Neurogenic Stress Urinary Incontinence Research Articles

Management of Neurogenic Stress Urinary Incontinence: An Updated Review

Management of Neurogenic Stress Urinary Incontinence: An Updated Review

Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach

BackgroundPeriprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). ObjectiveTo describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). Design, setting, and participantsData of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. Surgical procedureThirty-three patients underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. MeasurementsOutcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision–free survival (SRFS). Results and limitationsRApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150–210] min vs OpAUSi: 245 [228–300] min; p < 0.001), estimated blood loss (RApAUSi: 20 [0–50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4–6] d vs OpAUSi: 11 [10–14] d; p < 0.001). Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014). Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500). The median follow-up periods were 118 (50–183) and 56 (25–84) mo for OpAUSi and RApAUSi, respectively (p < 0.001). A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature. ConclusionsRApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery. Patient summaryCompared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.

Functional outcomes of mid-urethral tapes in female neurogenic stress and mixed urinary incontinence: A single centre experience

Study design:Retrospective Objectives:To evaluate the mid-term urodynamic and clinical efficacy of mid-urethral synthetic sling (MUS) in females with neurogenic stress urinary incontinence (N-SUI) or neurogenic mixed urinary incontinence (N-MUI). Materials and methods:Between January and April 2021, we conducted a retrospective review of all adult neurological women with clinically and urodynamically proven N-SUI or N-MUI who were treated with retropubic (TVT) or transobturator (TOT) tension free vaginal tape. The outcomes were recorded in a database over a 14-year period.The primary objective outcome measure was the absence of any N-SUI episodes at 3 days Bladder Diary (BD). A Patient Global Impression of Improvement (PGI-I) score ≤ 2 was a secondary endpoint for subjective success. Objective failure was defined as the detection of stress urinary incontinence during follow-up urodynamics. Results:Twenty-three women out of 65 were included. Mean follow-up was 72.2 ± 45.6 months. TVT was placed in 17/23 patients (74%) who were previously managed by intermittent catheters (IC) and TOT in those 6/23 women (26%) who spontaneously voided at baseline.Dryness at 3 days BD was observed in 12/23 patients (52%). Twenty patients (86%) reported subjective benefits (mean PGI-I 1.4 ± 0.62), of whom eleven (55%) were extremely satisfied (PGI-I = 1).Objective failure was documented in 2/23 women (8%) after surgery. Two patients shifted from IC to indwelling catheter during follow-up (respectively 6 and 8 years after surgery). De novo neurogenic detrusor overactivity was observed in two women at 3 months follow-up. No statistical differences were observed in cystometric parameters comparing baseline to follow-up. Conclusion:To the best of our knowledge, this is the first study confirming the clinical efficacy and urodynamic safety over a 5-year follow-up, for N-MUI as well. According to our results both TOT and TVT can be used to treat women with N-SUI with or without concomitant NDO. The choice between the two procedures depended on baseline bladder management.

MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER?

