Outcomes Of Artificial Urinary Sphincter Research Articles

Artificial Urinary Sphincter Outcomes in the “Fragile Urethra”

To assess artificial urinary sphincter (AUS) outcomes in challenging post-prostatectomy patients with a "fragile urethra" at risk for urethral erosion. An institutional retrospective review of all AUS placements between August 2004 and March 2014 was performed. A "fragile urethra" was defined as a history of pelvic radiation, previous failed AUS, previous urethroplasty, or cystoscopic and/or clinical findings of urethral atrophy. The primary outcome was continence, defined as requiring ≤1 pad per day. Secondary outcomes included 90-day complications, need for further treatment, change in continence pads, and patient-reported satisfaction. Thirty patients were identified as having a "fragile urethra." Thirteen of these patients underwent a transcorporal AUS (TCAUS) and 17 had a standard AUS cuff placement. Seventeen patients had radiation, 8 had a previous eroded AUS, and 10 had a prior urethroplasty. Five patients had multiple risk factors for urethral erosion. Continence was achieved in 77% (23/30), 97% (29/30) were improved, and the mean change in pads was 6.0 ± 2.8. Only 7% (2/30) required explantation, both for erosion. When the TCAUS and standard AUS groups were compared, no differences were noted in continence rates (P = .43), improvement (P = 1.00), explantation rates (P = .18), or erosion rates (P = .18), despite TCAUS having a higher proportion of previous urethroplasties. AUS is a viable treatment option for post-prostatectomy incontinence, even in the fragile urethra. TCAUS may be utilized in patients with a very high risk for atrophy with similar continence and complication rates compared with standard AUS.

Long-term Artificial Urinary Sphincter Outcomes Following a Prior Rectourethral Fistula Repair

To determine the long-term outcomes of artificial urinary sphincter (AUS) implantation following a successful rectourethral fistula (RUF) repair. Between January 1, 2006 and January 1, 2012, a total of 26 patients underwent successful repair of an RUF. Stress urinary incontinence was treated in 6 patients (23%) with implantation of an AUS. Preoperative and postoperative evaluation included demographic variables, voiding diaries, 24-hour pad weight, urodynamic characteristics, operative time, estimated blood loss, complication rates, follow-up time, and cuff selection. All 6 patients underwent successful RUF repair using a perineal approach. Mean age was 64.3 years (range 58-74). Mean follow-up after repair was 51.5 months (range 34-64). RUF etiology included radical prostatectomy (4), brachytherapy + external beam radiotherapy (1), and cryotherapy + external beam radiotherapy (1). The median time between RUF repair and AUS placement was 12 months (range 2-41). No intraoperative complications occurred during AUS implantation. The average operative time was 61.8 minutes with an estimated blood loss of 24 mL. The initial cuff size selected was 4.0 or 4.5 cm, and no patient required transcorporal cuff placement. Pad use was reported as ≤1 pad per day in all 6 patients at the initial 3-month follow-up. Median follow-up after AUS placement was 43.5 months (5-55). No patient required revision or removal for mechanical complications, infection, or erosion. No patient had recurrence of their previously repaired RUF or new-onset fecal incontinence. Patients who require placement of an AUS after an RUF repair seem to fare just as well as patients who undergo primary AUS implantation with no increased rate of complications postoperatively.

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 ...

Does Pressure Regulating Balloon Location Make a Difference in Functional Outcomes of Artificial Urinary Sphincter?

We compared functional outcomes in patients who received an artificial urinary sphincter in the space of Retzius vs the same device placed at a high submuscular location. We reviewed a prospectively maintained database of patients who received an artificial urinary sphincter between July 2007 and December 2014. After cuff placement was completed via a perineal incision, a 61 to 70 cm H2O pressure regulating balloon was placed through a separate high scrotal incision in the space of Retzius or in a high submuscular tunnel. Demographics, perioperative comorbidities and functional outcomes were compared between the groups. A total of 294 consecutive patients underwent artificial urinary sphincter placement. Mean followup was 23 months. Space of Retzius and high submuscular placement was performed in 140 (48%) and 154 patients (52%), respectively. Functional outcomes were similar between the groups, including the continence rate (defined as 0 or 1 pad daily) in 81% vs 88% (p = 0.11), the erosion rate in 9% vs 8% (p = 0.66) and the explantation rate in 10% vs 11% (p = 0.62). Artificial urinary sphincter revision for persistent incontinence was required in a similar proportion of the 2 groups (13% vs 8%, p = 0.16) with a comparable mean followup (24 vs 23 months, p = 0.30). Kaplan-Meier analysis revealed no difference between the groups in the rate of explantation (p = 0.70) or revision (p = 0.06). High submuscular placement of a pressure regulating balloon at artificial urinary sphincter surgery is a safe, effective alternative with functional outcomes equivalent to those of traditional placement in the space of Retzius.

