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The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation

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Abstract

Purpose

To determine whether salvage artificial urinary sphincter (AUS) implantation after prior incontinence surgery achieves outcomes comparable to primary AUS implantation.

Methods

We retrospectively evaluated data of patients undergoing AUS implantation from 2009 to 2014. Functional outcome was objectified by 1-h stress pad test, uroflowmetry, post-void residual urine measurement, clinical examination, and chart review. Complications were categorized according to Clavien–Dindo classification system. Kaplan–Meier analysis determined explantation-free survival.

Results

A total of 235 patients were included of whom 165 (70.2%) underwent primary AUS. In 70 patients, salvage incontinence surgery was performed, with 24 (10.2%) patients undergoing AUS reimplantation after prior AUS surgery (repeat AUS) and 46 (19.6%) patients undergoing AUS surgery after any other type of incontinence surgery (secondary AUS). There were no significant differences in rates of continence among primary AUS and repeat AUS patients. Patients undergoing secondary AUS had significantly better continence rates than primary and repeat AUS patients. Three-year explantation-free survival rates after AUS insertion were 82.3% (primary AUS), 78.6% (repeat AUS) and 81.5% (secondary AUS). There were no differences in complication rates among the groups.

Conclusion

AUS is a safe option in the treatment of severe incontinence even after prior AUS or any other prior incontinence surgery and can still achieve satisfactory outcomes as salvage treatment.

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References

  1. Markland AD, Goode PS, Redden DT, Borrud LG, Burgio KL (2010) Prevalence of urinary incontinence in men: results from the national health and nutrition examination survey. J Urol 184(3):1022–1027. https://doi.org/10.1016/j.juro.2010.05.025

    Article  PubMed  Google Scholar 

  2. Tang DH, Colayco D, Piercy J, Patel V, Globe D, Chancellor MB (2014) Impact of urinary incontinence on health-related quality of life, daily activities, and healthcare resource utilization in patients with neurogenic detrusor overactivity. BMC Neurol 14:74. https://doi.org/10.1186/1471-2377-14-74

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burkhard FC, Bosch JLHR, Cruz F et al (2018) EAU guidelines on urinary incontinence. Eur Urol. https://uroweb.org/guideline/urinary-incontinence. Accessed 10 Oct 2019

  4. Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB (2007) 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol 177(3):1021–1025. https://doi.org/10.1016/j.juro.2006.10.062

    Article  PubMed  Google Scholar 

  5. Linder BJ, de Cogain M, Elliott DS (2014) Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection. J Urol 191(3):734–738. https://doi.org/10.1016/j.juro.2013.08.089

    Article  PubMed  Google Scholar 

  6. Raj GV, Peterson AC, Webster GD (2006) Outcomes following erosions of the artificial urinary sphincter. J Urol 175(6):2186–2190. https://doi.org/10.1016/s0022-5347(06)00307-7(discussion 90)

    Article  PubMed  Google Scholar 

  7. Wang R, McGuire EJ, He C, Faerber GJ, Latini JM (2012) Long-term outcomes after primary failures of artificial urinary sphincter implantation. Urology 79(4):922–928. https://doi.org/10.1016/j.urology.2011.11.051

    Article  PubMed  Google Scholar 

  8. Gomha MA, Boone TB (2002) Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: a risk and outcome analysis. J Urol 167(2 Pt 1):591–596

    PubMed  Google Scholar 

  9. Raj GV, Peterson AC, Toh KL, Webster GD (2005) Outcomes following revisions and secondary implantation of the artificial urinary sphincter. J Urol 173(4):1242–1245. https://doi.org/10.1097/01.ju.0000152315.91444.d0

    Article  PubMed  Google Scholar 

  10. Lai HH, Boone TB (2012) Complex artificial urinary sphincter revision and reimplantation cases—how do they fare compared to virgin cases? J Urol 187(3):951–955. https://doi.org/10.1016/j.juro.2011.10.153

    Article  PubMed  Google Scholar 

  11. Abdou A, Cornu JN, Sebe P et al (2012) Salvage therapy with artificial urinary sphincter after advance male sling failure for post-prostatectomy incontinence: a first clinical experience. Prog Urol 22(11):650–656. https://doi.org/10.1016/j.purol.2012.06.011

    Article  CAS  PubMed  Google Scholar 

  12. Brito CG, Mulcahy JJ, Mitchell ME, Adams MC (1993) Use of a double cuff AMS800 urinary sphincter for severe stress incontinence. J Urol 149(2):283–285

    Article  CAS  PubMed  Google Scholar 

  13. Lentz AC, Peterson AC, Webster GD (2012) Outcomes following artificial sphincter implantation after prior unsuccessful male sling. J Urol 187(6):2149–2153. https://doi.org/10.1016/j.juro.2012.01.119

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Linder BJ, Rivera ME, Ziegelmann MJ, Elliott DS (2015) Long-term outcomes following artificial urinary sphincter placement: an analysis of 1082 cases at Mayo Clinic. Urology 86(3):602–607. https://doi.org/10.1016/j.urology.2015.05.029