You have accessJournal of UrologyCME1 Apr 2023MP71-09 WHICH REVISION STRATEGY IS THE BEST FOR NON-MECHANICAL FAILURE OF MALE ARTIFICIAL URINARY SPHINCTER? Tiffany Cousin, Benoit Peyronnet, Imad Bentellis, Sami Lasri, Fayek Taha, Nicolas Hermieu, Adrien Boileau, Augustin Zelmar, Clément Ciolek, Alexandre Dubois, Priscilla Léon, Jean-Francois Hermieu, Thibault Brierre, Xavier Gamé, Thibault Tricard, Christian Saussine, Pierre Lecoanet, Adrien Vidart, Franck Bruyère, Jean-Nicolas Cornu, Hervé Monsaint, Xavier Biardeau, and Grégoire Capon Tiffany CousinTiffany Cousin More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Imad BentellisImad Bentellis More articles by this author , Sami LasriSami Lasri More articles by this author , Fayek TahaFayek Taha More articles by this author , Nicolas HermieuNicolas Hermieu More articles by this author , Adrien BoileauAdrien Boileau More articles by this author , Augustin ZelmarAugustin Zelmar More articles by this author , Clément CiolekClément Ciolek More articles by this author , Alexandre DuboisAlexandre Dubois More articles by this author , Priscilla LéonPriscilla Léon More articles by this author , Jean-Francois HermieuJean-Francois Hermieu More articles by this author , Thibault BrierreThibault Brierre More articles by this author , Xavier GaméXavier Gamé More articles by this author , Thibault TricardThibault Tricard More articles by this author , Christian SaussineChristian Saussine More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , Adrien VidartAdrien Vidart More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , Hervé MonsaintHervé Monsaint More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , and Grégoire CaponGrégoire Capon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Persistence or recurrence of stress urinary incontinence (rSUI) after artificial urinary sphincter (AUS) implantation may be secondary to mechanical failure (MECA), whose management is standardized, or to non-mechanical failure (NOMECA). In NOMECA, rSUI have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. The primary endpoint was the complete continence status three months after revision for NOMECA. Secondary outcomes were complications, explantation-free and reoperation-free survivals. METHODS: NOMECA was defined as persistence or recurrence of stress urinary incontinence (SUI), with normally functioning device, no erosion, infection or loss of fluid in the pressure regulating balloon. The exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revision for NOMECA including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), 3 increasing balloon pressure (BALLOON-UP) were performed in 10 centers. The BALLOON-UP patients were not included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were then categorized in complete vs. partial change of the device. RESULTS: The three-month complete continence rates was 70,8% with a statistically significant difference between RELOC (100%) and DOWNSIZING (69.5%) (p=0.04). Complete change of the device was significantly associated with complete continence status at three months (83.3% vs. 63.3%; p=0.01) even in multivariate analysis (OR=2.7; CI95%:1.1-7.1; p=0.03). Complication rate at 30 days was very low (0.01%). Median follow up was 80 months. For the whole cohort, estimated 5-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9%, with no significant difference between groups (p=0.16; p=0.30). Estimated five-year explantation-free and reoperation-free survivals were significantly longer in the complete AUS change group (82.2% vs. 69.6%; p=0.03; 71.2% vs. 58.2%; p=0.047). CONCLUSIONS: AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff on the urethra. Change of all AUS components may improve functional outcomes, explantation-free and reoperation-free survivals. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1017 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tiffany Cousin More articles by this author Benoit Peyronnet More articles by this author Imad Bentellis More articles by this author Sami Lasri More articles by this author Fayek Taha More articles by this author Nicolas Hermieu More articles by this author Adrien Boileau More articles by this author Augustin Zelmar More articles by this author Clément Ciolek More articles by this author Alexandre Dubois More articles by this author Priscilla Léon More articles by this author Jean-Francois Hermieu More articles by this author Thibault Brierre More articles by this author Xavier Gamé More articles by this author Thibault Tricard More articles by this author Christian Saussine More articles by this author Pierre Lecoanet More articles by this author Adrien Vidart More articles by this author Franck Bruyère More articles by this author Jean-Nicolas Cornu More articles by this author Hervé Monsaint More articles by this author Xavier Biardeau More articles by this author Grégoire Capon More articles by this author Expand All Advertisement PDF downloadLoading ...

Neurogenic stress urinary incontinence management. From past to recent techniques: What have we learnt?

Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.

