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Transcorporal Artificial Urinary Sphincter Cuff Placement in Cases Requiring Revision for Erosion and Urethral Atrophy

2002; Lippincott Williams & Wilkins; Volume: 167; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(05)65088-4

1527-3792

Michael L. Guralnick, Elizabeth A. Miller, KHAI LEE TOH, George D. Webster,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 May 2002Transcorporal Artificial Urinary Sphincter Cuff Placement in Cases Requiring Revision for Erosion and Urethral Atrophy MICHAEL L. GURALNICK, ELIZABETH MILLER, KHAI LEE TOH, and GEORGE D. WEBSTER MICHAEL L. GURALNICKMICHAEL L. GURALNICK , ELIZABETH MILLERELIZABETH MILLER , KHAI LEE TOHKHAI LEE TOH , and GEORGE D. WEBSTERGEORGE D. WEBSTER View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65088-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A distal cuff location is often required in patients undergoing artificial urinary sphincter reimplantation after previous erosion or in those requiring revision because of urethral atrophy at the original cuff site. Dissecting the urethra at a more distal site increases the risk of urethral injury and erosion, and often the urethral circumference is so small that a 4 cm. cuff is too large. We present a novel technique for distal cuff placement using transcorporal dissection that leaves corporal tunica albuginea on the dorsal surface of the urethra, allowing for its safer mobilization and adding to its bulk. Materials and Methods: We reviewed the charts of 31 men who underwent this technique and contacted 26 by telephone. The indications for distal transcorporal cuff placement varied. In 7 men with inadequate urethral coaptation with a 4 cm. proximal cuff at initial implantation a primary transcorporal tandem cuff was implanted distal. In 8 men persistent or recurrent incontinence despite a 4 cm. proximal cuff led to secondary distal reimplantation. Previous artificial urinary sphincter erosion and/or infection in 10 cases, previous urethral surgery at the optimal cuff site in 5 and radiation changes at the optimal cuff site in 1 led to selection of the more distal site and technique. Of the transcorporally placed cuffs 18 were 4 cm. and 13 were 4.5 cm. Preoperatively 5.2 pads were used daily. Of the 31 patients 27 were impotent preoperatively, 1 had normal erections, 1 had partial erections with the MUSE drug delivery system (Vivus, Inc., Menlo Park, California) and 2 had a previously placed penile prosthesis. Results: At a mean followup of 17 months 26 of the 31 patients (84%) had occasional or no stress incontinence requiring 0 to 1 pad daily, 2 with pure urge incontinence used 1 to 2 pads daily and 3 had mixed incontinence requiring 0 to 3 pads daily. Of the 26 men surveyed 25 were very satisfied with the postoperative level of incontinence. Postoperatively erectile function deteriorated in 1 patient and was unchanged in the remainder. There was no erosion or infection of the transcorporally placed cuffs, although 3 were replaced for malfunction. Conclusions: This technique offers significant advantages in cases of revision. The technique protects the urethra from intraoperative dissection injury and decreases the risk of erosion because the urethra is buttressed at its vulnerable location. In addition, bulk is added to the urethra, allowing for better cuff sizing, which is usually a problem at this location where the urethra is small, thereby, improving continence in revised cases. Our success has recently led us to abandon tandem cuff placement altogether. There is a potential for deteriorating erectile function in potent men who undergo implantation in this fashion. References 1 : Artificial urinary sphincter cuff erosion: experience with reimplantation in 38 patients. Urology1990; 35: 215. 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Volume 167Issue 5May 2002Page: 2075-2079 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurinary incontinenceprostheses and implantsurethraimpotenceMetricsAuthor Information MICHAEL L. GURALNICK More articles by this author ELIZABETH MILLER More articles by this author KHAI LEE TOH More articles by this author GEORGE D. WEBSTER Financial interest and/or other relationship with Lifetech. More articles by this author Expand All Advertisement PDF downloadLoading ...