Factors effecting the outcomes of artificial urinary sphincter placement: a single-center study

Year 2020, Volume: 6 Issue: 4, 276 - 282, 04.07.2020

Mustafa Murat Aydos Volkan Çaglayan

https://doi.org/10.18621/eurj.503382

Abstract

Objectives: To evaluate the patients who underwent artificial urinary sphincter (AUS) placement and report outcomes of the procedure.

Methods: From March 2008 to February 2017, the data of patients who have undergone AUS placement were evaluated retrospectively. Age, body-mass index (BMI), comorbidities, education level, previous radiotherapy (RT) history of the patients were recorded. Cognitive status was examined using the Mini Mental Status Examination test (MMSE). International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) was completed pre- and post-operatively. Quality of life and satisfaction of patients were evaluated using Patient Global Impression of Improvement (PGI-I) scale. To analyze factors effecting success and revision rates, patients were grouped according to age, BMI, comorbidities, smoking habbit, previous RT history and etiology of incontinence. Treatment success was defined as requirement of ≤ 1/day.

Results: A total of 61 patients were included in the study and each were cognitive intact (MMSE > 25). ICIQ-SF significantly improved in postoperative period (p < 0.001). PGI-I median score was 1 (1-4) in postoperative period. Success rate was 96.7% (n = 59) and 47 (77%) patients were complete dry. Revision requirement occured in 10 (16.4%) patients. When patient groups were compared according to the success and revision rates; presence of BMI > 25 kg/m2 was the only significant factor associated with revision requirement and there was no significant factor associated with success status.

Conclusion: AUS placement is a safe and effective method in the treatment of post-prostatectomy incontinence (PPI). Success and revision rates are similar regardless the etiology of PPI. Cognitive functions of patients may be crucial in the postoperative satisfaction status. 

Keywords

Artificial urinary sphincter, post-prostatectomy incontinence, male incontinence

References

• 1. Holm H, Fossa S, Hedlund H, Schultz A, Dahl AA. How should continence and incontinence after radical prostatectomy be evaluated? A prospective study of patient ratings and changes with time. J Urol 2014;192:1155-61.
• 2. Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA 2000;283:354-60.
• 3. Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, et al. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2004;96:1358-67.
• 4. Tienza A, Robles JE, Hevia M, Algarra R, Diez-Caballero F, Pascual JI. Prevalence analysis of urinary incontinence after radical prostatectomy and influential preoperative factors in a single institution. Aging Male 2018;21:24-30.
• 5. Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 2004:172:1012-6.
• 6. Muzzonigro G, Milanese G, Minardi D, Yehia M, Galosi AB, Dellabella M. Safety and efficacy of transurethral resection of prostate glands up to 150 ml: a prospective comparative study with 1 year of followup. J Urol 2004:172:611-5.
• 7. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol 2006:50:969-79.
• 8. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008:180:246-9.
• 9. Montague DK. Artificial urinary sphincter: long-term results and patient satisfaction. Adv Urol 2012;2012:835290.
• 10. Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS. Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic. Urology 2015;86:602-7.
• 11. Trigo Rocha F, Gomes CM, Mitre AI, Arap S, Srougi M. A prospective study evaluating the efficacy of the artificial sphincter AMS 800 for the treatment of postradical prostatectomy urinary incontinence and the correlation between preoperative urodynamic and surgical outcomes. Urology 2008;71:85-9.
• 12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
• 13. Scott, FB., Bradley WE, Timm GW. Treatment of urinary incontinence by implantable prosthetic sphincter. J Urol 1974;112:75-80.
• 14. Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN. The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 2013;63:681-9.
• 15. Kowalczyk JJ, Spicer DL, Mulcahy JJ. Long-term experience with the double-cuff AMS 800 artificial urinary sphincter. Urology 1996;47:895-7.
• 16. Manunta A, Guille F, Patard JJ, Lobel B. Artificial sphincter insertion after radiotherapy: is it worthwhile? BJU Int 2000;85:490-2.
• 17. Biardeau X, Aharony S, AUS Consensus Group, Campeau L, Corcos J. Artificial Urinary Sphincter: Executive Summary of the 2015 Consensus Conference. Neurourol Urodyn 2016;35(Suppl 2):S5-7.
• 18. Ravier E, Fassi-Fehri H, Crouzet S, Gelet A, Abid N, Martin X. Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int 2015;115:300-7.
• 19. Sathianathen NJ, McGuigan SM, Moon DA. Outcomes of artificial urinary sphincter implantation in the irradiated patient. BJU Int 2014;113:636-41.
• 20. de Cogain MR, Elliott DS. The impact of an antibiotic coating on the artificial urinary sphincter infection rate. J Urol 2013;190:113-7.
• 21. Bordenave M, Rouprêt M, Taksin L, Parra J, Cour F, Richard F, et al. Long-term results of the treatment of urinary incontinence with bulbar implantation of artificial urinary sphincter in men: a single-center experience. Prog Urol 2011;21:277-82.
• 22. Montague DK, Angermeier KW. Postprostatectomy urinary incontinence: the case for artificial urinary sphincter implantation. Urology 2000;55:2-4.
• 23. Suarez OA, McCammon KA. The artificial urinary sphincter in the management of incontinence. Urology 2016;92:14-9.
• 24. Motley RC, Barrett DM. Artificial urinary sphincter cuff erosion. Experience with reimplantation in 38 patients. Urology 1990;35:215-8.
• 25. Bryan DE, Mulcahy JJ, Simmons GR. Salvage procedure for infected noneroded artificial urinary sphincters. J Urol 2002;168:2464-6.
• 26. Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C, et al. Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology 2014;84:934-8.
• 27. Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM. Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol 2008;179:1912-6.
• 28. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37-43.
• 29. O'Connor RC, Nanigian DK, Patel BN, Guralnick ML, Ellision LM, Stone AR. Artificial urinary sphincter placement in elderly men. Urology 2007;69:126-8.
• 30. Ziegelmann MJ, Linder BJ, Rivera ME, Viers BR, Rangel LJ, Elliott DS. Outcomes of artificial urinary sphincter placement in octogenarians. Int J Urol 2016;23:419-23.