Raşit ALTINTAŞ, Mehmet Ceyhun ÖZYURT, Adnan ŞİMŞİR

Artificial urinary sphincter implantation: what do patients and urologists face?

To investigate the main problems faced by patients undergoing artificial urinary sphincter (AUS) implantation and the important factors that the surgeon should take into consideration in predicting these problems. Postprostatectomy incontinence continues to be a complication that most severely impairs the quality of life. Materials and methods: Of 82 initial patients, 64 patients with complete data who responded positively to the invitation for examination were divided into 3 groups: patients with implant-tissue interaction, patients with no problems, and those with mechanical failure. Univariate analysis, Student's t-test, Pearson's chi-square test, logistic regression, and Kaplan-Meier analysis were used in this study. Results: Of the 64 patients, 20 (31.2%) were reoperated on with a mean follow-up of 62 (range: 1-120) months. It was found that the risk of urethral erosion was higher in patients with obesity (P = 0.04), diabetes (P < 0.0001), radical prostatectomy (P < 0.0001), and adjuvant radiotherapy (P < 0.0001), and in those with the suspicion of urethral stricture who would undergo sphincter implantation within at least 3 months after the latest surgical treatment of urethral stricture, compared to other patients (P < 0.0001). Additionally, we found that surgical experience also had a strong effect on the risk of urethral erosion. Conclusion: Given increasing medicolegal awareness, patients should be informed of the possible need for reoperation, and those in the specific patient groups mentioned above should particularly be notified of a higher risk before implantation of an AUS.

Anahtar Kelimeler:

Key words: Urinary sphincter, artificial, erosion, incontinence, prostatectomy

Artificial urinary sphincter implantation: what do patients and urologists face?

Keywords:

Key words: Urinary sphincter, artificial, erosion, incontinence, prostatectomy,

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Benoit RM, Naslund MJ, Cohen J. Complications aft er radical retropubic prostatectomy in the Medicare population. Urology 2000; 56: 116-20.
Herr HW. Quality of life of incontinent men aft er radical prostatectomy. J Urol 1994; 151: 652-4.
Klinger HC, Marberger M. Incontinence aft er radical prostatectomy: surgical treatment options. Curr Opin Urol 2006; 16: 60-4.
Bianco FJ Jr, Riedel ER, Begg CB, Kattan MW, Scardino PT. Variations among high volume surgeons in the rate of complications aft er radical prostatectomy: further evidence that technique matters. J Urol 2005; 173: 2099-103.
Fowler FJ Jr, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment aft er radical prostatectomy. Th e National Medicare Experience: 1988-1990 (updated June 1993). Urology 1993; 42: 622-9. 6. Reynolds WS, Patel R, Msezane L, Lucioni A, Rapp DE, Bales GT. Current use of artifi cial urinary sphincters in the United States. J Urol 2007; 178: 578-83.
Raj GV, Peterson AC, Webster GD. Outcomes following erosions of the artifi cial urinary sphincter. J Urol 2006; 175: 2186-90. 8. Bartelink ML, Hoek L, Freriks JP, Rutten GE. Infections in patients with type 2 diabetes in general practice. Diabetes Res Clin Pract 1998; 40: 15-9. 9. Tecilazich F, Dinh T, Veves A. Treating diabetic ulcers. Expert Opin Pharmacother 2011; 12: 593-606.
Prasad SM, Gu X, Lavelle R, Lipsitz SR, Hu JC. Comparative eff ectiveness of perineal versus retropubic and minimally invasive radical prostatectomy. J Urol 2011; 185: 111-5.
Gomha MA, Boone TB. Artifi cial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 2002; 167: 591-6.
Walsh IK, Williams SG, Mahendra V, Nambirajan T, Stone AR. Artifi cial urinary sphincter implantation in the irradiated patient: safety, effi cacy and satisfaction. BJU Int 2002; 89: 364- 8.
Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB. 13 years of experience with artifi cial urinary sphincter implantation at Baylor College of Medicine. J Urol 2007; 177: 1021-5.
Elliott DS, Barrett DM. Mayo Clinic long-term analysis of the functional durability of the AMS 800 artifi cial urinary sphincter: a review of 323 cases. J Urol 1998; 159: 1206-11.
Manunta A, Guille P, Patard JJ, Lobel B. Artifi cial sphincter insertion aft er radiotherapy: is it worthwhile? BJU Int 2000; 85: 490-6.
Martins FE, Boyd SD. Artifi cial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: are they less favorable candidates? J Urol 1995; 153: 1188-93.
Perez LM, Webster GD. Successful outcome of artifi cial urinary sphincters in men with post-prostatectomy urinary incontinence despite adverse implantation features. J Urol 1992; 148: 1166-70.
Elliott DS, Boone TB. Combined stent and artifi cial urinary sphincter for management for severe recurrent bladder neck contracture and stress incontinence aft er prostatectomy: a long term evaluation. J Urol 2001; 165: 413-7.
Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003; 21: 401-5.