Advertisement

Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation

  • Khalid SayedahmedEmail author
  • Roberto Olianas
  • Bjoern Kaftan
  • Mohamed Omar
  • Mohamed El Shazly
  • Maximilian Burger
  • Roman Mayr
  • Bernd Rosenhammer
Original Article
  • 21 Downloads

Abstract

Purpose

To evaluate the impact of previous urethroplasty on complication rates and postoperative continence after primary artificial urinary sphincter (AUS) implantation in male patients with severe stress urinary incontinence.

Patients and methods

A prospective evaluation of patients undergoing primary AUS implantation was conducted. Patients with previous radiotherapy, AUS implantation or urethral stent placement were excluded. Main endpoints were postoperative continence and complication rates including necessity of AUS explantation. Kaplan–Meier analysis evaluated explantation-free survival. Logistic regression analyses were performed to identify potential predictors for AUS explantation.

Results

105 patients were included with a mean follow-up of 76.6 months (SD 15.9). 30 of these patients had a history of urethroplasty. Postoperatively, 96.2% of all patients were objectively continent (≤ 1 pad/day). No differences in postoperative continence and early complication rates were observed. Concerning long-term complications, infection, mechanical implant failure, and tissue atrophy were also comparable. Overall sphincter erosion rate was 12.3%, but significantly higher in urethroplasty patients (23.3% vs. 8.0%, p = 0.038) and sphincter explantation rate was threefold higher (p = 0.016) in the urethroplasty group. Furthermore, explantation-free survival was reduced compared to the non-urethroplasty group (p = 0.044). On logistic regression analysis, the previous urethroplasty was the only significant predictor for AUS explantation (p = 0.016).

Conclusion

AUS implantation in patients with former urethroplasty can provide satisfying results. Compared to patients without the previous urethroplasty, the higher risk of cuff erosion and AUS explantation has to be addressed during preoperative consultation. Patients with the previous urethroplasty with grafting, long strictures and previous visual internal urethrotomy might be at highest risk.

Keywords

Artificial urinary sphincter Urethroplasty Stress urinary incontinence Outcome Cuff erosion Explantation 

