Artificial Urinary Sphincter Placement Research Articles

Long-term Follow-up of the Virtue Quadratic Male Sling

To report our long-term outcomes of Virtue Quadratic (VQ) sling since male slings have been introduced as a potential alternative treatment option to the artificial urinary sphincter (AUS), with limited long-term data available for proof of efficacy. Herein, we report our data. A retrospective review was performed on all Virtue slings performed at our institution over a 2-year period. Patient-reported outcomes regarding procedure success, complications, as well as subsequent procedures were identified. Procedure failure was defined as the inability to reduce patient's preoperative pad use, sling explant for complications, and need for AUS due to continued incontinence. We identified 32 consecutive male patients who were implanted with the VQ sling over the study period. One patient was excluded due to no follow-up. Median follow-up was 55 months. Median preoperative and postoperative pads per day were 3 (interquartile range: 1-3) and 2 (1-2.5). There were 21 (68%) patients who were considered procedure failures. Two (7%) patients reported chronic pain following placement and 7 (22%) underwent subsequent sling explant due to pain or for failure (1 vs 6). Six (20%) patients underwent subsequent AUS placement. Failure was more likely in patients with external beam radiation therapy (6, 19%) (P = .02). There was no association between procedure failure with age (P = .65) or severity of incontinence (P = .17). This study demonstrated a significant procedure failure and complication rate with the VQ sling. Thus, we do not recommend the use of the VQ sling and have abandoned all further implantation of the device.

Outcomes of artificial urinary sphincter placement in octogenarians.

To evaluate the impact of patient age on device outcomes among patients undergoing primary artificial urinary sphincter. A total of 1081 male patients who underwent primary artificial urinary sphincter placement from 1983 to 2011 were analyzed, including 91 men (8%) who were aged >80 years at the time of surgery. Revisions and explanations were compared between men stratified by decade of life. Hazard ratios adjusting for competing risks were used to determine the association with age and artificial urinary sphincter device outcomes (infection/erosion, urethral atrophy and malfunction), while overall device failure was estimated using Kaplan-Meier and Cox regression analysis. Patients aged >80 years were more likely to have coronary disease (P = 0.009), diabetes mellitus (P = 0.04), hypertension (P = 0.002) and lower body mass index (P < 0.0001). On multivariable analysis, patients aged >80 years were significantly more likely to experience device erosion or infection compared with a reference of patients aged <60 years (hazard ratio 4.13; P = 0.046), whereas there was no difference in those patients aged 60-70 years or 70-80 years compared with the reference group (P = 0.56 and 0.45). There was no significant difference in overall device survival between the age-stratified groups (P = 0.26). Although overall artificial urinary sphincter device survival is similar, patients aged >80 years are more likely to experience erosion or infection compared with younger patients. Despite this, the overall device failure rate is low, and artificial urinary sphincter might be considered for appropriately selected and counseled octogenarians.

The Impact of Prior Radiation Therapy on Artificial Urinary Sphincter Device Survival

The literature on artificial urinary sphincter device survival in individuals with a history of radiation therapy is conflicting. We assess device survival outcomes among individuals after prior radiation therapy exposure undergoing primary artificial urinary sphincter placement. An institutional review board approved database of allpatients who underwent artificial urinary sphincter surgery from 1999 to 2011 was used to assess device survival in patients treated with radiotherapy compared to individuals without radiotherapy exposure. Hazard regression and competing risk analysis were used to determine the association between radiation therapy and device outcomes. From 1999 to 2011 a total of 872 patients underwent artificial urinary sphincter surgery at our institution. Of these patients 489 underwent primary artificial urinary sphincter placement, with 181 of 489 (37%) having received radiation therapy. Patients with prior radiation therapy were older (median age72.0 vs 70.1 years, p <0.01) and had a higher median body mass index (29.4vs 28.6 kg/m(2), p <0.03) than those without radiation exposure. Rates of diabetes mellitus and hypertension were similar between the 2 groups. There was no significant difference in overall device survival between individuals who received radiation therapy and those without radiation therapy exposure, with 1and 5-year device survival rates of 92% vs 90% and 77% vs 74%, respectively (p=0.24). While individuals who underwent radiation therapy were significantly older and had a higher body mass index, device survival was not significantly different between the 2 groups when using a cuff size greater than 3.5 cm. These findings will assist the urologist with the preoperative counseling of men undergoing primary artificial urinary sphincter placement with a history of radiation therapy.