9 - Mid-urethral sling compared to urethral bulking in female neurogenic stress urinary incontinence

9 - Mid-urethral sling compared to urethral bulking in female neurogenic stress urinary incontinence

PD24-08 ROBOT ASSISTED BLADDER NECK ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN NEUROLOGICAL MALE PATIENTS: PRELIMINARY RESULTS

You have accessJournal of UrologyCME1 May 2022PD24-08 ROBOT ASSISTED BLADDER NECK ARTIFICIAL URINARY SPHINCTER IMPLANTATION IN NEUROLOGICAL MALE PATIENTS: PRELIMINARY RESULTS Benoit Peyronnet, Thibault Tricard, Thibaut Brierre, Juliette Hascoet, Thomas Prudhomme, Baptiste Poussot, Andrea Manunta, Evelyne Castel-Lacanal, Christian Saussine, and Xavier Gamé Benoit PeyronnetBenoit Peyronnet More articles by this author , Thibault TricardThibault Tricard More articles by this author , Thibaut BrierreThibaut Brierre More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Thomas PrudhommeThomas Prudhomme More articles by this author , Baptiste PoussotBaptiste Poussot More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , Evelyne Castel-LacanalEvelyne Castel-Lacanal More articles by this author , Christian SaussineChristian Saussine More articles by this author , and Xavier GaméXavier Gamé More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002566.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In neurological male patients, implanting the artificial urinary sphincter (AUS) cuff at the bladder neck is an option aiming to decrease the risk of erosion. The robotic approach may decrease the morbidity of bladder neck AUS implantation but only scant evidence exist. The aim of this study was to report the preliminary results of robot-assisted bladder neck AUS implantation in male patients with neurogenic stress urinary incontinence (SUI) METHODS: The charts of all male patients with spina bifida (SB) or spinal cord injury (SCI) who underwent a primary robotic bladder neck AUS implantation at three academic centers between 2011 and 2020 were retrospectively reviewed. The procedure was performed with the Da-Vinci robot (Si and Xi) using a four arm transperitoneal approach. The primary endpoint was continence at 3 months and at the last follow-up categorized as: complete continence (0 pads), improved SUI, unchanged SUI, or worsened SUI. Patient characteristics, perioperative outcomes, and follow-up data were also collected. RESULTS: Eleven patients were included over the study period: 7 SCI and 4 SB. The median age was 40 years. One patient had a supra-trigonal cystectomy with concomitant robot-assisted augmentation cystoplasty. The median length of hospitalization was 4 days. There were 2 post-operative complications (33.3%): one Clavien 3 and one Clavien 4. After a median follow-up of 14 months, only one explantation was required (16.7%) due to early AUS infection in the patient who had a concomitant augmentation cystoplasty. Three patients underwent device revision at 4, 7 and 12 months respectively for pump repositioning (n=1) and early recurrence of SUI with cuff downsizing in the two later cases. At 3 months and at the last follow-up, four patients had recovered complete continence (36.4%), 6 patients had improvement in SUI (54.5%) and one patient had unchanged incontinence (9%). CONCLUSIONS: In this preliminary experience, robot-assisted bladder neck AUS implantation for neurogenic SUI yielded interesting results. The functional outcomes were satisfactory but the high rate of early revisions, already reported in the literature (Hervé, BMJ case report 2017), should prompt further evaluation in the upcoming years. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e418 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet More articles by this author Thibault Tricard More articles by this author Thibaut Brierre More articles by this author Juliette Hascoet More articles by this author Thomas Prudhomme More articles by this author Baptiste Poussot More articles by this author Andrea Manunta More articles by this author Evelyne Castel-Lacanal More articles by this author Christian Saussine More articles by this author Xavier Gamé More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study.

To evaluate the impact of an history of radiation therapy on the outcomes of artificial urinary sphincter (AUS) implantation in male patients. The charts of all patients who underwent AUS implantation for stress urinary incontinence (SUI) after prostate surgery in thirteen centers between 2004 and 2020 were retrospectively reviewed. We excluded patients with neurogenic SUI. Continence rates and incidence of complications, revision and cuff erosion were evaluated. The outcomes in irradiated men were compared to those of non irradiated men. A total of 1277 patients who had an AUS met the inclusion criteria with a median age of 70 years, of which 437 had an history of prior radiotherapy. There was no difference in comorbidities. In irradiated patients, postoperative social continence, urethral atrophy and infection rates were respectively 75.6%, 2.4% and 9.5% and 76.8%, 5.4%, and 5.8% in nonirradiated men (respectively, p = 0.799, p = 0.128, p = 0.148). There were more urethral erosion in irradiated male patients. After a mean follow up of 36.8 months, the explantation free survival was poorer in irradiated patients (p = 0.001). These data suggest that pelvic radiotherapy before AUS adversely affect device survival with and increased greater occurrence of infection-erosion and therefore of explantation.