    Article  PubMed  Google Scholar 

  16. De Ridder D, Webster G (2011) Clinical overview of the AdVance® male sling in postprostatectomy incontinence. Eur Urol Suppl 10(4):401–406. https://doi.org/10.1016/j.eursup.2011.04.007

    Article  Google Scholar 

  17. Silva LA, Andriolo RB, Atallah Á, da Silva EMK (2014) Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev 2014:9. https://doi.org/10.1002/14651858.CD008306.pub3

    Article  Google Scholar 

  18. Kowalczyk JJ, Nelson R, Mulcahy JJ (1996) Successful reinsertion of the artificial urinary sphincter after removal for erosion or infection. Urology 48(6):906–908

    Article  CAS  PubMed  Google Scholar 

  19. Maillet F, Buzelin JM, Bouchot O, Karam G (2004) Management of artificial urinary sphincter dysfunction. Eur Urol 46(2):241–245. https://doi.org/10.1016/j.eururo.2004.01.017(discussion 46)

    Article  PubMed  Google Scholar 

  20. DiMarco DS, Elliott DS (2003) Tandem cuff artificial urinary sphincter as a salvage procedure following failed primary sphincter placement for the treatment of post-prostatectomy incontinence. J Urol 170(4 Pt 1):1252–1254. https://doi.org/10.1097/01.ju.0000085787.21140.db

    Article  PubMed  Google Scholar 

  21. Wang Y, Hadley HR (1992) Experiences with the artificial urinary sphincter in the irradiated patient. J Urol 147(3):612–613

    Article  CAS  PubMed  Google Scholar 

  22. Frank I, Elliott DS, Barrett DM (2000) Success of de novo reimplantation of the artificial genitourinary sphincter. J Urol 163(6):1702–1703

    Article  CAS  PubMed  Google Scholar 

  23. Ahyai SA, Ludwig TA, Dahlem R et al (2016) Outcomes of single- vs double-cuff artificial urinary sphincter insertion in low- and high-risk profile male patients with severe stress urinary incontinence. BJU Int 118(4):625–632. https://doi.org/10.1111/bju.13449

    Article  PubMed  Google Scholar 

  24. 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(5):2075–2078 (discussion 79)

    Article  PubMed  Google Scholar 

  25. Van der Aa F, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN, Young Academic Urologists Functional Urology G (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(4):681–689. https://doi.org/10.1016/j.eururo.2012.11.034

    Article  PubMed  Google Scholar 

  26. Tuygun C, Imamoglu A, Gucuk A, Goktug G, Demirel F (2009) Comparison of outcomes for adjustable bulbourethral male sling and artificial urinary sphincter after previous artificial urinary sphincter erosion. Urology 73(6):1363–1367. https://doi.org/10.1016/j.urology.2008.10.073

    Article  PubMed  Google Scholar 

  27. 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(3):838–843. https://doi.org/10.1016/j.juro.2016.03.076

    Article  PubMed  Google Scholar 

  28. Fisher MB, Aggarwal N, Vuruskan H, Singla AK (2007) Efficacy of artificial urinary sphincter implantation after failed bone-anchored male sling for postprostatectomy incontinence. Urology 70(5):942–944. https://doi.org/10.1016/j.urology.2007.07.022

    Article  PubMed  Google Scholar 

  29. Brant WO, Erickson BA, Elliott SP et al (2014) Risk factors for erosion of artificial urinary sphincters: a multicenter prospective study. Urology 84(4):934–938. https://doi.org/10.1016/j.urology.2014.05.043

    Article  PubMed  Google Scholar 

  30. Cohen AJ, Kuchta K, Park S, Milose J (2018) Patterns and timing of artificial urinary sphincter failure. World J Urol 36(6):939–945. https://doi.org/10.1007/s00345-018-2203-0

    Article  PubMed  Google Scholar 

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Author notes

  1. Clemens M. Rosenbaum and Tina Pham contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Clemens M. Rosenbaum, Tina Pham, Roland Dahlem, Valentin Maurer, Philip Marks, Malte W. Vetterlein, Margit Fisch & Tim Ludwig

  2. Department of Urology, Asklepios Medical Center Barmbek, Hamburg, Germany

    Clemens M. Rosenbaum

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  1. Clemens M. Rosenbaum
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  2. Tina Pham
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Contributions

CMR: project development, data management, data analysis, manuscript writing and editing. TP: project development, data management, and manuscript writing. RD: project development and manuscript editing. VM: project development, manuscript editing, and data management. PM: project development, manuscript editing, and data management. MWV: project development and manuscript editing. MF: project development and manuscript editing. TL: project development, data collection and management, data analysis, and manuscript editing.

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Correspondence to Clemens M. Rosenbaum.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Clemens M. Rosenbaum: on behalf of the Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU).

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Rosenbaum, C.M., Pham, T., Dahlem, R. et al. The impact of surgical sequence on outcome rates of artificial urinary sphincter implantation: comparative effectiveness of primary, secondary and repeat implantation. World J Urol 38, 2289–2294 (2020). https://doi.org/10.1007/s00345-019-03029-6

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  • DOI: https://doi.org/10.1007/s00345-019-03029-6

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