Re: Complications following Artificial Urinary Sphincter Placement after Radical Prostatectomy and Radiotherapy: A Meta-Analysis

Re: Complications following Artificial Urinary Sphincter Placement after Radical Prostatectomy and Radiotherapy: A Meta-Analysis

Editorial Comment

The fifth generation of the artificial urinary sphincter (AUS) has been in use since 1983. This report presents a single institution (3 surgeons') experience with this device in first time male recipients more than 18 years of age. The majority had urinary incontinence following prostatectomy. Patients with neurogenic bladder were excluded. To allow adequate follow-up the study was terminated before 2011. The goal of this study, the largest to date reported (1082 patients), was to record the time to treatment failure (device survival) defined as any secondary surgery. Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo ClinicUrologyVol. 86Issue 3PreviewTo evaluate long-term device outcomes following primary artificial urinary sphincter (AUS) implantation. Full-Text PDF ReplyUrologyVol. 86Issue 3PreviewWe appreciate the comments of Dr. Montague1 regarding our recent publication evaluating our institutional experience and long-term outcomes of artificial urinary sphincter (AUS) placement.2 We would like to echo a few highly salient points that we hope will help with future patient counseling and management of patients undergoing AUS placement. Full-Text PDF

Revision Techniques After Artificial Urinary Sphincter Failure in Men: Results From a Multicenter Study

To compare the results of various single-component artificial urinary sphincter (AUS) revision techniques for continued/recurrent stress urinary incontinence (SUI). Although AUS placement for male SUI has a high rate of success, revisions may be performed for mechanical failure of an isolated component or continued/recurrent SUI. From 1993 to 2012, 90 AUS revisions including urethral cuff downsizing (19), pressure-regulating balloon replacement (18), cuff repositioning (11), or tandem cuff placement (42) were performed at 2 institutions. End points included reoperation, incontinence failure, and urethral erosion. The Kruskal-Wallis test was used to compare continuous variables, and the log-rank test was used to compare Kaplan-Meier curves. Mean age was 70.2 years, and median follow-up was 33.6 months. Median time to revision was 28.9 months. Tandem cuff placement was associated with a lower rate of incontinence failure (P = .02), whereas cuff repositioning was associated with a higher rate of incontinence failure (P = .02). An increased rate of mechanical failure was observed with cuff downsizing (P = .01). Among options for revision (1) cuff downsizing is associated with a higher rate of mechanical failure, and (2) cuff repositioning with the same size is associated with a higher rate of incontinence failure, whereas (3) tandem cuff placement is associated with a lower rate of recurrent SUI compared to other types of AUS revision. Cuff repositioning is associated with an increased rate of persistent incontinence after AUS revision whereas tandem cuff placement is associated with a lower rate of recurrent or persistent incontinence.

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.

Long-term Outcomes Following Artificial Urinary Sphincter Placement: An Analysis of 1082 Cases at Mayo Clinic

To evaluate long-term device outcomes following primary artificial urinary sphincter (AUS) implantation. We identified 1802 male patients with stress urinary incontinence that underwent AUS placement from 1983 to 2011. Of these, 1082 (60%) were involving primary implantations and comprise the study cohort. Multiple clinical and surgical variables were evaluated for potential association with treatment failure, defined as any secondary surgery. Patient follow-up was obtained through office examination, operative report, and written or telephone correspondence. Patients undergoing AUS implantation had a median age of 71 years (interquartile range 66-76) and median follow-up of 4.1 years (interquartile range 0.8-7.7). Overall, 338 of 1082 patients (31.2%) underwent secondary surgery, including 89 for device infection and/or erosion, 131 for device malfunction, 89 for urethral atrophy, and 29 for pump malposition or tubing complications. No patient-related risk factors were independently associated with an increased risk of secondary surgery on multivariable analysis. Secondary surgery-free survival was 90% at 1 year, 74% at 5 years, 57% at 10 years, and 41% at 15 years. Primary AUS implantation is associated with acceptable long-term outcomes. Recognition of long-term success is important for preoperative patient counseling.