PD04-02 PREVALENCE AND RISK FACTORS OF ARTIFICIAL URINARY SPHINCTER REVISION IN NON-NEUROLOGICAL MALE PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-02 PREVALENCE AND RISK FACTORS OF ARTIFICIAL URINARY SPHINCTER REVISION IN NON-NEUROLOGICAL MALE PATIENTS Imad Bentellis, Mehdi El Akri, Jean-Nicolas Cornu, Thibaut Brierre, Tiffany Cousin, Victor Gaillard, Baptiste Poussot, Hugo Dupuis, Thibaut Tricard, Nicolas Hermieu, Damien Robin, Alice Pitout, Florian Beraud, Bertrand-Leon Priscilla, Daniel Chevallier, Frank Bruyère, Xavier Biardeau, Hervé Monsaint, Luc Corbel, Jean-François Hermieu, Pierre Lecoanet, Grégoire Capon, Xavier Game, Christian Saussine, Matthieu Durand, and Benoit Peyronnet Imad BentellisImad Bentellis More articles by this author , Mehdi El AkriMehdi El Akri More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu More articles by this author , Thibaut BrierreThibaut Brierre More articles by this author , Tiffany CousinTiffany Cousin More articles by this author , Victor GaillardVictor Gaillard More articles by this author , Baptiste PoussotBaptiste Poussot More articles by this author , Hugo DupuisHugo Dupuis More articles by this author , Thibaut TricardThibaut Tricard More articles by this author , Nicolas HermieuNicolas Hermieu More articles by this author , Damien RobinDamien Robin More articles by this author , Alice PitoutAlice Pitout More articles by this author , Florian BeraudFlorian Beraud More articles by this author , Bertrand-Leon PriscillaBertrand-Leon Priscilla More articles by this author , Daniel ChevallierDaniel Chevallier More articles by this author , Frank BruyèreFrank Bruyère More articles by this author , Xavier BiardeauXavier Biardeau More articles by this author , Hervé MonsaintHervé Monsaint More articles by this author , Luc CorbelLuc Corbel More articles by this author , Jean-François HermieuJean-François Hermieu More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Xavier GameXavier Game More articles by this author , Christian SaussineChristian Saussine More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , and Benoit PeyronnetBenoit Peyronnet More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the prevalence and risk factors of male AUS mechanical failures and non-mechanical failures. METHODS: The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations for infections and/or erosions. Causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), non-mechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and non-mechanical failures were determined by Cox proportional hazards model. RESULTS: Overall 1020 patients had a median follow-up of 20 months (Table 1A, 1B), the estimated 5-year and 10-year revision free survival were 60% and 40% (Figure 1A). There were 214 AUS revisions: 59 (27,6%) for mechanical failures, 121 (56,5%) for non-mechanical failures and 34 (15,8%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01-1.07]; p=0.01) and revision for non-mechanical failure (HR=1.05 [1.02-1.09]; p=0.004) (Table 1C). CONCLUSIONS: Half of male AUS patients undergo device revision over the first ten years after implantation. Non-mechanical failures are the primary cause of AUS revision in non-neurological men. Larger cuff size appears to be the main determinant of AUS revision’s risk. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e49-e50 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Imad Bentellis More articles by this author Mehdi El Akri More articles by this author Jean-Nicolas Cornu More articles by this author Thibaut Brierre More articles by this author Tiffany Cousin More articles by this author Victor Gaillard More articles by this author Baptiste Poussot More articles by this author Hugo Dupuis More articles by this author Thibaut Tricard More articles by this author Nicolas Hermieu More articles by this author Damien Robin More articles by this author Alice Pitout More articles by this author Florian Beraud More articles by this author Bertrand-Leon Priscilla More articles by this author Daniel Chevallier More articles by this author Frank Bruyère More articles by this author Xavier Biardeau More articles by this author Hervé Monsaint More articles by this author Luc Corbel More articles by this author Jean-François Hermieu More articles by this author Pierre Lecoanet More articles by this author Grégoire Capon More articles by this author Xavier Game More articles by this author Christian Saussine More articles by this author Matthieu Durand More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement Loading ...

