Can TUYGUN, Abdurrahim İMAMOĞLU, Fuat DEMİREL, Göksel GÖKTUĞ, Orhan YİĞİTBASI, Hasan BAKIRTAŞ

Yapay idrar sfinkter implantasyonu geçirmis hastalarda kaf erozyonları

Amaç: Yapay idrar sfinkter (YİS) implantasyonu sonrası kaf erozyon oranlarını verisk faktörlerini sunmak. Gereç ve Yöntem : 1989–2007 tarihleri arasında, sfinkterik yetersizliğe bağlı prostatektomi sonrasında idrar kaçırmanın tedavisi için YİS konulmus hastalar arasından,kaf erozyonları nedeniyle reoperasyon geçirmis hastaların kayıtları gözden geçirildi. Bulgular: YİS implantasyonu geçirmis 51 hastanın 19’unun (%37) implantı, erozyonlar nedeniyle çıkartılmıstı. YİS, 11 hastada radikal prostatektomi, 4’ünde transüretral prostatektomi ve diğer 4’ünde transvezikal prostatektomi sonrasında yerlestirilmisti. YİS implantasyonları ile erozyonlar sırasında hastaların ortalama yasları,sırasıyla, 67 (56–70) ve 70 (65–75) idi. İmplantasyonlar ile erozyonlar arasındageçen ortalama süre 29 ay (8–204) idi. 19 hastanın 11’inde (%58) koroner arter hastalığı, hipertansiyon, kronik obstrüktif akciğer hastalığı, diabetes mellitus gibi birveya birden fazla sistemik hastalıklar vardı. YİS öncesinde, 5 hastanın (%26) 2’si,üretral darlık tedavisi için internal üretrotomi (İÜ) ve dilatasyon, 3’ü üretral stentimplantasyonu geçirmisti. 19 kaf erozyonlu hastanın altısında (2 üretral stentli, 2 İÜ’li) acil sistemik hastalıkların tedavisi sırasında idrar çıkısınıntakibi için üretral kateter uygulanma öyküsü, birinde ise sol üreter dilatasyonununtedavisi için üreterorenoskopi geçirme öyküsü vardı. Geri kalan 12 hastada ise saptanabilir bir neden yoktu. Sonuç: YİS implantasyonu öncesinde ve sonrasında ortaya çıkan bir veya daha fazlasistemik hastalıkların varlığı ve/veya geçirilmis transüretral girisimler, erozyonlariçin önemli risk faktörleri olabileceğini düsünmekteyiz.

The cuff erosions in patients who underwent artificial urinary sphincter implantation

Purpose: To present the rates of cuff erosion and its risk factors after artificial urinary sphincter (AUS) implantation. Material and Method: Between 1989–2007, the records of patients who had undergone reoperation due to cuff erosions were reviewed amongst patients who hadundergone AUS implantation for the treatment of postprostatectomy incontinencedue to sphincteric insufficiency. Results: AUS implant was removed because of erosions in 19 of the 51 patients whohad undergone AUS implantation. AUS was implanted in 11, 4 and 4 patients follo- wing radical prostatectomy, transurethral prostatectomy and transvesical prostatectomy, respectively. Mean patient age during AUS implantations and erosions were 67years (56–70) and 70 years (65–75), respectively. Mean interval time between implantations and erosions were 29 months (8–204). Of the 19 patients, 11 (58%) hadone or more than one systemic disorders such as coronary artery disease, hypertension, chronic obstructive pulmoner disease, and diabetes mellitus. Of the 5 patients,2 had undergone internal urethrotomy (IU) and dilatation, 3 had undergone urethralstent implantation for the treatment of urethral stricture before AUS implantation.In history of 19 patients, 6 (2 had urethral stent, 2 had (IU) had undergone urethralcatheterization for monitoring of the urine volume output during the treatment ofacut systemic disorder, 1 had undergone ureterorenoscopy for left ureteral dilatation.There was no identifiable causes in the remaining 12 patients. Conclusion: We think that the existence of systemic disorders and/or transurethralinterventions before or after AUS implantation may have important risk factors forerosions

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