Underwent Artificial Urinary Sphincter Implantation Research Articles

Inguinal hernia repair in patients with artificial urinary sphincter after radical prostatectomy.

Stress urinary incontinence (UI) often develops after radical prostatectomy for prostate cancer, and in those patients with moderate-to-severe stress UI an artificial urinary sphincter (AUS) is implanted. Inguinal hernias (IHs) often occur after radical prostatectomy. As the prevalence of AUS implantation increases, it is possible to encounter patients with IHs undergoing AUS implantation (IHA). This study investigated our treatment and discussed an appropriate approach for IHAs. We retrospectively investigated patients who underwent IH repair with AUS implantation at our hospital from January 2018 to March 2023. We classified IHAs into Types A-D based on the positions of the IHs and AUS devices (the positions of the control pump, pressure-regulating balloon, and connecting tube). The hernia and control pump were ipsilateral in Types A and B, whereas the hernia and pressure-regulating balloon were ipsilateral in Types A and C. This study included 12 IHs of 11 patients. The median patient age was 77years. We conducted open repair in nine patients with all types and laparoscopic repair in two patients with Type B. The median operation times for unilateral and bilateral repairs were 96 and 182min, respectively. There were no complications with AUS or hernia surgeries. IHA has its own characteristics, and multidisciplinary knowledge thereof will help surgeons safely perform IH surgery.

Outcomes of Artificial Urinary Sphincter Implantation in Patients with Detrusor Underactivity and Postprostatectomy Incontinence.

There is insufficient evidence for postoperative outcomes of artificial urinary sphincter (AUS) implantation for postprostatectomy incontinence (PPI) with detrusor underactivity (DU). Thus, we assessed the impact of preoperative DU on the outcomes of AUS implantation for PPI. Medical records of men who underwent AUS implantation for PPI were reviewed. Patients who had bladder outlet obstruction surgery before radical prostatectomy or AUS-related complications that required revision of AUS within three months were excluded. Patients were divided into two groups based on the preoperative urodynamic study including pressure flow study, a DU group, and a non-DU group. DU was defined as a bladder contractility index less than 100. The primary outcome was postoperative postvoid residual urine volume (PVR). The secondary outcomes included maximum flow rate (Qmax), postoperative satisfaction, and international prostate symptom score (IPSS). A total of 78 patients with PPI were assessed. The DU group consisted of 55 patients (70.5%) and the non-DU group comprised 23 patients (29.5%). Qmax was lower in the DU group than in the non-DU group and PVR was higher in the DU group as per a urodynamic study before AUS implantation. There was no significant difference in postoperative PVR between the two groups, although the Qmax after AUS implantation was significantly lower in the DU group. While the DU group showed significant improvements in Qmax, PVR, IPSS total score, IPSS storage subscore, and IPSS quality of life (QoL) score after AUS implantation, the non-DU group showed postoperative improvement in IPSS QoL score. There was no clinically significant impact of preoperative DU on the outcome of AUS implantation for PPI; thus, surgery can be safely performed in patients with PPI and DU.