The Impact of Urethral Risk Factors on Transcorporeal Artificial Urinary Sphincter Erosion Rates and Device Survival

We report the impact of urethral risk factors on erosion rates and device survival outcomes after transcorporeal artificial urinary sphincter placement. We performed a retrospective analysis of all transcorporeal artificial urinary sphincters placed at a single institution between January 2000 and May 2014. We assessed patient demographic, comorbid diseases and surgical characteristics for risk factors considered poor for device survival. Risk factors were compared to postoperative complications requiring explantation, including cuff erosion, infection and device revision. A total of 37 transcorporeal artificial urinary sphincters were placed in 35 men. Placement was performed as a primary procedure in 21 of 37 cases (56.8%) and as salvage in the remainder. In this transcorporeal population there were 7 explantations (18.9%) due to erosion in 4 cases, cuff downsizing in 2 and infection in 1. Median followup from implantation to last followup was 8.5 months (range 0.9 to 63). Median time from artificial urinary sphincter placement to explantation was 17.3 months (range 0.9 to 63) and time specifically to transcorporeal erosion was 7.4 months (range 0.9 to 26). On univariate analysis no parameters were associated with sphincter cuff erosion but a history of an inflatable penile prosthesis was associated with a higher device explantation rate (60% vs 12.5%, p=0.04). No associations were revealed on multivariate logistic analysis. All 4 cuff erosion cases demonstrated greater than 2 urethral risk factors, including prior radiation therapy in all. The probability of cuff erosion in patients with 2 or more urethral risk factors was 1.65 times the probability of erosion in those with 0 or 1 urethral risk factor (95% CI 1.3, 2.2). The proportion of patients free of erosion at 35 months was 100% in those with 0 or 1 urethral risk factor and 64% in those with 2 or more risk factors (log rank test p=0.00). Similarly the proportion of patients free of explantation at 35 months was 100% in those with 0 or 1 urethral risk factor and 52% in those with 2 or more (log rank test p=0.02). Transcorporeal artificial urinary sphincter implantation is generally reserved for complex and high risk cases but favorable functional results were demonstrated. However, patients with multiple urethral risk factors face a higher risk of erosion and device loss.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Sep 2015This Month in Adult Urology Joseph A. SmithMD Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.06.017AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 194(3), pp. 609–610 References 1 : Oncologic efficacy of radio frequency ablation for small renal masses: clear cell vs papillary subtype. J Urol2015; 194: 653. Link, Google Scholar 2 : Cystocele repair by autologous rectus fascia graft: the pubovaginal cystocele sling. J Urol2015; 194: 721. Link, Google Scholar 3 : Perioperative complications following artificial urinary sphincter placement. J Urol2015; 194: 716. Link, Google Scholar 4 : Brain mechanisms underlying urge incontinence and its response to pelvic floor muscle training. J Urol2015; 194: 708. Link, Google Scholar 5 : Active Surveillance is an appropriate management strategy for a proportion of men diagnosed with prostate cancer by prostate specific antigen testing. J Urol2015; 194: 680. Link, Google Scholar 6 : Course and moderators of hot flash interference during androgen deprivation therapy for prostate cancer: a matched comparison. J Urol2015; 194: 690. Link, Google Scholar 7 : Transarterial embolization of angiomyolipoma: a systematic review. J Urol2015; 194: 635. Abstract, Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 194Issue 3September 2015Page: 609-610 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Public Restroom Habits in Patients After Artificial Urinary Sphincter Implantation

