety of the double-cuff artificial urinary sphincter over a long-term period. Methods Ninety-five patient charts were reviewed from December 1986 to November 1995. Data on the degree of urinary incontinence and complications were compiled and tabulated. Results There were 10 cuff erosions (10.5%) and one infection (1.1 %) requiring removal of the double-cuff system, with one death from unrelated causes. Two patients in the erosion group had a double-cuff system reinserted at a later date. Eighty-six patients have a double-cuff system, with 97.6% remaining dry. Conclusions A tandemly placed double-cuff artificial urinary sphincter is safe and effective in the treatment of severe postprostatectomy urinary incontinence.