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 ...

Outcomes of robot-assisted urinary sphincter implantation for male neurogenic urinary incontinence.

To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation (R-AUS) in men with neurogenic stress urinary incontinence (SUI). A monocentric retrospective study included all consecutive adult male neuro-urological patients who underwent R-AUS for SUI between January 2011 and August 2018. The AUS was implanted via a transperitoneal robot-assisted laparoscopic approach. Intraoperative and early postoperative complications were reported (Clavien-Dindo classification). Continence was defined as no pad usage. Revision and explantation rates were also evaluated. Overall, 19 men with a median (interquartile range [IQR]) age of 45 (37-54) years were included. No conversion to laparotomy was needed. Three minor (Clavien-Dindo Grade I-II) early postoperative complications occurring in three (15.8%) patients were reported. The median (IQR) follow-up was 58 (36-70) months. At the end of the follow-up, the continence rate was 89.5%. The AUS revision and explantation rates were 5.3% and 0%, respectively. A R-AUS is a safe and efficient procedure for AUS implantation in adult male neuro-urological patients, referring to the challenging open technique.

Prevalence and Risk Factors of Artificial Urinary Sphincter Revision in Nonneurological Male Patients.

The main objective of this study was to assess the prevalence and risk factors of male artificial urinary sphincter (AUS) mechanical failures and nonmechanical failures. The charts of all male patients who underwent AUS implantation between 2004 and 2020 in 16 centers were retrospectively reviewed. Patients with neurogenic stress urinary incontinence (SUI) were excluded as well as revisions/explantations due to infections and/or erosions. The causes of revision were divided into mechanical failures (fluid loss or malfunction from any components of the AUS), nonmechanical failures (urethral atrophy, recurrence/persistence of SUI despite normally functioning device) and other (pump malposition, balloon herniation, hematoma, pain). Failure-free survival analysis was performed both for general and specific causes of revision. Predictors of mechanical and nonmechanical failures were determined by Cox proportional hazards model. A total of 1,020 patients met the inclusion criteria. After a median followup of 20 months, the estimated 5-year and 10-year overall revision-free survival was 60% and 40%, respectively. There were 214 AUS revisions: 59 (27.6%) for mechanical failures, 121 (56.5%) for nonmechanical failures and 34 (15.9%) other causes of revision. In multivariable Cox regression analysis, larger cuff size was the only predictor of overall revisions (HR=1.04 [1.01-1.07]; p=0.01) and revision for nonmechanical failure (HR=1.05 [1.02-1.09]; p=0.004). Half of the male AUS patients underwent device revision within the first 10 years after implantation. Nonmechanical failures are the primary cause of AUS revision in nonneurological men. Larger cuff size appears to be the main determinant of AUS revision risk.

P0307 - Efficacy and safety of surgical treatments for neurogenic stress urinary incontinence in adults: A systematic review

P0307 - Efficacy and safety of surgical treatments for neurogenic stress urinary incontinence in adults: A systematic review

P0119 - Functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation for the treatment of adult male neurogenic stress urinary incontinence

P0119 - Functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation for the treatment of adult male neurogenic stress urinary incontinence

Therapeutic Efficacy of Urethral Sphincter Injections of Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence due to Intrinsic Sphincter Deficiency: A Proof-of-Concept Clinical Trial.

