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

Ajay, Divya; Zhang, JJ H.; Gupta, Shubham; Selph, J. Patrick; Belsante, Michael; Lentz, Aaron; Webster, George D.; Peterson, Andrew C.

doi:10.1016/j.juro.2015.04.106

Cited by 36 publications

(24 citation statements)

References 28 publications

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“…32 In a case series of 61 men after a failed primary male sling procedure, continence was higher with placement of an AUS, rather than by a secondary sling procedure (treatment failure of 6% and 55%, respectively). 33 We demonstrated that institutional caseload is associated to dry rate and surgical revision. A median ICL above 39 and 42 is a protective factor in terms of dry rate and surgical revision respectively.…”

Section: Discussionmentioning

confidence: 77%

“…In a small prospective case series assessing clinical results of AUS placement after failure of male sling surgery, mid‐term results evidenced that results of this procedure are comparable to first‐line AUS implantation in terms of continence (87%) and complications (17%) . In a case series of 61 men after a failed primary male sling procedure, continence was higher with placement of an AUS, rather than by a secondary sling procedure (treatment failure of 6% and 55%, respectively) …”

Section: Discussionmentioning

confidence: 97%

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Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi‐institutional cohort of patients with mid‐term follow‐up

Tutolo

Cornu

Bauer

et al. 2018

Neurourology and Urodynamics

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Aims To assess efficacy and safety as well as predictive factors of dry rate and freedom from surgical revision in patients underwent AUS placement. The artificial urinary sphincter (AUS) is still considered the standard for the treatment of moderate to severe post‐prostatectomy stress urinary incontinence (SUI). However, data reporting efficacy and safety from large series are lacking. Methods A multicenter, retrospective study was conducted in 16 centers in Europe and USA. Only primary cases of AUS implantation in non‐neurogenic SUI after prostate surgery, with a follow‐up of at least 1 year were included. Efficacy data (continence rate, based on pad usage) and safety data (revision rate in case of infection and erosion, as well as atrophy or mechanical failure) were collected. Multivariable analyses were performed in order to investigate possible predictors of the aforementioned outcomes. Results Eight hundred ninety‐two men had primary AUS implantation. At 32 months mean follow‐up overall dry rate and surgical revision were 58% and 30.7%, respectively. Logistic regression analysis showed that patients without previous incontinence surgery had a higher probability to be dry after AUS implantation (OR: 0.51, P = 0.03). Moreover institutional case‐load was positively associated with dry rate (OR: 1.18; P = 0.005) and freedom from revision (OR: 1.51; P = 0.00). Conclusions The results of this study showed that AUS is an effective option for the treatment of SUI after prostate surgery. Moreover previous incontinence surgery and low institutional case‐load are negatively associated to efficacy and safety outcomes.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 97%

Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi‐institutional cohort of patients with mid‐term follow‐up

Tutolo

Cornu

Bauer

et al. 2018

Neurourology and Urodynamics

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“…There is some evidence to consider that AUS placement is superior to a secondary transobturator male sling after primary sling failure [19], but randomized trials for this specific indication are lacking. On the other hand, recurrent or persistent SUI after AUS may result from different scenarios leading to explant in 1 out of 5 devices in the short term [20].…”

Section: Discussionmentioning

confidence: 99%

Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study

et al. 2018

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Objectives: Feasibility study to evaluate the efficacy and safety of Adjustable Transobturator Male System (ATOMS) after failed surgical devices for male stress urinary incontinence (SUI). Materials and Methods: Thirty patients were implanted with ATOMS after they were implanted with surgical device/s previously. SUI severity was evaluated as dryness (0–1 pad/day), mild (2 pads/day), moderate (3–5 pads/day), or severe (≥6 pads/day). Change in pad-test and pad-count after adjustment, operative parameters, patient satisfaction, and number and grade of complications were investigated. Results: Previous failed treatment methods were artificial urinary sphincter (AUS; n = 19), Advance (n = 10), and Virtue (n = 1). Six cases had multiple previous treatments. Preoperative SUI was mild 6 (20%), moderate 11 (36.7%), and severe 13 (43.3%). Median pad-test decreased from 435 mL baseline to 10 mL after adjustment and pad-count from 4 to 0. Dry-rate was 76.7 and 83.3% declared satisfied. Postoperative SUI distribution was mild in 3 (10%) and moderate in 4 (13.3%). No patient had urinary retention after catheter removal. Complications presented in 4 (13.3%; 3 grade-I, 1 grade-II). After a median of 24 months follow-up, no system experienced infection or urethral erosion and 1 (3.3%) was removed for inefficacy. Conclusion: Based on short-term efficacy and patient satisfaction, ATOMS can be a realistic alternative for male SUI after other failed systems, including AUS. The absence of urethral erosion and limited infective problems makes this alternative attractive for cases with previous failed treatments.

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“…Early and mild degrees of SUI after prostate surgery may be improved by intensive pelvic floor muscle training and life style modifications but when conservative therapy options fail, surgical treatment is recommended . The artificial urinary sphincter (AUS), by far the most frequently implanted device worldwide, is the established ‘gold standard’ in severe UI and is superior to a secondary male sling as reported in the literature . Yet the last few years have been marked by a rapid development of various adjustable or non‐adjustable sling systems of different designs to treat milder forms of SUI without any mechanical components that need to be de‐activated or activated by the patient himself .…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study

et al. 2016

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

Cited by 36 publications

References 28 publications

Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi‐institutional cohort of patients with mid‐term follow‐up

Efficacy and safety of artificial urinary sphincter (AUS): Results of a large multi‐institutional cohort of patients with mid‐term follow‐up

Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study

Long‐term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study

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