Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

Bernard, Clémence; Bentellis, Imad; El-Akri, Mehdi; Durand, Matthieu; Guérin, Olivier; Cornu, Jean-Nicolas; Cousin, Tiffany; Gaillard, Victor; Dupuis, Hugo; Tricard, Thibault; Hermieu, Nicolas; Lecoanet, Pierre; Bruyère, Franck; Capon, Grégoire; Biardeau, Xavier; Karam, Elias; Saussine, Christian; Hermieu, Jean-François; Peyronnet, Benoit; Game, Xavier; Brierre, Thibaut

doi:10.1016/j.fjurol.2024.102604

The French Journal of Urology

2024

DOI: 10.1016/j.fjurol.2024.102604

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Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

Clémence Bernard,

Imad Bentellis,

Mehdi El-Akri

et al.

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Cited by 2 publications

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Artificial urinary sphincter: recent developments and the way forward

Reus,

Tran,

Mozer

et al. 2024

Current Opinion in Urology

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Purpose of review The AMS 800 has dominated the treatment of postprostatectomy urinary incontinence (PPUI) due to intrinsic sphincter deficiency (ISD) for five decades. A narrative review from June 2022 to June 2024 was conducted using ‘artificial urinary sphincter’ (AUS) MeSH terms in Embase. We extracted information on innovative AUS, randomized controlled trials (RCTs) or prospective studies, and systematic reviews. We evaluated the latest guidelines and consensus and analyzed current trends to discuss options for advancing AUS practices. Recent findings Of 465 papers identified, 320 were excluded (irrelevant, duplicates, non-AUS devices, non-English, veterinary), and 145 were reviewed, with 24 selected: seven on novel AUS in development, 7 with higher-level evidence (1 RCT, 1 prospective, 4 systematic reviews, 1 nonsystematic review), and 9 retrospective relevant studies [pressure regulating balloon (PRB), revision strategies, radiotherapy history, manual dexterity/cognition, transscrotal vs. transperineal approach]. The final paper summarized current guidelines from Asia & Pacific on AUS. Summary In the past 2 years, six novel AUS have emerged, two female RCTs are ongoing, the SATURN study published its 1-year outcomes, and four systematic reviews on female AUS were conducted. These findings enhance evidence levels and position novel AUS to challenge the Gold Standard.

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Artificial urinary sphincter: recent developments and the way forward

Reus,

Tran,

Mozer

et al. 2024

Current Opinion in Urology

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Primary and revision artificial urinary sphincter for stress urinary incontinence post-radical prostatectomy: a surgery with high rewards but high risks?

Roth,

Hjelle,

Johansen

et al. 2024

SJU

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Objectives: To evaluate the efficacy of artificial urinary sphincter (AUS) implantation in men with stress urinary incontinence post-radical prostatectomy and the complication burden with a focus on identifying potential risk factors for reoperation as well as determining the fate of revision surgeries. Methods: Retrospective analysis of consecutive patients undergoing primary AUS (pAUS) and revision AUS (rAUS) implantation at a tertiary centre. Logistic regression was employed to identify risk factors for reoperation associated with non-mechanical failures. Kaplan Meier method was applied to generate implant patency curves. Results: Over 11-years, 108 and 28 patients underwent pAUS and rAUS, respectively. Amongst the former group, a 30-day complication rate of 20.4% was found with a complete (zero pad) dryness rate at follow-up of 49.1%. Post-operative infection was the commonest occurring complication in 7.4%. After pAUS, 27.8% underwent reoperation with cuff erosion being the top indication in 46.7%. Diabetes was a significant predictor for reoperation with an associated 3.6-fold increased risk. The 3-year and 5-year device survival rates without reoperation for pAUS were 80% and 76%, respectively. For rAUS, complete dryness rates achieved were lower at 32.1%. The rate of reoperation was higher at 42.9% with a significantly worse survival probability compared to pAUS (p = 0.024). Conclusions: Whilst men may achieve complete dryness after pAUS, the potential complication burden and risk of reoperation are not low, and patients need to be counselled regarding this. Chances of continence success are lower when revision surgery is performed with a worse implant survival probability.

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Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures

Cited by 2 publications

References 13 publications

Artificial urinary sphincter: recent developments and the way forward

Artificial urinary sphincter: recent developments and the way forward

Primary and revision artificial urinary sphincter for stress urinary incontinence post-radical prostatectomy: a surgery with high rewards but high risks?

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