Notes

Author contributions

KS: project development, data collection, and analysis, manuscript writing. RO: manuscript editing. BK: data collection. MO: data collection. MS: data collection. MB: manuscript editing. RM: manuscript editing. BR: project development, data analysis, and manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The study has been performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL (2009) Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol 11(3):145–165Google Scholar
  2. 2.
    Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A et al (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417Google Scholar
  3. 3.
    Kim PH, Pinheiro LC, Atoria CL, Eastham JA, Sandhu JS, Elkin EB (2013) Trends in the use of incontinence procedures after radical prostatectomy: a population based analysis. J Urol 189(2):602–608Google Scholar
  4. 4.
    Comiter CV (2010) Male incontinence surgery in the 21st century: past, present, and future. Curr Opin Urol 20(4):302–308Google Scholar
  5. 5.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention. Eur Urol 50(5):969–979 (discussion 80) Google Scholar
  6. 6.
    Madersbacher S, Marberger M (1999) Is transurethral resection of the prostate still justified? BJU Int 83(3):227–237Google Scholar
  7. 7.
    Kuntz RM, Lehrich K, Ahyai SA (2008) Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 53(1):160–166Google Scholar
  8. 8.
    Naspro R, Suardi N, Salonia A, Scattoni V, Guazzoni G, Colombo R et al (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol 50(3):563–568Google Scholar
  9. 9.
    Elliott DS, Barrett DM (1998) Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol 159(4):1206–1208Google Scholar
  10. 10.
    Montague DK, Angermeier KW, Paolone DR (2001) Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. J Urol 166(2):547–549Google Scholar
  11. 11.
    Raj GV, Peterson AC, Toh KL, Webster GD (2005) Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol 173(4):1242–1245Google Scholar
  12. 12.
    Leibovich BC, Barrett DM (1997) Use of the artificial urinary sphincter in men and women. World J Urol 15(5):316–319Google Scholar
  13. 13.
    Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB (2007) 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol 177(3):1021–1025Google Scholar
  14. 14.
    Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM (2008) Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol 179(5):1912–1916Google Scholar
  15. 15.
    Lai HH, Boone TB (2012) Complex artificial urinary sphincter revision and reimplantation cases–how do they fare compared to virgin cases? J Urol 187(3):951–955Google Scholar
  16. 16.
    Wang R, McGuire EJ, He C, Faerber GJ, Latini JM (2012) Long-term outcomes after primary failures of artificial urinary sphincter implantation. Urology 79(4):922–928Google Scholar
  17. 17.
    Brant WO, Erickson BA, Elliott SP, Powell C, Alsikafi N, McClung C et al (2014) Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology 84(4):934–938Google Scholar
  18. 18.
    Aaronson DS, Elliott SP, McAninch JW (2008) Transcorporal artificial urinary sphincter placement for incontinence in high-risk patients after treatment of prostate cancer. Urology 72(4):825–827Google Scholar
  19. 19.
    Sundaram V, Cordon BH, Hofer MD, Morey AF (2016) Is risk of artificial urethral sphincter cuff erosion higher in patients with penile prosthesis? J Sex Med 13(9):1432–1437Google Scholar
  20. 20.
    Mock S, Dmochowski RR, Brown ET, Reynolds WS, Kaufman MR, Milam DF (2015) The impact of urethral risk factors on transcorporeal artificial urinary sphincter erosion rates and device survival. J Urol 194(6):1692–1696Google Scholar
  21. 21.
    Kretschmer A, Buchner A, Grabbert M, Stief CG, Pavlicek M, Bauer RM (2016) Risk factors for artificial urinary sphincter failure. World J Urol 34(4):595–602Google Scholar
  22. 22.
    McGeady JB, McAninch JW, Truesdale MD, Blaschko SD, Kenfield S, Breyer BN (2014) Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol 192(6):1756–1761Google Scholar
  23. 23.
    Ahyai SA, Ludwig TA, Dahlem R, Soave A, Rosenbaum C, Chun FK et al (2016) Outcomes of single- vs double-cuff artificial urinary sphincter insertion in low- and high-risk profile male patients with severe stress urinary incontinence. BJU Int 118(4):625–632Google Scholar
  24. 24.
    Andersen JT, Blaivas JG, Cardozo L, Thuroff J (1992) Seventh report on the standardisation of terminology of lower urinary tract function: lower urinary tract rehabilitation techniques. Scand J Urol Nephrol 26(2):99–106Google Scholar
  25. 25.
    Levy ME, Elliott SP (2017) Graft use in bulbar urethroplasty. Urol Clin N Am 44(1):39–47Google Scholar
  26. 26.
    Browne BM, Vanni AJ (2017) Use of alternative techniques and grafts in urethroplasty. Urol Clin N Am 44(1):127–140Google Scholar
  27. 27.
    Raj GV, Peterson AC, Webster GD (2006) Outcomes following erosions of the artificial urinary sphincter. J Urol 175(6):2186–2190 (discussion 90) Google Scholar
  28. 28.
    Guralnick ML, Miller E, Toh KL, Webster GD (2002) Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol 167(5):2075–2078 (discussion 9) Google Scholar
  29. 29.
    Lee D, Zafirakis H, Shapiro A, Westney OL (2012) Intermediate outcomes after transcorporal placement of an artificial urinary sphincter. Int J Urol 19(9):861–866Google Scholar
  30. 30.
    Blah M, Caremel R, Sibert L, Bugel H, Grise P (2008) Treatment of male urinary incontinence by artificial urinary sphincter with intracavernous cuff. Prog Urol 18(2):114–119Google Scholar
  31. 31.
    Wiedemann L, Cornu JN, Haab E, Peyrat L, Beley S, Cathelineau X et al (2013) Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series. BJU Int 112(8):1163–1168Google Scholar
  32. 32.
    Le Long E, Rebibo JD, Nouhaud FX, Grise P (2016) Transcorporal artificial urinary sphincter in radiated and non-radiated compromised urethra. Assessment with a minimum 2 year follow-up. Int Braz J Urol 42(3):494–500Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyMenoufia UniversityShebeen El KomEgypt
  2. 2.Department of UrologyRhein-Maas HospitalWürselenGermany
  3. 3.Department of UrologyLueneburg HospitalLüneburgGermany
  4. 4.Department of Urology, Caritas St. Josef Medical CentreUniversity of RegensburgRegensburgGermany
  5. 5.DürenGermany

Personalised recommendations