Skip to main content

Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra

Abstract

Purpose

To compare transcorporal vs bulbar artificial urinary sphincter (AUS) implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this population.

Methods

The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. The primary endpoint was device explantation-free survival. Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal.

Results

464 patients were included for analysis. 88 patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. Explantation-free survival was similar in both groups (estimated 5-year explantation free survival rates 55.3% vs. 58.4%; p=0.98). In the subgroup of patients with a history of previous AUS explantation, transcorporal approach tended to bring longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate analysis, the only risk factor of shorter explantation-free survival was the history of previous AUS explantation (HR=2.65; p=0.01).

Conclusions

Transcorporal AUS implantation was not associated with longer explantation-free survival. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival and this subgroup of patients may be the only one to draw benefits of transcorporal AUS implantation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

AUS explantation. Log-rank test: p = 0.096. NA not applicable

References

  1. 1.

    Hald T, Byström J, Alfthan O (1975) Treatment of urinary incontinence by the Scott-Bradley-Timm artificial sphincter. A report of eight cases. Urol Res 3:133–137

    CAS  Article  Google Scholar 

  2. 2.

    Yafi FA, Powers MK, Zurawin J, Hellstrom WJG (2016) Contemporary review of artificial urinary sphincters for male stress urinary incontinence. Sex Med Rev 4:157–166

    Article  Google Scholar 

  3. 3.

    Ortiz NM, Wolfe AR, Baumgarten AS, Ward EE, VanDyke ME, Hudak SJ et al (2020) Artificial urinary sphincter cuff erosion heat map shows similar anatomic characteristics for transcorporal and standard approach. J Urol. https://doi.org/10.1097/JU0000000000001148

    Article  PubMed  Google Scholar 

  4. 4.

    Moser DC, Kaufman MR, Milam DF, Johnsen NV, Cleves MA, Broghammer JA et al (2018) Impact of radiation and transcorporeal artificial sphincter placement in patients with prior urethral cuff erosion: results from a retrospective multicenter analysis. J Urol 200:1338–1343

    Article  Google Scholar 

  5. 5.

    Sayedahmed K, Olianas R, Kaftan B, Omar M, El Shazly M, Burger M et al (2020) Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation. World J Urol 38:183–191

    CAS  Article  Google Scholar 

  6. 6.

    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 84:934–938

    Article  Google Scholar 

  7. 7.

    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 192:1756–1761

    Article  Google Scholar 

  8. 8.

    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 167:2075–2078 (discussion 2079)

    Article  Google Scholar 

  9. 9.

    Redmond EJ, Tong S, Zemp L, Hoy N, Rourke KF (2020) Improved artificial urinary sphincter outcomes using a transcorporal cuff placement in patients with a “fragile urethra.” Can Urol Assoc J J Assoc Urol Can 14:E62

    Google Scholar 

  10. 10.

    Davenport MT, Akhtar AM, Shakir NA, Baumgarten AS, Yi YA, Bergeson RL et al (2020) Comparison of 3.5 cm and transcorporal cuffs in high-risk artificial urinary sphincter populations. Transl Androl Urol 9:62–66

    Article  Google Scholar 

  11. 11.

    Linder BJ, Piotrowski JT, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS (2015) Perioperative complications following artificial urinary sphincter placement. J Urol 194:716–720

    Article  Google Scholar 

  12. 12.

    Khene Z-E, Paret F, Perrouin-Verbe M-A, Prudhomme T, Hascoet J, Nedelec M et al (2018) Artificial urinary sphincter in male patients with spina bifida: comparison of perioperative and functional outcomes between bulbar urethra and bladder neck cuff placement. J Urol 199:791–797

    Article  Google Scholar 

  13. 13.

    Tutolo M, Cornu J-N, Bauer RM, Ahyai S, Bozzini G, Heesakkers J et al (2019) Efficacy and safety of artificial urinary sphincter (AUS): results of a large multi-institutional cohort of patients with mid-term follow-up. Neurourol Urodyn 38:710–718

    Article  Google Scholar 

  14. 14.

    Viers BR, Linder BJ, Rivera ME, Rangel LJ, Ziegelmann MJ, Elliott DS (2016) Long-term quality of life and functional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence. J Urol 196:838–843

    Article  Google Scholar 

  15. 15.

    Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu J-N, Young Academic Urologists Functional Urology Group (2013) The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol 63:681–689

    Article  Google Scholar 

  16. 16.

    Manka MG, Linder BJ, Rangel LJ, Elliott DS (2020) The impact of prior external beam radiation therapy on device outcomes following artificial urinary sphincter revision surgery. Transl Androl Urol 9:67–72

    Article  Google Scholar 

  17. 17.

    Wiedemann L, Cornu J-N, 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 112:1163–1168

    Article  Google Scholar 

  18. 18.

    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 Off J Braz Soc Urol 42:494–500

    Article  Google Scholar 

  19. 19.

    Biardeau X, Aharony S, AUS Consensus Group, Campeau L, Corcos J (2016) Artificial urinary sphincter: report of the 2015 consensus conference. Neurourol Urodyn 35 Suppl 2:S8-24

    Google Scholar 

  20. 20.

    Sandhu JS, Maschino AC, Vickers AJ (2011) The surgical learning curve for artificial urinary sphincter procedures compared to typical surgeon experience. Eur Urol 60:1285–1290

    Article  Google Scholar 

  21. 21.

    Radomski SB, Ruzhynsky V, Wallis CJD, Herschorn S (2018) Complications and interventions in patients with an artificial urinary sphincter: long-term results. J Urol 200:1093–1098

    Article  Google Scholar 

  22. 22.

    Viers BR, Linder BJ, Rivera ME, Andrews JR, Rangel LJ, Ziegelmann MJ et al (2016) The impact of diabetes mellitus and obesity on artificial urinary sphincter outcomes in men. Urology 98:176–182

    Article  Google Scholar 

Download references

Funding

No disclosures. This research did not receive any specifc grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Contributions

MEA: Protocol/project development, data collection or management, data analysis, manuscript writing/editing; IB: protocol/project development, data collection or management; TT: data collection or management; TB: data collection or management; TC: data collection or management; HD: data collection or management; NH: data collection or management; VG: data collection or management; BP: data collection or management; DR: data collection or management; AP: data collection or management; FB: data collection or management; PB-L: data collection or management; DC: data collection or management; FB: data collection or management; XB: data collection or management; HM: data collection or management; LC: data collection or management; CS: data collection or management; JFH: data collection or management; PL: data collection or management; GC: data collection or management; J-NC: data collection or management; XG: data collection or management; AR: data collection or management; BP: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Mehdi El-Akri.

Ethics declarations

Conflict of interest

Benoit Peyronnet, Jean Nicolas Cornu, Xavier Gamé, Franck Bruyère, Gregoire Capon, Xavier Biardeau, Jean Francois Hermieu are consultant for Boston Scientific. Other authors have no conflicts of interest.

Informed consent

As this was a retrospective study, no informed consent was required for this study by the internal review board.

Research involving human participants and/or animals

As this was a retrospective study, this study did not contain any contact with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 102 KB)

Supplementary file2 (PDF 100 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

El-Akri, M., Bentellis, I., Tricard, T. et al. Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra. World J Urol (2021). https://doi.org/10.1007/s00345-021-03783-6

Download citation

Keywords

  • Urinary sphincter
  • artificial
  • Urinary incontinence
  • Urethra
  • Reoperation