MP71-05 RISK FACTORS FOR 30-DAY REOPERATION SURGERY AFTER ARTIFICIAL URINARY SPHINCTER IMPLANTATION

You have accessJournal of UrologyCME1 Apr 2023MP71-05 RISK FACTORS FOR 30-DAY REOPERATION SURGERY AFTER ARTIFICIAL URINARY SPHINCTER IMPLANTATION Zhenyue Huang, Arshia Aalami Harandi, Chris Du, and Jason Kim Zhenyue HuangZhenyue Huang More articles by this author , Arshia Aalami HarandiArshia Aalami Harandi More articles by this author , Chris DuChris Du More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincter (AUS) implantation is the gold standard for surgical treatment of male stress urinary incontinence but carries a 50% long-term revision rate. Prior studies have noted hypertension, diabetes, cardiovascular disease, peri-operative anticoagulation use, and low pre-operative serum albumin as risk factors for AUS complications. We sought to investigate risk factors for short-term AUS reoperation using the National Surgical Quality Improvement Program (NSPIQ) database. METHODS: Patients who underwent AUS implantation between 2012-2022 were queried from the NSQIP database using CPT code 53445. The primary outcome was reoperation within 30 days. Patient characteristics and pre-operative laboratory findings were compared between outcome groups. Binary logistic regression was utilized to calculate unadjusted (univariate) and adjusted (multivariate) odds ratio for variables that were significantly different between outcomes (SPSS v 27.0). RESULTS: 1,884 cases were identified. Forty-three (2.3%) cases required reoperation within 30-days. Patients requiring reoperation within 30-days were older (71.9 vs 69.5, p=.033) and more likely to be insulin-dependent diabetics (IDDM) (18.6% vs 7.6%, p=.05). There was a higher percentage of African American patients in the reoperation group (20.5% vs 10.8%, p=.041). No significant associations were found between preoperative laboratory values and 30-day reoperation rates. Univariate logistic regression found that African Americans and IDDM had a 2-fold and nearly 3-fold increased odds of reoperation within 30-days, respectively (p=.041, p=.011). When adjusting for covariates, only IDDM remained significant (aOR: 2.68, p=.020). CONCLUSIONS: Short-term risk factors for reoperation after AUS may include increased age, IDDM, and African American race. Preoperative diabetic counseling may improve short term AUS management. Further research is required to elucidate the causes of this racial disparity. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhenyue Huang More articles by this author Arshia Aalami Harandi More articles by this author Chris Du More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Early activation of artificial urinary sphincter for stress incontinence is safe: A pilot study

Background: Artificial urinary sphincter (AUS) activation is usually deferred until 6 weeks following insertion. However, this timeframe for activation is based on traditional dogma. This study aims to assess the feasibility, efficacy and safety of earlier activation of AUS. Methods: A prospective database was established on consecutive patients undergoing AUS implantation (AMS-800 Boston Scientific) from March 2019 to March 2022 by a single fellowship-trained urologist. Early activation was defined as <30 days from the date of implantation. Results: Twenty-one patients were included in the study with a median follow-up of 34 (range: 3–96) months. The most common indication for AUS insertion was post-prostatectomy stress urinary incontinence ( n = 19, 90%). All 21 patients had their AUS successfully activated and used before 30 days, with a median of 14 (range: 9–28) days. Median (range) pre-operative continence pad numbers were 3 (2–6) and 0 (0–1) at 4 weeks post-operatively. Median (range) pad weight per day was 600 g (190–1310 g) pre-operatively and 6 g (0–6 g) at 4 weeks post-operatively. There were no adverse events associated with early activation. Conclusion: To our knowledge, this is the first description of the early activation of the AMS-800 AUS device. Our preliminary experience indicates early activation is safe and acceptable for patients. Level of evidence: II

MP22-06 THE IMPACT OF PROSTATE CANCER DISEASE PROGRESSION AND SALVAGE OR ADJUVANT TREATMENT ON ARTIFICIAL URINARY SPHINCTER DEVICE OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP22-06 THE IMPACT OF PROSTATE CANCER DISEASE PROGRESSION AND SALVAGE OR ADJUVANT TREATMENT ON ARTIFICIAL URINARY SPHINCTER DEVICE OUTCOMES Shree Agrawal, Hanson Zhao, Joao Pedro Emrich Accioly, Hadley Wood, and Kenneth Angermeier Shree AgrawalShree Agrawal More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , Joao Pedro Emrich AcciolyJoao Pedro Emrich Accioly More articles by this author , Hadley WoodHadley Wood More articles by this author , and Kenneth AngermeierKenneth Angermeier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While utilization of artificial urinary sphincter (AUS) for post prostate cancer intervention incontinence can improve quality of life, AUS placement in men with prostate cancer (CaP) progression to biochemical recurrence (BR) or distant metastatic disease (DM) with respect to AUS outcomes has yet to be characterized. METHODS: Retrospective review of patients who underwent AUS implantation from 1/2009-8/2021 was performed. Demographics, comorbidities, CaP treatment, pathology, progression, timing of AUS following primary intervention, surgical characteristics, incontinence outcomes and device revisions were assessed by chi-square and Pearson’s t-test analyses. Multivariable Cox proportional hazards and Kaplan Meier models were used to assess time to AUS device revision by CaP progression. RESULTS: We identified 526 patients who underwent AUS implantation, 255 had complete CaP and AUS characteristics as summarized in the table. Mean follow up from AUS and primary CaP treatment was 56 and 118 months, respectively. Among 134 patients treated with radiation, 40 developed AUS complications with 11 erosions and 11 with recurrent incontinence (p=0.21). In 78 patients treated with androgen deprivation therapy (ADT), AUS complications were noted in 22 with 7 erosions and 6 with recurrent incontinence, prompting revision (p=0.77). BR occurred in 101 patients (40%), with 16% requiring AUS revision (p=0.92). DM developed in 28 patients (11%), with 8 undergoing AUS after DM diagnosis. On univariate analysis, only transcorporal cuff use [HR 3.6 (95% CI 1.7-7.3), p=0.001] significantly correlated with AUS revision.There was no significant difference in continence rates following AUS for patients who underwent prostatectomy, radiation therapy, ADT, or who developed BR or DM. A majority (76%) reported 0-1 pads/day at last follow up. AUS durability for those with BR, by 2 years was 92%, 5 years 85%, and by 10 years 60% (p=0.55). In DM, this was 96% by 2 years, 90% by 5 years, and 71% by 10 years (p=0.26). CONCLUSIONS: There were no significant differences in AUS outcomes between patients without CaP disease progression and those with BR, local recurrence, or DM. Based on this data, AUS implantation in patients undergoing salvage or adjuvant therapy may still be an effective procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e373 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shree Agrawal More articles by this author Hanson Zhao More articles by this author Joao Pedro Emrich Accioly More articles by this author Hadley Wood More articles by this author Kenneth Angermeier More articles by this author Expand All Advertisement PDF DownloadLoading ...