Functional Outcomes and Long-term Durability of Artificial Urinary Sphincter Application: Review of 56 Patients With Long-term Follow-up

PurposeTo evaluate the long-term outcomes of artificial urinary sphincter (AUS) implantation and to report the complication rates, including mechanical failure, erosion, and infection.Materials and MethodsFrom June 1990 to May 2011, AUS (AMS 800) implantations were performed in 56 adult males by one surgeon. Various demographic and preoperative variables, surgical variables, and postoperative outcomes, including success and complication rates with a median follow-up of 96 months, were recorded retrospectively.ResultsThe mean age of the patients at the time of AUS implantation was 61.8 (±14.2) years. During the follow-up period, the total complication rate was 41.1% (23 patients). The incidence of complications was significantly lower during the follow-up period after 48 months (p<0.05). Kaplan-Meier analysis revealed that 5- and 10-year failure-free rates were 50.3% and 45.2%, respectively.ConclusionsLong-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure, and infection of up to 30%.

Editorial Comment

This retrospective study provides some interesting, if not surprising findings on United States and worldwide use of the American Medical Systems, Inc. artificial urinary sphincter (AUS). A potential bias in interpretation, pointed out by the authors, is the fact that the data are based on a voluntarily filled patient information leaflet. In the study by Reynolds et al (Ref. 28 in the paper) on a much smaller cohort of patients in the United States only, the number of patient information forms (PIFs) was only 89% of the sales number for the same period. Are surgeons less likely to fill PIFs on revisions and does the rate vary between countries? These facts are unknown but may conceal an even higher revision rate. The most important message is the observation that of the implanting surgeons, 72% to 76% (depending on the country) only ever performed 1 or 2 implant procedures that we know of. Unfortunately, the authors missed an opportunity to explore the interesting question of whether the revision and complication rate was related directly to the implant experience of the individual surgeon! This would pave the way for the recommendation of a threshold number of cases per year per surgeon or institution which should be achieved to reduce morbidity and cost. International Variation in Artificial Urinary Sphincter UseUrologyVol. 80Issue 3PreviewTo analyze international trends in artificial urinary sphincter (AUS) use, indications for placement, and application by gender. Full-Text PDF ReplyUrologyVol. 80Issue 3PreviewWe thank the reviewers and acknowledge the comments above. Although we agree that a voluntarily filled patient information form does not replace prospective data collection, the database that formed the basis for this study has been vetted extensively by our group to ensure it includes the vast majority of revisions. Furthermore, we have explored the effect of individual surgeon experience on outcomes of artificial urinary sphincter (AUS) surgery, and found that as surgeons gain more experience, their complication rate (measured by rate of reoperation within 5 years) decreases significantly. Full-Text PDF

25‐year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence

To report the outcome of artificial urinary sphincter (AUS) in female patients for the treatment of stress urinary incontinence (SUI). We retrospectively reviewed all female patients with AUS implanted over the last 25 years in one institution. Patient demographics, renal tract imaging and urodynamics assessment were documented. Outcomes measures included complications, duration and cause of AUS failure. Urinary continence was defined as no pad use after AUS insertion. AUS failure was defined as malfunction, infection or erosion. AUS malfunction included either mechanical (fluid leak) or non-mechanical (infection or surgical damage to AUS). A Kaplan-Meier analysis was used to determine device failure over time. In all, 47 consecutive women with a mean (range) age of 51 (17-78) years received an AUS for the treatment of UI. Of these, 35 women had failed anti-incontinence surgery previously. There were two wound infections after AUS insertion but no mortality. Of the 47 AUS implanted, 39 (83%) AUS remained in situ. Eight (17%) AUS were removed due to AUS erosion or infection. There were 20 AUS revisions, 16 of which were primary AUS revisions. Most of the AUS revisions were related to mechanical malfunctions. Comparison of the proportion of AUS device survival over time using Kaplan-Meier analysis showed >80% of AUS remained functioning after 100 months. At the time of review, 83% of patients had a device in situ and the continence rate with no pads use was 59% with AUS only; this figure increased to 85% when concurrent clean intermittent self-catheterization was performed. AUS is an effective and durable treatment option for female SUI. In properly selected women, high continence rates can be achieved. Most patients maintained satisfactory long-term continence rates despite revision surgery.

490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture

You have accessJournal of UrologyPodium, Sunday, May 9, 2004, 10:00 am - 12:00 pm1 Apr 2004490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture Mohamed A. Gomha, and Timothy B. Boone Mohamed A. GomhaMohamed A. Gomha More articles by this author , and Timothy B. BooneTimothy B. Boone More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37752-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture." The Journal of Urology, 171(4S), p. 131 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 131 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Mohamed A. Gomha More articles by this author Timothy B. Boone More articles by this author Expand All Advertisement Loading ...

Management of artificial urinary sphincter dysfunction.

