Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study

Queissert, Fabian; Huesch, Tanja; Kretschmer, Alexander; Anding, Ralf; Kurosch, M.; Kirschner‐Hermanns, Ruth; Pottek, Tobias; Olianas, Roberto; Friedl, Alexander; Pfitzenmaier, Jesco; Naumann, Carsten Maik; Wotzka, Carola; Nyarangi‐Dix, Joanne; Hoffmann, Torben; Herrmann, Edwin; Obaje, Alice; Rose, Alison; Homberg, Roland; Abdunnur, Rudi; Loertzer, Hagen; Bauer, Ricarda M.; Haferkamp, Axel; Schrader, Andres Jan

doi:10.5213/inj.1938032.016

Cited by 16 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As expected, AUS survival rates decreased over time. We found AUS survival rate of 17% at 14 years, and similar findings have been reported by Boswell et al 20 One possible explanation for differences in previously reported explantation rates could be due to the follow‐up time The global explanation rate has been shown in several studies as 21.1% 21 and 29.1%, 22 and in our study, 23.2% had AUS removal. In a study reported in 2020, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received AMS 800, and showed better continence results and lower revision rates at high‐volume centers 23 .…”

Section: Discussionsupporting

confidence: 90%

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long‐term real‐world nationwide analysis

Plata

Zuluaga

Santander

et al. 2022

Neurourology and Urodynamics

View full text Add to dashboard Cite

Purpose The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high‐volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. Methods Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan‐Meier analysis was used to determine AUS survival rate. Results Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow‐up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow‐up with the device still in place, 80.7% defined their urinary condition as “does not cause or causes minor discomfort,” and 99% would recommend the device to a friend or relative in the same condition. Conclusions This series from a community‐based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real‐world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision‐making process before the procedure.

show abstract

Section: Discussionsupporting

confidence: 90%

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long‐term real‐world nationwide analysis

Plata

Zuluaga

Santander

et al. 2022

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…Thereby, this is true for both studies showing the lowest stricture rates in case of AUS erosion. The impact of AUS cuff size on outcomes and complication rates is still discussed ( 25 ), though most authors did not report increased adverse results for the implantation of smaller AUS cuff sizes ( 26 , 27 ). Regarding urethral erosions, our findings together with Agarwal et al might point to a possible influence on urethral erosions and following risk of urethral stricture formation, which needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

“…In contrast, Utomo et al already detected unspecified tissue damage requiring revision during a short followup in 3.7 % of patients who received the adjustable balloon device ProAct (9). Urethral erosion after AUS implantation is also attributed to urethral atrophy caused by circular compression and impaired perfusion (12,13). Apart from the risk of urethral erosion, urethral atrophy in the cuff area also harbors the risk of recurrent incontinence through inadequate urethral closure.…”

Section: Discussionmentioning

confidence: 99%

Compression or obstruction: Prospective analysis of the function of the adjustable transobturator male system (ATOMS) based on pre- and postoperative urodynamic data

Queissert

Bruecher

Ruiz

et al. 2021

CUAJ

Self Cite

View full text Add to dashboard Cite

Introduction: This analysis, based on pre- and postoperative urodynamic data, is the first to elucidate the influence of the adjustable transobturator male system (ATOMS, A.M.I. GmbH, Feldkirch, Austria) on the lower urinary tract and disclose possible obstructive properties. Methods: A prospective study was performed in patients who had stress urinary incontinence and were scheduled for ATOMS implantation after radical prostatectomy. Apart from continence assessment (24-hour pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-SF]), urodynamic testing was done with International Continence Society (ICS)-standardized pressure-flow analysis before and after ATOMS implantation/adjustment. The Wilcoxon signed-rank test was used for statistical analysis. Results: The analysis included 12 consecutive patients from two centers (mean 69 years) with a mean followup of 246 days. Median urine leakage dropped from 240 (72–1250) to 70 (0–700) g/24 hours postoperatively, with a pad reduction of 4 to 0.9 pads/day. Pressure-flow analysis revealed a significant change only in the bladder outlet obstruction index (BOOI). The bladder contractility index, intravesical pressure conditions, and uroflowmetry were not significantly affected. None of the patients showed de novo obstruction postoperatively in the ICS analysis. Conclusions: The ATOMS significantly increases the BOOI in conjunction with good continence results. However, no case reached pathological level according to the BOOI and thus there is no potential danger to the lower urinary tract or urethral integrity.

show abstract

Artificial Urinary Sphincter Cuff Size Predicts Outcome in Male Patients Treated for Stress Incontinence: Results of a Large Central European Multicenter Cohort Study

Cited by 16 publications

References 22 publications

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long‐term real‐world nationwide analysis

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long‐term real‐world nationwide analysis

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

Compression or obstruction: Prospective analysis of the function of the adjustable transobturator male system (ATOMS) based on pre- and postoperative urodynamic data

Contact Info

Product

Resources

About