Peri-operative outcomes between primary and replacement artificial urinary sphincter surgery: An ACS-NSQIP analysis.

To evaluate differences in perioperative clinical outcomes in men undergoing artificial urinary sphincter (AUS) implantation in primary versus replacement settings. Secondarily, we aimed to identify patient-related factors contributing to complications associated with AUS placement. A review of the American College of Surgeons-National Surgical Quality Improvement Program was performed between 2010 and 2018 identifying males undergoing AUS implantation. Subjects were further subdivided into primary implantation or removal/replacement of AUS simultaneously via current procedural terminology codes 53445 and 53447, respectively. 30-Day postoperative outcomes were compared between cohorts using t-test and Fisher's exact test. The relationship between patient factors and complications was evaluated using logistic regression. A total of 1,892 patients were identified: 1,445 primary AUS placement and 447 AUS replacement procedures. Patients undergoing AUS replacement were statistically older than those undergoing primary implantation (71.4 vs 69.7 years, P < .001). AUS replacement procedures were associated with an increased rate of superficial surgical site infection (SSI) compared to primary procedures (1.3% vs 0.4%, P ¼ .042). There were no differences identified between cohorts for deep SSI, cardiopulmonary complications, reoperation, operative time, or length of stay. Logistic regression demonstrated that higher body mass index was found to be independent risk factors for any complications, and diabetes mellitus was associated with increased risk of AUS-related readmission. Within the perioperative period, patients undergoing replacement AUS have an increased risk of superficial SSI compared to primary AUS implantation. These findings can assist with appropriate perioperative counseling of patients undergoing primary and replacement AUS implantations.

Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach.

ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.

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.

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.

Artificial urinary sphincter implantation in non-neurogenic men: a place for out-patient surgery.

To assess feasibility, safety and risk factors for failure associated with out-patient surgery for artificial urinary sphincter (AUS) implantation/revision in non-neurogenic men. In the present retrospective monocentric study conducted between May 2016 and March 2020, 81 patients undergoing AUS implantation or revision during an out-patient surgery were included. The primary outcome was the success rate of out-patient surgery. Success was assessed using two distinct definitions, a narrow definition, where success was defined as a one-day hospitalization and the absence of any unscheduled consultation or re-hospitalization within the 3days following surgery, a broad definition, where success was defined as a one-day hospitalization and the absence of any unscheduled re-hospitalization within the 3days following surgery. In parallel, risk factors for failure of out-patient surgery, as well as efficacy and safety were assessed. Eighty-one patients were enrolled, with a mean age of 71.2years ± 5.9. Out-patient surgery was successfully completed in 58 men (71.6% [95% CI 60.5-81.1]) and in 76 men (93.8% [95% CI 86.2-97.9]) according to the narrow and the broad definition, respectively. After multivariate analysis, anticoagulant therapy (OR 25.97 [95% CI 4.44-152.04]) and low socio-professional status (OR 22.1 [95% CI 3.701-131.95]) were statistically associated with failure of out-patient surgery. The continence rate after a 90-day follow-up was 79%. AUS implantation/revision in non-neurogenic men could be safely proposed in out-patient surgery. Special attention may however be paid to patients undergoing anticoagulant therapy or belonging to a low socio-professional category. DEC20-173 (French National Commission for Data Protection and Liberties).