PurposeThe aim of this study was to investigate the efficacy of autologous platelet-rich plasma (PRP) in the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) refractory to medical treatment.MethodsThirty-five patients with SUI due to urodynamically proven ISD were prospectively enrolled. Five milliliters of PRP (2.5–5 times the platelet concentration in peripheral blood) was injected into the external sphincter at 5 sites; all patients received 4 injections at monthly intervals. The primary end-point was the change in SUI severity as assessed by a visual analogue scale (VAS of SUI). The secondary-endpoints were the Global Response Assessment score and changes in urodynamic parameters from baseline to 3 months after treatment.ResultsThe mean age of patients was 68.7±12 years; the median duration of SUI was 4 years. Five patients had neurogenic SUI, while 30 had nonneurogenic SUI (21 with postprostatectomy incontinence, 6 with previous radical cystectomy, and 3 with other etiologies). Complete dryness was achieved in 7 patients (20.0%) while moderate improvement was observed in 14 (40.0%). The mean VAS of SUI score decreased significantly from 6.57±1.89 to 3.77±2.41 after treatment. The abdominal leak point pressure (ALPP) increased significantly from 98.3±55.8 to 157.3±79.3 cm H2O. There was no increase of ALPP in neurogenic SUI and less increase of ALPP in patients with failed treatment outcomes. No perioperative adverse events or severe complications occurred.ConclusionsUrethral PRP injection is safe and effective in increasing urethral resistance and improving SUI. PRP could be an alternative treatment modality for male and female patients with moderate SUI due to nonneurogenic causes.

Current Use of the Artificial Urinary Sphincter in Adult Females.

The aim of the present report was to review the recent evidences regarding the use of artificial urinary sphincter (AUS) in adult females. While the excellent functional outcomes of AUS in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) have been reported for decades, its use has remained confidential in most countries likely due to its challenging implantation and inherent morbidity. Over the past few years, laparoscopic and, more recently, robotic techniques of AUS implantation in female patients have been described with promising perioperative outcomes. As a result, the use of AUS has increased in several countries. The indications are mostly recurrent or persistent SUI after previous anti-incontinence procedures and neurogenic SUI. Owing to its unique potential to restore continence while maintaining low outlet resistance during the voiding phase, AUS may be of special interest in female patients with detrusor underactivity. High level of evidence data from trials which are underway, along with developments in robotic surgery and technological refinements of the device, may well, almost 50years after its introduction, give to the AUS its momentum as a major contributor in the female SUI armamentarium. While the use of AUS in female patients has been restricted to some countries and a few high-volume centers, it has started spreading again over the past few years, thanks to the rise of minimally invasive approaches which facilitate its implantation, and this is yielding promising outcomes.

SC331 - First Italian experience with ATOMS system implant in neurogenic stress urinary incontinence

SC331 - First Italian experience with ATOMS system implant in neurogenic stress urinary 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.

First experience with ATOMS system implant in neurogenic stress urinary incontinence.

To evaluate efficacy and safety of ATOMS implant in neurogenic patients with stress incontinence performing clean intermittent catheterization (CIC). We included all patients with neurogenic sacral/subsacral lesion and stress urinary incontinence, treated with ATOMS implant between January 2018 and March 2019. All patients received anamnesis, 24-hour pad test and pad count, physical examination, video urodynamic evaluation, Qualiveen questionnaire. All patients were followed up at 12 months after implantation. Patients were considered "continent" when dry or when wearing a security pad (social continence). We treated eight male patients with a median age of 25 years, four affected by myelomeningocele, and four by cauda equine syndrome. The median preoperative 24-hour pad test was 225 g (interquartile range [IQR]: 180-275). During the surgical procedure, we did not fill the cushion to prevent postoperative urethral injuries when performing CIC in the early postoperative time. At a 12-month follow-up, we had a significant reduction in postoperative 24-hour pad test (median value: 7.5 g; IQR: 0-16.25; P < .05). All patients reached continence. We had a significant reduction in the Qualiveen scores (P < .05). Patients demonstrated to be satisfied with the results of the intervention at the PGI-I questionnaire. The only complications were four cases of temporary scrotal edema (Clavien-Dindo 1) treated with conservative therapy. All patients resumed CIC without urethral traumatism nor catheter insertion difficulties. We had no cases of device infection nor device removal. Implantation of ATOMS device seems to be an effective and safe minimally invasive procedure also in neurological patients with a low rate of postoperative complications.