To investigate public restroom habits with secondary outcomes evaluating health-related quality of life (HRQoL) outcomes in our patients who underwent artificial urinary sphincter (AUS) implantation after prostatectomy. Postprostatectomy incontinence is a significant burden on patients' emotional health and ability to perform activities of daily living. Between June 2012 and January 2014, we identified 50 men who had undergone AUS placement for postprostatectomy incontinence. All 50 men completed baseline Expanded Prostate Cancer Index Composite-Urinary Domain (EPIC-UD) and Urogenital Distress Inventory Short Form (UDI-6) questionnaires preoperatively. We evaluated patients' subjective postoperative continence status using the UDI-6 and EPIC-UD scales via a telephone-administered questionnaire. Thirty-one of 50 patients (62%) were contacted and agreed to participate in the study. The pad score decreased significantly from 3 (median = 3 pads per day [ppd]; interquartile range [IQR] = 2) during minimal activity before surgery to 1 (median = 1.0 ppd; IQR = 0.5) after surgery (P <.001), and from 5 pads (median =5 ppd; IQR = 5) during strenuous activity to 1 pad (median = 1 ppd; IQR = 2; P <.001). QoL analysis pre- and post-AUS revealed a score increase of 16.5 points (P <.007) in EPIC-UD and an increase of 23.93 (P <.022) in UDI-6. Men reporting lower ppd before AUS placement were more likely to report higher public restroom urinal use (R = 0.366; P <.043) and increased public restroom comfort level (R = 0.342; P <.060) as compared with men with higher preoperative ppd usage. EPIC-UD and UDI-6 scores improved significantly and demonstrated high levels of correlation to self-reported ppd; however, both failed to show any correlation to patients' comfort level with public restrooms. The single predictor of patients' comfort was self-reported ppd with minimal activity.

Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy.

To analyze the rates of incontinence procedures after radical prostatectomy, and define the variables associated with them. We conducted an IRB approved retrospective review of patients with prostate cancer who underwent radical prostatectomy at a single institute from January 1998 to December 2012. Logistic regression and time to event analyses were performed to ascertain variables associated with receipt of incontinence procedure after prostatectomy. Four thousand four hundred one men underwent radical prostatectomy (69.8% open, 30.1% laparoscopic or robotic) of whom 74.3% were white Caucasian and 22.1% were African-American. Overall, 165 (3.7%) patients underwent a total of 191 procedures for male urethral sling or artificial urinary sphincter placement. African-American men received fewer incontinence procedures than white Caucasian men (2.1% versus 4.3%, P = 0.001); and with a longer delay after prostatectomy than white Caucasian men (28.3 months versus 19.9 months, P = 0.029). Men who had a laparoscopic or robotic prostatectomy received an incontinence procedure earlier than men who had an open prostatectomy (17.6 months versus 24.4 months, P = 0.0001). On multivariate analysis, age at prostatectomy, diagnosis of incontinence, and race were independently associated with receiving an incontinence procedure. The overall rate of incontinence surgery after radical prostatectomy is low at 3.7%. African-American men receive incontinence procedures at a lower rate and with a longer delay after prostatectomy than white Caucasian men. Further studies are needed to define the reasons for this racial disparity in urinary incontinence surgery in the prostate cancer survivor. Neurourol. Urodynam. 35:733-737, 2016. © 2015 Wiley Periodicals, Inc.

The Artificial Urinary Sphincter is Superior to a Secondary Transobturator Male Sling in Cases of a Primary Sling Failure

We compared continence outcomes in patients with post-prostatectomy stress urinary incontinence treated with a salvage artificial urinary sphincter vs a secondary transobturator sling. We retrospectively reviewed the records of patients undergoing salvage procedures after sling failure from 2006 to 2012. Postoperative success was defined as the use of 0 or 1 pad, a negative stress test and pad weight less than 8 gm per day. We performed the Wilcoxon test and used a Cox regression model and Kaplan-Meier survival analysis. A total of 61 men presenting with sling failure were included in study, of whom 32 went directly to an artificial urinary sphincter and 29 received a secondary sling. Of the artificial urinary sphincter cohort 47% underwent prior external beam radiation therapy vs 17% of the secondary sling cohort (p = 0.01). Average preoperative 24 hour pad weight and pad number were higher in the artificial urinary sphincter cohort. Median followup in artificial urinary sphincter and secondary sling cases was 4.5 (IQR 4-12) and 4 months (IQR 1-5), respectively. Overall treatment failure was seen in 55% of patients (16 of 29) with a secondary sling vs 6% (2 of 32) with an artificial urinary sphincter (unadjusted HR 7, 95% CI 2-32 and adjusted HR 6, 95% CI 1-31). In this cohort of patients with post-prostatectomy stress urinary incontinence and a failed primary sling those who underwent a secondary sling procedure were up to 6 times more likely to have persistent incontinence vs those who underwent artificial urinary sphincter placement. These data are useful for counseling patients and planning surgery. We currently recommend placement of an artificial urinary sphincter for patients in whom an initial sling has failed.