The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation

OBJECTIVETo examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODSBetween January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients’ overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTSAUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as “much better.” Patients’ education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSIONAUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.

Functional outcomes of artificial urinary sphincter implantation with distal bulbar double cuff in men with and without a history of external beam radiotherapy: an analysis of a prospective database

ObjectivesTo analyse functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation with a distal bulbar double cuff (DC) for the treatment of stress urinary incontinence (SUI) in men with and without a history of external beam radiotherapy (RT).Patients and MethodsData of all patients undergoing AUS implantation with a distal bulbar DC (DC‐AUS) were collected prospectively from 2009 to 2015. Indications for DC implantation were based on urethral risk factors in terms of RT and previous proximal bulbar urethral interventions including, endoscopic or open surgery for urethral stricture or SUI. Implantation was carried out to a standardised protocol. Activation of the AUS was performed 6 weeks after implantation. Further follow‐up (FU) included pad test, uroflowmetry, post‐void residual urine measurements, radiography, and a standardised questionnaire. Continence and complication rates were compared between patients with a history of RT and non‐RT patients. Explantation‐free survival was estimated using Kaplan–Meier curves and the log‐rank test. Firth's penalized Cox‐regression analyses were performed to analyse proportional hazard ratios for explantation.ResultsIn all, 150 men (median age 70 years, interquartile range [IQR] 66–74) after DC‐AUS implantation were available for analysis. Overall, 73 men (48.7%) had a history of RT. The median (IQR) FU was 24 (7.25–36) months. Baseline clinical characteristics only differed regarding previous open SUI surgery (P = 0.016). Social and objective continence was achieved in 94.8% and 84.3% of all patients treated by implantation of a DC‐AUS, respectively. Between the RT and non‐RT patients there were no statistically significant differences in continence rates [social continence: 100% vs 90.2% (P = 0.194); objective continence: 87% vs 82% (P = 0.877)]. For complications rates there were no significant differences between RT and non‐RT patients after DC‐AUS implantation [infection (P = 0.09), erosion (P = 0.31), mechanical failures (P = 0.14)]. According to Kaplan–Meier analysis explantation rates in patients with a history of RT (26.0%) vs non‐RT patients (20.8%), estimated explantation‐free survival, and AUS durability, did not differ significantly (log‐rank P = 0.219).ConclusionOur data from a large institutional series indicate DC‐AUS implantation to be an effective and safe treatment strategy in men with SUI and a history of RT.

Effect of artificial urinary sphincter implantation on erectile function and sexual satisfaction.

Artificial urinary sphincter (AUS) implantation is the gold standard treatment in total stress urinary incontinence (SIU). Our aim is to evaluate the effect of AUS implantation on erectile function and sexual satisfaction (SS). Fourteen patients aged 58-73years (mean: 66.92±4.51years) who underwent AUS implantation by a perineal approach between May 2015 and April 2018 were included in our study. Patients with neurogenic disease or very low or no erectile function and those who underwent non-nerve-sparing radical prostatectomy were excluded. Erectile function and intercourse satisfaction were evaluated pre-operatively and post-operatively at 6-month follow-up using international index of erectile function (IIEF) questionnaires. After AUS implantation; eight patients were totally dry, four achieved social continence (less than one pad/day), and two still had SUI (two or more pads/day). Mean pre- and post-operative IIEF values of the patients were 16.14±3.18 and 17.42±4.43 respectively. Mean pre- and post-operative SS values were 8.57±1.78 and 8.71±2.19 respectively. There was no statistically significant difference between pre- and post-operative IIEF-5 and intercourse satisfaction scores (p>0.05). Although we did not see a significant effect of AUS implantation in our study, in SIU patients, coital incontinence or unpleasant odour during intercourse can lead to sexual avoidance and reduced SS, and AUS implantation may improve SS.

Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty.

To analyze functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation in patients who had undergone buccal mucosa graft urethroplasty (BMGU) beforehand. This prospectively maintained single-center database comprises data from 236 patients from 2009 to 2015 who underwent AUS implantation. A total of 17 patients after BMGU were available for analysis. Primary endpoints consisted of continence and complication rates. Continence was defined as no use of safety pads, social continence as < 2 pads per day. Stricture recurrence was defined as a decrease in uroflowmetry, a maximum flow rate < 10ml/s or residual urine volume (> 100ml). Kaplan-Meier analysis determined explantation-free survival. Median follow-up was 24months (interquartile range [IQR] 6-31months). Indication for AUS implantation was severe urinary incontinence with a history of radical prostatectomy (RRP) in 8 (47.1%), trauma in 1 (5.9%) and TUR-P in 8 (47.1%) patients. Pelvic irradiation was reported in 13 (76.5%) cases. The median length of buccal mucosa graft for urethroplasty was 4cm (3-5cm). A double cuff was implanted in 14 patients (82.4%), 3 patients received a single cuff. Complete and social continence was achieved in 76.5% and 100% of the patients, respectively. There was no significant difference in complications and explantation-free survival (log-rank, p = 0.191) between patients who had undergone BMGU before AUS compared to patients with no history of BMGU. According to the prospective follow-up data in a homogenous cohort, AUS implantation seems to be a viable, safe and effective therapeutic strategy for incontinence treatment despite previous BMGU.

Comparison of adjustable male slings and artificial urinary sphincter in the treatment of male urinary incontinence: a retrospective analysis of patient selection and postoperative continence status.

To analyze and compare preoperative patient characteristics and postoperative results in men with stress urinary incontinence (SUI) selected for an adjustable male sling system or an artificial urinary sphincter (AUS) in a large, contemporary, multi-institutional patient cohort. 658 male patients who underwent implantation between 2010 and 2012 in 13 participating institutions were included in this study (n = 176 adjustable male sling; n = 482 AUS). Preoperative patient characteristics and postoperative outcomes were analyzed. For statistical analysis, the independent T test and Mann-Whitney U test were used. Patients undergoing adjustable male sling implantation were less likely to have a neurological disease (4.5% vs. 8.9%, p = 0.021), a history of urethral stricture (21.6% vs. 33.8%, p = 0.024) or a radiation therapy (22.7% vs. 29.9%, p = 0.020) compared to patients that underwent AUS implantation. Mean pad usage per day (6.87 vs. 5.82; p < 0.00) and the ratio of patients with a prior incontinence surgery were higher in patients selected for an AUS implantation (36.7% vs. 22.7%; p < 0.001). At maximum follow-up, patients that underwent an AUS implantation had a significantly lower mean pad usage during daytime (p < 0.001) and nighttime (p = 0.018). Furthermore, the patients' perception of their continence status was better with a subjective complete dry rate of 57.3% vs. 22.0% (p < 0.001). Patients selected for an AUS implantation showed a more complex prior history and pathogenesis of urinary incontinence as well as a more severe grade of SUI. Postoperative results reflect a better continence status after AUS implantation, favoring the AUS despite the more complicated patient cohort.

