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The role of urethral ligation after AUS failure and end stage urethra

  • Urology - Original Paper
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Abstract

Purpose

To provide our single-center experience with an approach to refractory stress urinary incontinence (SUI) with permanent urethral ligation (PUL) and suprapubic tube (SPT) placement, in hopes of contributing to the limited body of research surrounding this surgical treatment option for patients with end-stage urethra (ESU).

Methods

All patients undergoing PUL with SPT placement from 01/01/2018 to 04/30/2022 were identified from an institutional database. Institutional Review Board exempt status was granted for the conduct of this study. Patients were seen postoperatively at 1 month and 1 year. If there were any concerns of incontinence, an antegrade urethrogram via the SPT was performed. Descriptive statistics were used to evaluate patients.

Results

Seven patients underwent PUL with SPT in our timeframe and were included in the study. All patients previously had an AUS placed, and two patients had a urethral sling previously placed. The median follow-up time was 21 months, ranging between 2 and 48 months. Complications included bladder spasms (43%) and continued leakage per urethra (14%). Of the 7 patients, 6 have reported continence through their urethra at their most recent follow-up.

Conclusion

This initial data suggest that PUL with SPT placement may be a viable surgical approach to treating refractory SUI, especially for patients with ESU who wish to avoid the morbidity associated with more formal supravesical diversion. Further study of this technique and longer follow-up is required to determine its long-term efficacy and tolerability for patients.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, USA

    Peter J. Arnold, Mary E. Soyster, Ramzy T. Burns & Matthew J. Mellon

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  1. Peter J. Arnold
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  2. Mary E. Soyster
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  3. Ramzy T. Burns
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Correspondence to Peter J. Arnold.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The Indiana University School of Medicine Institutional Review Board exempt status was granted for the conduct of the study. As this was performed as a retrospective review of outcomes, patients did not undergo separate consent from the procedural consent prior to surgery.

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Arnold, P.J., Soyster, M.E., Burns, R.T. et al. The role of urethral ligation after AUS failure and end stage urethra. Int Urol Nephrol 54, 2827–2831 (2022). https://doi.org/10.1007/s11255-022-03315-0

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