MP88-14 ARTIFICIAL URINARY SPHINCTER OUTCOMES IN OCTOGENARIANS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-14 ARTIFICIAL URINARY SPHINCTER OUTCOMES IN OCTOGENARIANS Matthew J. Ziegelmann, Brian J. Linder, Joshua Piotrowski, Boyd R. Viers, David Barrett, and Daniel S. Elliott Matthew J. ZiegelmannMatthew J. Ziegelmann More articles by this author , Brian J. LinderBrian J. Linder More articles by this author , Joshua PiotrowskiJoshua Piotrowski More articles by this author , Boyd R. ViersBoyd R. Viers More articles by this author , David BarrettDavid Barrett More articles by this author , and Daniel S. ElliottDaniel S. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1847AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) has a significant impact on a patient's quality of life. As the average male life expectancy continues to increase, it is likely that we will see an increasing number of older patients seeking treatment for SUI. To date, few studies have evaluated artificial urinary sphincter (AUS) placement in older men, and little data exists with which to counsel this specific group of patients preoperatively. Thus, we sought to assess the outcomes in octogenarians undergoing AUS placement. METHODS From 1983-2012, 2005 AUS surgeries were performed at our institution. Of these 2005, 1157 (58%) were primary AUS placement. 101 (8.7%) men were >/= 80 years old at the time of their primary implant surgery. Outcomes evaluated included AUS revisions and explantations, and these were compared between men < 80 years old and those >/= 80 years. A multivariate Cox proportional logistic regression model with competing risk analysis was utilized to identify covariates independently associated with AUS device outcomes (removal or revision). Specific variables included age (< 80 years, and >/= 80 years), tobacco use, coronary artery disease (CAD), hypertension, diabetes mellitus, history of prostate radiation, current or prior androgen deprivation therapy, and history of bladder neck contracture. RESULTS In total, 101 men undergoing primary AUS placement were 80 years or older, with a median age of 82.5, compared with a median age of 69.8 in those patients less than 80 years old. When stratified by age, octogenarians were more likely to have a history of coronary artery disease (25% vs 14%, respectively; p=0.003). On univariate analysis, there was no significant difference in overall AUS revision events between octogenarians and those patients less than 80 years old (HR 0.86, p=0.5). However, octogenarians were significantly more likely to experience device erosion/infection (HR 2.31, p=0.008). On multivariable analysis, advanced age (>/= 80) was independently associated with a significantly increased risk of device erosion/infection (HR 2.055, p=0.03). CONCLUSIONS While the overall rate of AUS revisions is similar for younger and older patients, octogenarians are twice as likely to experience device erosion or infection. Recognizing this increased risk is important to consider when counseling patients preoperatively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1097 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew J. Ziegelmann More articles by this author Brian J. Linder More articles by this author Joshua Piotrowski More articles by this author Boyd R. Viers More articles by this author David Barrett More articles by this author Daniel S. Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-20 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY Christopher Powell, Travis Dum, William Brant, and Joshua Broghammer Christopher PowellChristopher Powell More articles by this author , Travis DumTravis Dum More articles by this author , William BrantWilliam Brant More articles by this author , and Joshua BroghammerJoshua Broghammer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing artificial urinary sphincter (AUS) following urethroplasty are often categorized as high-risk due to previous urethral instrumentation and theoretical altered urethral vascular supply. Limited data exist regarding outcomes in these patients making appropriate patient counseling difficult at best. We compare outcomes of AUS placement at two tertiary care centers to determine outcomes of AUS placement in patients who had undergone previous urethroplasty. METHODS A retrospective analysis of patients treated with AUS placement from November 2008 to December 2013 was performed at two tertiary care centers. All patients receiving AUS placement were included regardless of urinary incontinence etiology. Patients were divided into “average risk” (AR) and previous urethroplasty (PU) cohorts. Patients with a history of radiation therapy, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS and were excluded from the AR cohort. Charts were analyzed for pre-operative risk factors as well as post-operative complications, revisions, and pad usage. RESULTS 141 patients underwent AUS placement during the study period. 13 patients undergoing AUS placement had a history of previous urethroplasty (PU). Patients were included regardless of indication for urethroplasty. Indications for urethroplasty included urethral stricture, AUS erosion, and bladder neck contracture in 9, 3, and 1 patient respectively. 63 patients were considered average risk (AR). Post-operative complication rate was 15.4% (n=2, RR 1.38, p=0.66) in the PU group and 11.1% (n=7) in the AR group. Complications in the PU group included persistent bothersome incontinence and erosion each in a single patient. Mean postoperative pad use was 0.96 (n=53) in AR group vs 2.1 in PU group (n=8). Mean follow-up time was 10.9 months (range 1-35) for AR group and 4 months (range 1-9) for PU group. CONCLUSIONS Patients who had previously undergone a urethroplasty for any indication were not statistically more likely to develop a postoperative complication than “average risk” patients. Post-operative pad usage was twice that of the AR group. While longer follow-up is necessary, these data suggest that patients undergoing AUS placement following urethroplasty may have a similar complication rate to that of the general population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Powell More articles by this author Travis Dum More articles by this author William Brant More articles by this author Joshua Broghammer More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP88-19 POST-OPERATIVE ANTIBIOTICS AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT DO NOT REDUCE INFECTION OR EROSION RATES