MP60-03 THE EFFECTIVENESS AND SAFETY OF SURGICAL PROCEDURES FOR STRESS URINARY INCONTINENCE IN PATIENTS WITH NEUROGENIC STRESS INCONTINENCE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (MP60)1 Apr 2020MP60-03 THE EFFECTIVENESS AND SAFETY OF SURGICAL PROCEDURES FOR STRESS URINARY INCONTINENCE IN PATIENTS WITH NEUROGENIC STRESS INCONTINENCE Min Soo Choo*, Bahaa Malaeb, John Park, Paholo Barboglio-Romo, J Quentin Clemens, Anne Cameron, and John T Stoffel Min Soo Choo*Min Soo Choo* More articles by this author , Bahaa MalaebBahaa Malaeb More articles by this author , John ParkJohn Park More articles by this author , Paholo Barboglio-RomoPaholo Barboglio-Romo More articles by this author , J Quentin ClemensJ Quentin Clemens More articles by this author , Anne CameronAnne Cameron More articles by this author , and John T StoffelJohn T Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000929.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the effectiveness and safety of 3 surgical procedures (Artificial Urinary Sphincter, Suburethral Sling, Urethral Bulking agents) for treating stress urinary incontinence in patients with neurogenic lower urinary tract dysfunction. METHODS: We used CPT and ICD-9 codes between 2012 – 2019 to identify patients with neurogenic bladder dysfunction who underwent urethral bulking injection (UBI), sling, or artificial urethral sphincter (AUS) for treatment of stress urinary incontinence (SUI). Failure of procedure was defined as stress incontinence > 50% from pre operative baseline (pad number, review of symptoms) at any follow up visit and/or additional surgical intervention for SUI. Time to failure was compared between procedures and risk factors for failure assessed. RESULTS: Of the consecutive 1138 patients reviewed, 68 procedures in 51 patients (37 male) with neurogenic SUI were included. There were 39, 15, and 14 cases of UBI, sling, and AUS, respectively. The median age was 37 years (IQ: 15-56). Spinal cord injury and spina bifida were the most common diagnoses (33 patients). The median follow-up was 256 days (IQ: 108-717). AUS had the longest failure free interval, followed by sling, and UBI (Figure 1). AUS had 46% failure rate at 2700 days post implantation and sling and UBI had 50% failure rates at 760 and 369 days, respectively (log-rank, p = 0.037). Age< 19 years was a significant factor for failure of any procedure in multivariable analysis (OR 0.088, p=0.020). Failure was particularly prevalent in patients < age 19 treated with UBI (90% failure). Sex and cause of neurogenic bladder were not associated with failure. No Clavien IV-V complications were noted in any procedure and there were no differences in overall complication rates. CONCLUSIONS: Neurogenic stress incontinence can be safely treated with artificial urinary sphincter, sling or bulking agent. Artificial sphincter had the longest failure free interval and urethral bulking agents demonstrated the most rapid time to failure. Since the durability is different between each procedure, shared decision making between patient and physician is necessary to match expectations and outcomes. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e889-e890 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Min Soo Choo* More articles by this author Bahaa Malaeb More articles by this author John Park More articles by this author Paholo Barboglio-Romo More articles by this author J Quentin Clemens More articles by this author Anne Cameron More articles by this author John T Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...