Muhammed Abdurrahim İMAMOĞLU, AHMET NİHAT KARAKOYUNLU, CAN TUYGUN, Fevzi ÖZER, VOLKAN SELMİ, UFUK ÖZTÜRK, İsmail NALBANT

Artifisyel üriner sfinkter implantasyonunun başarı ve komplikasyonunu etkileyen faktörler ve uzun dönem sonuçlarımız (25 yıllık deneyim)

Amaç: Artifisyel Üriner Sfinkter (AUS) implantasyonu uyguladığımız olgularda yöntemin başarı ve komplikasyon oranlarını ve bunu etkileyen faktörler ile uzun dönem sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntemler:1990 ile 2015 yılları arasında Ankara Dışkapı Eğitim ve Araştırma Hastanesi Üroloji kliniğinde toplam 97AUS implantasyonu uyguladığımız 82 hastanın verileri retrospektif olarak incelendi. 11 hastaya 2 kez ve 2 hastaya 3 kez olmak üzere toplam 13 hastaya rekürren AUS implantasyonu uygulandı. Hastaların inkontinans derecesi International Consultation on Incontinence Questionnaire-Short form (ICIQ-UI SF)’a göre miktarı ise pad testi yapılarak, yaşam kaliteleri ise ICIQ-UI SF’ daki 5. soru ile ayrıca değerlendirilip kaydedildi. Hastalarımızın yaş ortalaması 66.2 (15-79) yıl iken ortalama takip süresi 76 (6-300) ay idi. Bir kez ve rekürren AUS implantasyonu şeklinde 2 grup oluşturularak sonuçları karşılaştırıldı. Bulgular: AUS uyguladığımız hastalarımızdan 57’sinde (%69.5) tam kuruluk, 15’inde (%18.2) sosyal kontinans ve 10 (%12.1) tanesinde ise inkontinans oranları saptanmıştır. Rekürren AUS uyguladığımız 13 hastamızın 5’inde (%38.4) tam kuruluk, 5’inde (%38.4) sosyal kontinans, 3’ünde (%23.07) ise kontinansa ulaşılamamıştır. Semptom skorları, inkontinans miktarları ve yaşam kaliteleri karşılaştırıldığında 1 kez AUS uygulanan grupta rekürren uygulanan gruba göre sonuçlar daha iyi gözükse de istatistiksel olarak anlamlı bulunmamıştır. 12 hastada enfeksiyon ve/ veya cuf erozyonu, 5 hastada ise mekanik arıza olmak üzere %20.7 oranında komplikasyon saptanmıştır.

Anahtar Kelimeler:

Üretra, prostatektomi, Artifisyel Üriner Sfinkter

Factors affecting the success and complications of artificial urinary sphincter implantation and our long-term outcomes (25 years of experience)

Objective: In this study we investigated the factors affecting both our success and complication rates in patients undergone artificial urinary sphincter (AUS) implantation and our long-term results. Material and Methods: Data from 82 patients which were performed a total of 97 AUS implantation (including 13 recurrent patients; 2 were performed 3 times and 11 were performed 2 times) in Urology Clinic of Ankara Dıskapı Training and Research Hospital between the years 1990 and 2015 were analyzed retrospectively. Degree and amount of incontinence and quality of life were evaluated by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), pad test and the 5th question in ICIQ-UI SF, respectively. Mean age of our patients were 66.2 (15-79) years while mean follow-up period was 76 (6-300) months. Two groups were composed as AUS implantation one time and recurrent times and the results were compared. Results: Of our AUS implantated patients, we noticed complete dryness in 57 (69.5%), social continence in 15(18.2%) and incontinence in 10 (12.1%). Of the 13 recurrent patients, we noticed complete dryness in 5 (38.4%), social continence in 5 (38.4%) an incontinence in 3 (23.07%). When compared; symptom score, amount of incontinence and quality of life score results seemed to be better in the 1 time AUS performed group than the recurrent group, but it was not statistically significant. Complication rate was 20.7% including infection and/or cuff erosion in 12 patients and mechanical failure in 5 patients. Conclusion: AUS is the most effective treatment method of incontinence in appropriate patients. We believe that it may be preferable by considering cost analysis and revision and re-implantation facilities in terms of being a safe and economical procedure.

Keywords:

Urethra Prostatectomy, Urinary Sphincter, Artificial,

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1. Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, et al. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (Cap- SURE), a national disease registry. J Urol 2004;171:1393-401.
2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013.CA Cancer J Clin 2013;63:11-30.
3. Lim B, Kim A, Song M, Chun JY, Park J, Choo MS. Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence. J Exerc Rehabil 2014;10:337-42.
4. Krupski TL, Saigal CS, Litwin MS. Variation in continence and potency by definition. J Urol 2003;170:1291-4.
5. Olsson LE, Salomon L, Nadu A, Hoznek A, Cicco A, Saint F, et al. Prospective patient-reported continence after laparoscopic radical prostatectomy. Urology 2001;58:570-2. 6. Rodriguez E, Jr., Skarecky DW, Ahlering TE. Post-robotic prostatectomy urinary continence: characterization of perfect continence versus occasional dribbling in pad-free men. Urology 2006;67:785-8.
7. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008;358:1250-61.
8. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 1989;141:243-7.
9. Gousse AE, Madjar S, Lambert MM, Fishman IJ. Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results. J Urol 2001;166:1755-8.
10. Montague DK, Angermeier KW. Postprostatectomy urinary incontinence: the case for artificial urinary sphincter implantation. Urology 2000;55:2-4.
11. Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM. Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol 2008;179:1912-6.
12. Raj GV, Peterson AC, Toh KL, Webster GD. Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol 2005;173:1242-5.
13. Clemens JQ, Schuster TG, Konnak JW, McGuire EJ, Faerber GJ. Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol 2001;166:1372-5.
14. Hajivassiliou CA. A review of the complications and results of implantation of the AMS artificial urinary sphincter. Eur Urol 1999;35:36-44.
15. Gomha MA, Boone TB. Artificial urinary sphincter for postprostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 2002;167:591-6.
16. Walsh IK, Williams SG, Mahendra V, Nambirajan T, Stone AR. Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction. BJU Int 2002;89:364-8.
17. James MH, McCammon KA. Artificial urinary sphincter for post-prostatectomy incontinence: a review. Int J Urol 2014;21:536-43.
18. Litwiller SE, Kim KB, Fone PD, White RW, Stone AR. Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol 1996;156:1975-80.
19. Montague DK, Angermeier KW, Paolone DR. Long-term continence and patient satisfaction after artificial sphincter implantation for urinary incontinence after prostatectomy. J Urol 2001;166:547-9.