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-19 POST-OPERATIVE ANTIBIOTICS AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT DO NOT REDUCE INFECTION OR EROSION RATES J. Patrick Selph, Michael Belsante, Divya Ajay, Aaron Lentz, George Webster, Ngoc-Bich Le, and Andrew Peterson J. Patrick SelphJ. Patrick Selph More articles by this author , Michael BelsanteMichael Belsante More articles by this author , Divya AjayDivya Ajay More articles by this author , Aaron LentzAaron Lentz More articles by this author , George WebsterGeorge Webster More articles by this author , Ngoc-Bich LeNgoc-Bich Le More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1852AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The AMS 800 artificial urinary sphincter (AUS) is considered the gold standard surgical treatment for post-prostatectomy stress incontinence. Feared complications of placement include infection and erosion, with reported rates of 0.5-10.6% and 2.9-12%, respectively. While no guidelines or data exist to support the practice, one study showed that 94% of surgeons send patients home with oral antibiotics after penile prosthesis placement. We postulate that a similar practice exists after AUS placement. We sought to determine if giving post-operative antibiotics at the time of discharge would reduce infection rates in patients undergoing primary AUS placement. METHODS We retrospectively reviewed all patients undergoing AUS placement from 2007 to 2012 at our institution by three surgeons. Two surgeons routinely gave postoperative antibiotics, while a third did not. We included only patients undergoing primary AUS implantation with an Inhibizone-coated device who developed an infection and/or erosion at any time after placement. Exclusion criteria included revision surgery, prior urethral erosion, or device infection or erosion after urethral instrumentation or trauma. Patient records were assessed for postoperative antibiotic prescriptions and device infection or erosion. Statistical analysis of categorical variables was performed using Fisher's exact test. RESULTS 223 patients met inclusion criteria. 159 patients were given antibiotics at discharge, and 65 received no discharge antibiotics. Mean follow-up of the entire group was 17.1 months. There was no significant difference between the two groups in body mass index, presence of a urethral stent, smoking status, radiation history, or presence of diabetes. 6/159 (3.8%) and 1/64 (1.5%) of the antibiotic group and non-antibiotic group developed an infection and/or erosion, respectively. There was no statistically significant difference in infection and/or erosion rates between antibiotic and non-antibiotic groups (p = 0.67). Of the seven patients who developed a device infection and/or erosion, six had prior radiation therapy. CONCLUSIONS Antibiotics given after primary Inhibizone-coated AUS placement do not appear to reduce infection rates. Given the general concern over increasing resistance to antimicrobials, this study supports the notion that patients undergoing primary Inhibizone-coated AUS placement do not require antibiotics after implantation of the AUS. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1099 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. Patrick Selph More articles by this author Michael Belsante More articles by this author Divya Ajay More articles by this author Aaron Lentz More articles by this author George Webster More articles by this author Ngoc-Bich Le More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