PD16-09 HYPOGONADISM IS A RISK FACTOR FOR ARTIFICIAL URINARY SPHINCTER CUFF EROSION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-09 HYPOGONADISM IS A RISK FACTOR FOR ARTIFICIAL URINARY SPHINCTER CUFF EROSION Matthias D Hofer, Kunj R Sheth, Timothy J Tausch, Jordan Siegel, Billy H Cordon, Nicholas L Kavoussi, Alexandra Klein, Claus G Roehrborn, and Allen F Morey Matthias D HoferMatthias D Hofer More articles by this author , Kunj R ShethKunj R Sheth More articles by this author , Timothy J TauschTimothy J Tausch More articles by this author , Jordan SiegelJordan Siegel More articles by this author , Billy H CordonBilly H Cordon More articles by this author , Nicholas L KavoussiNicholas L Kavoussi More articles by this author , Alexandra KleinAlexandra Klein More articles by this author , Claus G RoehrbornClaus G Roehrborn More articles by this author , and Allen F MoreyAllen F Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1161AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In order to determine a possible relationship between hypogonadism and AUS cuff erosion, we evaluated the serum testosterone levels among men having artificial urinary sphincter (AUS) cuff erosions and compared these results to a cohort of uncomplicated AUS patients. METHODS After obtaining IRB approval, we reviewed 46 patients in whom serum testosterone levels were available and who received an AUS between 2007 and 2014. We defined hypogonadism as testosterone serum level <280 ng/dl. Mean follow-up was 2.96 years (range 1.01-7.67 years). Demographics of 18 patients with cuff erosion (39.1%) and 28 patients without erosion (60.9%) were similar with respect to cuff size, prior surgeries, radiation therapy, diabetes, or hypertension. Statistical analysis was performed with chi-square test, t-test, Kaplan-Meier analysis, and Cox regression analysis. RESULTS Of 18 AUS cuff erosions, 16 patients (88.9%) were hypogonadal compared to only 10 of 28 patients without cuff erosions (35%, p<0.001). Mean time to AUS erosion was 1.92 years (0.08-6.86 years). Cox regression analysis revealed that hypogonadism had a hazard ratio of 5.1 for AUS erosion compared to patients with normal testosterone levels (95% CI 1.1-22.6, p=0.003). Kaplan-Meier analysis demonstrated a significant decrease of erosion-free follow-up time in hypogonadal men compared to normogonadal men (log-rank p=0.018). There was no difference between hypogonadal and normogonadal men in respect to cuff size used, prior surgery, radiation therapy or comorbidities. Transcorporal placement was used more frequently in hypogonadal compared to normogonadal men (9/25 (36%) vs. 2/20 (10%), p=0.006). CONCLUSIONS Hypopgonadism in patients undergoing AUS implantation is a significant risk factor for subsequent cuff erosion. It is unknown whether testosterone supplementation prior to surgery would mitigate this almost unacceptable risk. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e397 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Matthias D Hofer More articles by this author Kunj R Sheth More articles by this author Timothy J Tausch More articles by this author Jordan Siegel More articles by this author Billy H Cordon More articles by this author Nicholas L Kavoussi More articles by this author Alexandra Klein More articles by this author Claus G Roehrborn More articles by this author Allen F Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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.

PD14-03 OPEN SURGICAL RECONSTRUCTION FOR RECALCITRANT BLADDER NECK CONTRACTURES – FUNCTIONAL OUTCOME AFTER IMPLANTATION OF AN ARTIFICIAL URINARY SPHINCTER