The long-term outcome of artificial urinary sphincter (AUS) is unpredictable because of, among others, the risk of breakdown of one of its components. Our objective was to define a strategy for an accurate diagnosis and an appropriate management of these problems. From 1985 to 2000, 298 AUS (AMS 800) have been implanted in 288 patients aged 53 +/- 21 years (8 to 87 years). There were 130 women with urinary stress incontinence, 84 with neurological disorders, 76 following prostatic surgery and 8 for other reasons. Diagnosis was often done following the recurrence of urinary incontinence. The pump was systematically checked and all patients underwent radiographic and urodynamic studies. We have systematically looked for the defective component in order to avoid replacing the entire sphincter. Fifty-five patients (19%) have been re-operated on after a median follow-up of 23 months (11 days-10 years): Thirty-two only once, 20 twice and 3 patients 4 times. There were 55 depressurizations, 18 device dysfunctions without depressurization and 11 removals of the sphincter. Among the 55 depressurizations, 30 were related to a perforation of one component, 24 to a functional but insufficient sphincter and 1 to tubing disconnection. In forty cases, only one component of the AUS was replaced while 2 components were replaced in 10 cases, the entire AUS in 4 cases and no component in one case. The longer the follow-up the greater is the probability of a dysfunction. We systematically continue to look for the defective component and just to replace it instead of the entire sphincter.

Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction

To compare the long-term outcome of artificial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation. The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty-two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow-up of 46 (5-118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire. Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients. After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs. 11%; P < 0.05); 70% of patients reported a significant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with > 80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision. Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous irradiation, the long-term continence and patient satisfaction appear not to be adversely affected.

A single‐centre long‐term outcome analysis of artificial urinary sphincter placement in children

Objective To retrospectively evaluate the outcome of artificial urinary sphincter (AUS) placement in 79 children, with a mean follow‐up of 12.5 years. Patients and methods A total of 89 children had an AUS placed between 1977 and 1994; complete data were obtained for 79 (63 boys and 16 girls). The indication for AUS placement was urinary incontinence caused by sphincteric deficiency with a stable bladder. Before and after surgery, all patients underwent ultrasonography, voiding cysto‐urethrography and urodynamics. Logistic regression was used to assess the factors influencing the outcome. Results The mean (range) age at surgery was 11.7 (3–18) years. The cause of incontinence was a neuropathic bladder in 74 patients and bladder exstrophy in five. At a mean (range) follow‐up of 12.5 (5–22) years, 63 of 79 patients (80%) had an intact AUS. The AUS was removed in 16 patients (20%) because of erosion at a mean (range) of 5.6 (1–11) years after insertion; there were 0.035 revisions per patient‐year. Of 63 patients with an AUS in place, 57 (90%) are completely dry and 36 (57%) are using clean intermittent catheterization. Thirteen patients (20%) developed bladder instability during the follow‐up, which was managed by anticholinergics in eight, spinal cord de‐tethering in three and enterocystoplasty in two. Hydronephrosis occurred in 12 of 126 renal units (10%) that improved after enterocystoplasty or anticholinergics. The overall 10‐year survival of the AUS was 79% (78% for early models and 80% for the AMS800); the survival was not affected by age, sex, model, previous bladder neck surgery, augmentation cystoplasty or intermittent catheterization. Bladder exstrophy was associated with lower AUS survival, as four of the five patients affected had the AUS removed secondary to erosion (P = 0.014). Conclusion In children the AUS has a 79% 10‐year survival and gives a 90% continence rate. Bladder instability after AUS placement can be managed with anticholinergics or enterocystoplasty. The AUS is not a justifiable treatment option for patients with bladder exstrophy.

A single-centre long-term outcome analysis of artificial urinary sphincter placement in children.

To retrospectively evaluate the outcome of artificial urinary sphincter (AUS) placement in 79 children, with a mean follow-up of 12.5 years. A total of 89 children had an AUS placed between 1977 and 1994; complete data were obtained for 79 (63 boys and 16 girls). The indication for AUS placement was urinary incontinence caused by sphincteric deficiency with a stable bladder. Before and after surgery, all patients underwent ultrasonography, voiding cysto-urethrography and urodynamics. Logistic regression was used to assess the factors influencing the outcome. The mean (range) age at surgery was 11.7 (3-18) years. The cause of incontinence was a neuropathic bladder in 74 patients and bladder exstrophy in five. At a mean (range) follow-up of 12.5 (5-22) years, 63 of 79 patients (80%) had an intact AUS. The AUS was removed in 16 patients (20%) because of erosion at a mean (range) of 5.6 (1-11) years after insertion; there were 0.035 revisions per patient-year. Of 63 patients with an AUS in place, 57 (90%) are completely dry and 36 (57%) are using clean intermittent catheterization. Thirteen patients (20%) developed bladder instability during the follow-up, which was managed by anticholinergics in eight, spinal cord de-tethering in three and enterocystoplasty in two. Hydronephrosis occurred in 12 of 126 renal units (10%) that improved after enterocystoplasty or anticholinergics. The overall 10-year survival of the AUS was 79% (78% for early models and 80% for the AMS800); the survival was not affected by age, sex, model, previous bladder neck surgery, augmentation cystoplasty or intermittent catheterization. Bladder exstrophy was associated with lower AUS survival, as four of the five patients affected had the AUS removed secondary to erosion (P = 0.014). In children the AUS has a 79% 10-year survival and gives a 90% continence rate. Bladder instability after AUS placement can be managed with anticholinergics or enterocystoplasty. The AUS is not a justifiable treatment option for patients with bladder exstrophy.