V3-02 ROBOTIC-ASSISTED LAPAROSCOPIC PLACEMENT OF BLADDER NECK ARTIFICIAL URINARY SPHINCTER IN A MALE

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2015V3-02 ROBOTIC-ASSISTED LAPAROSCOPIC PLACEMENT OF BLADDER NECK ARTIFICIAL URINARY SPHINCTER IN A MALE Stephen Blakely, Henry Okafor, Gennady Bratslavsky, and Dimitriy Nikolavsky Stephen BlakelyStephen Blakely More articles by this author , Henry OkaforHenry Okafor More articles by this author , Gennady BratslavskyGennady Bratslavsky More articles by this author , and Dimitriy NikolavskyDimitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Placement of a bladder neck artificial urinary sphincter (AUS) is indicated in select patients with urinary incontinence and the need for frequent urethral manipulation. This procedure is challenging by any approach. We present a step by step video instruction for performing this procedure through a robotic-assisted laparoscopic approach. METHODS A 24 year old male with transverse myelitis presented with urinary retention requiring clean intermittent catheterization (CIC) as well as severe stress urinary incontinence between catheterizations. Video urodynamic evaluation revealed a large capacity, acontractile bladder along with low valsalva leak point pressure and an open bladder neck during filling. An AUS was placed at the bladder neck to reduce the risk of cuff erosion with CIC while maintaining continence between catheterizations. RESULTS The patient remained for one week with a urethral catheter in place through a deactivated AUS. The catheter was then removed and the patient resumed CIC. He was notably incontinent as the device remained deactivated. At 6 weeks the AUS was activated and the patient continued CIC, now continent between catheterizations. CONCLUSIONS Placement of a bladder neck AUS in a male is challenging. A robotic-assisted approach offers a minimally invasive alternative to the open approach. This video abstract provides a visual step-by-step technique for this procedure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e335 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Blakely More articles by this author Henry Okafor More articles by this author Gennady Bratslavsky More articles by this author Dimitriy Nikolavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP88-12 EFFECTS OF RADIATION THERAPY ON DEVICE SURVIVAL AMONG INDIVIDUALS WITH ARTIFICIAL URINARY SPHINCTERS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-12 EFFECTS OF RADIATION THERAPY ON DEVICE SURVIVAL AMONG INDIVIDUALS WITH ARTIFICIAL URINARY SPHINCTERS Marcelino Rivera, Matthew Ziegelmann, Brian Linder, Boyd Viers, Laureano Rangel, and Daniel Elliott Marcelino RiveraMarcelino Rivera More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Brian LinderBrian Linder More articles by this author , Boyd ViersBoyd Viers More articles by this author , Laureano RangelLaureano Rangel More articles by this author , and Daniel ElliottDaniel Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1845AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Literature surrounding artificial urinary sphincter (AUS) device survival among individuals with a history of radiation therapy is conflicting with limited data to date. Therefore, we aim was to assess AUS device survival outcomes among individuals with prior radiation therapy exposure undergoing AUS placement. METHODS An institutional review board approved database of all AUS patients from 1999-2014 was utilized to assess device survival in patients who underwent radiotherapy compared to individuals without radiotherapy exposure. Kaplan-Meier analysis was performed to determine survival including overall device and erosion/infection-free survival. Hazard regression analysis was utilized to determine the association between radiation therapy and device outcomes. RESULTS From 1999-2014 a total of 1,153 patients underwent AUS surgery at our institution. Of these, a total of 650 underwent primary AUS placement with 285 (44%) having received radiation therapy. When compared with patients who did not receive radiation therapy those who did were older (median age 72.8 vs 70.2, p<0.0001), had a greater BMI (28.9 vs 28.1, p<0.0019), and higher rates of diabetes and hypertension (HTN) (p<0.02 and <0.009 respectively). On univariate analysis, only age was significantly