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) II1 Apr 2015PD14-03 OPEN SURGICAL RECONSTRUCTION FOR RECALCITRANT BLADDER NECK CONTRACTURES – FUNCTIONAL OUTCOME AFTER IMPLANTATION OF AN ARTIFICIAL URINARY SPHINCTER Simon Bugeja, Anastasia Frost, Enrique Fes, Stella Ivaz, Daniela E. Andrich, and Anthony R. Mundy Simon BugejaSimon Bugeja More articles by this author , Anastasia FrostAnastasia Frost More articles by this author , Enrique FesEnrique Fes More articles by this author , Stella IvazStella Ivaz More articles by this author , Daniela E. AndrichDaniela E. Andrich More articles by this author , and Anthony R. MundyAnthony R. Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1332AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open surgical reconstruction is the only curative treatment for bladder neck contractures (BNC) and prostatic urethral stenoses resulting from the treatment of prostate cancer which are refractory to endoscopic intervention. This invariably results in incontinence requiring a second intervention to restore continence. We review the functional outcome after open reconstructive surgery and subsequent artificial urinary sphincter (AUS) implantation. METHODS Between 2006 and 2012, 32 patients (mean age 65.5 years) were treated in a single unit. Men with anastomotic contractures following radical prostatectomy (RP) (n=16) or RP and adjuvant radiotherapy (n=6) underwent transperineal revision of the vesico-urethral anastomosis (VUA). Those with prostatic stenoses following external beam radiotherapy, HIFU, cryotherapy, brachytherapy or a combination of these (n=10) were treated by salvage RP via an abdomino-perineal approach. All had failed multiple previous attempts at endoscopic management. A bulbar AUS was subsequently implanted on average 9.1 months after the reconstruction. RESULTS The overall stricture-free rate after reconstruction was 87.5% (28 of 32). Two patients developed recurrent strictures following transperineal redo-VUA. All the rest, except one who declined, went on to have a bulbar AUS implanted (n=19). All are dry at a mean follow-up of 31.2 months except one unirradiated patient with recurring incontinence due to device malfunction. 8 of 10 patients (80%) having salvage RP were successful. 7 underwent AUS implantation. 4 remain dry after their primary implant, 3 are dry however had their devices revised for erosion (1) and malfunction (2). Therefore functional normality (unobstructed and continent) was achieved in 18 of 22 (81.8%) transperineal reconstructions. In irradiated patients with prostatic stenoses, 7 of 10 (70%) were rendered functionally normal after salvage RP albeit with a higher rate of AUS revision as a consequence of the primary irradiation treatment. CONCLUSIONS Surgical correction of recalcitrant BNC after treatment of prostate cancer is feasible and very effective in experienced hands however requires implantation of an AUS to restore functional normality. Patients must be councelled appropriately especially if previously continent. Salvage RP, though technically challenging, with longer hospital stays and time to catheter-free status, is the treatment of choice in radiotherapy or focal therapy-related prostatic urethral stenoses. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e319-e320 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Bugeja More articles by this author Anastasia Frost More articles by this author Enrique Fes More articles by this author Stella Ivaz More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP29-08 INDICATIONS AND TIMING OF REVISION SURGERY IN PATIENTS HAVING HAD MULTIPLE ARTIFICIAL URINARY SPHINCTERS

You have accessJournal of UrologyTrauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II1 Apr 2015MP29-08 INDICATIONS AND TIMING OF REVISION SURGERY IN PATIENTS HAVING HAD MULTIPLE ARTIFICIAL URINARY SPHINCTERS Anastasia Frost, Simon Bugeja, Daniela Andrich, and Anthony Mundy Anastasia FrostAnastasia Frost More articles by this author , Simon BugejaSimon Bugeja More articles by this author , Daniela AndrichDaniela Andrich More articles by this author , and Anthony MundyAnthony Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.611AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many patients with an artificial urinary sphincter (AUS) go on to have one or more revisions/replacements over the course of their life. We carried out a retrospective study to evaluate how long the device lasts before it needs to be revised and whether this is reduced with each subsequent implant. METHODS 469 patients underwent AUS implantation in a single unit between April 1982 and June 2013. There were 380 males and 89 females, (age 4.3-84.7 years). Those who went on to have more than one sphincter were identified and evaluated. RESULTS Of 469 patients, 211 (45%) had the AUS explanted after a mean of 5.62 years (range 23 days – 30.5 years). The devices were removed due to malfunction in 47.9% at a mean of 7 years (range 116 days – 30.5 years), erosion in 44.1% at a mean of 4.7 years (29 days – 26.4 years), and infection in 6.6% at a mean time of 1.3 years (23 days – 5.3 years). 149 patients (71%) went on to have a second device implanted. 46 (30.1%) had it removed after a mean of 4.01 years (range 42 days – 17 years). In these, erosion was the commonest cause, occurring on average 4.1 years after implantation. 25 patients had a third sphincter inserted. Of these, 7(28%) were explanted, most commonly due to malfunction (57%). In this group the mean time to explantation was 2.8 years. 6 patients had a fourth device, of which 2(33%) were explanted after 0.6 years and 3.2 years for malfunction and erosion respectively. One patient went on to have a fifth sphincter which was explanted following erosion at 1.9 years. CONCLUSIONS Replacement/revision AUS surgery is feasible. The complication rate associated with successive implantations is more or less similar, ranging between 28 and 33%. However, when complications do arise, they will occur earlier with each subsequent sphincter. This is important when counselling patients who have had multiple previous failed artificial sphincters and are being considered for even further revision surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e342 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anastasia Frost More articles by this author Simon Bugeja More articles by this author Daniela Andrich More articles by this author Anthony Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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

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