associated with AUS overall device survival (HR 0.976, p<0.002). Likewise, survival analysis demonstrated no significant difference in 1 and 5-year overall device (88% vs 84% and 62% vs 57% respectively, p=0.5) and erosion/infection-free survival (94% vs 92% and 89% vs 89% respectively, p=0.7) rates among individuals who received radiation therapy relative to those without radiation therapy exposure. CONCLUSIONS While individuals who underwent radiation therapy were significantly older, had a higher BMI and higher rates of diabetes and HTN, device survival, as well as infection/erosion rates were not significantly different between the two groups. Clinically, these findings will assist the urologist with preoperative counseling of men undergoing primary AUS placement with a history of radiation therapy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1096-e1097 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcelino Rivera More articles by this author Matthew Ziegelmann More articles by this author Brian Linder More articles by this author Boyd Viers More articles by this author Laureano Rangel More articles by this author Daniel Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP88-15 LOCATION OF AUS PRESSURE REGULATING BALLOON: FUNCTIONAL OUTCOMES OF HIGH SUBMUSCULAR POSITION ARE EQUIVALENT TO SPACE OF RETZIUS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Male Incontinence: Therapy1 Apr 2015MP88-15 LOCATION OF AUS PRESSURE REGULATING BALLOON: FUNCTIONAL OUTCOMES OF HIGH SUBMUSCULAR POSITION ARE EQUIVALENT TO SPACE OF RETZIUS Nirmish Singla, Jay Simhan, Jordan Siegel, Timothy Tausch, and Allen Morey Nirmish SinglaNirmish Singla More articles by this author , Jay SimhanJay Simhan More articles by this author , Jordan SiegelJordan Siegel More articles by this author , Timothy TauschTimothy Tausch More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1848AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Traditional placement of artificial urinary sphincter (AUS) pressure regulating balloons (PRB) within the space of Retzius (SOR) may be challenging and subject to troublesome complications. We report our longitudinal experience utilizing a novel high submuscular (HSM) PRB placement technique and compare functional outcomes to traditional SOR placement of the PRB. METHODS We reviewed a prospectively maintained database of AUS patients between July 2007 and January 2014. Only 61-70 cm H2O PRBs were placed through a trans-scrotal approach via an HSM tunnel (2011-2014) or within the SOR (2007-2010). Our HSM technique consisted of uniform placement of the PRB beneath the rectus abdominis muscle while SOR placement involved perforation of the transversalis fascia at the pubic tubercle, beneath the external inguinal ring. Demographics, patient data, cuff durability, and functional outcomes were compared between groups. RESULTS 232 consecutive patients underwent AUS placement with a mean follow up of 38 months. SOR placement was performed in 139 (60%) patients while HSM placement was performed in 93 (40%). Functional outcomes including continence (defined as 0-1 pads/day) rates (88% vs. 81%, p=0.15), erosion rates (9% vs. 5%, p=0.32), and explantation rates (12% vs. 10%, p=0.83) were similar between groups. Fewer AUS revisions for persistent incontinence were required in patients undergoing HSM PRB placement (6.5% vs. 18%, p=0.01). Although mean follow-up was longer for patients undergoing SOR placement (51 vs. 20 months, p<0.001), Kaplan-Meier analysis revealed no difference between groups with regards to rates of explantation (p=0.71) or revision (p=0.36). CONCLUSIONS High submuscular placement of the PRB at the time of AUS surgery offers a safe and effective alternative with equivalent functional outcomes to traditional SOR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1097-e1098 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nirmish Singla More articles by this author Jay Simhan More articles by this author Jordan Siegel More articles by this author Timothy Tausch More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

462 Post-operative antibiotics after primary artificial urinary sphincter placement do not reduce infection or erosion rates

462 Post-operative antibiotics after primary artificial urinary sphincter placement do not reduce infection or erosion rates