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Artificial Urinary Sphincter Placement in Compromised Urethras and Survival: A Comparison of Virgin, Radiated and Reoperative Cases

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 6 Linguagem: Inglês

10.1016/j.juro.2014.06.088

1527-3792

James B. McGeady, Jack W. McAninch, Mathew D. Truesdale, Sarah D. Blaschko, Stacey A. Kenfield, Benjamin N. Breyer,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyAdult Urology1 Dec 2014Artificial Urinary Sphincter Placement in Compromised Urethras and Survival: A Comparison of Virgin, Radiated and Reoperative Cases James B. McGeady, Jack W. McAninch, Mathew D. Truesdale, Sarah D. Blaschko, Stacey Kenfield, and Benjamin N. Breyer James B. McGeadyJames B. McGeady Department of Urology, University of California, San Francisco, San Francisco, California Urologic Specialists of Oklahoma, Tulsa, Oklahoma , Jack W. McAninchJack W. McAninch Department of Urology, University of California, San Francisco, San Francisco, California , Mathew D. TruesdaleMathew D. Truesdale Department of Urology, University of California, San Francisco, San Francisco, California , Sarah D. BlaschkoSarah D. Blaschko Department of Urology, University of California, San Francisco, San Francisco, California , Stacey KenfieldStacey Kenfield Department of Urology, University of California, San Francisco, San Francisco, California , and Benjamin N. BreyerBenjamin N. Breyer Department of Urology, University of California, San Francisco, San Francisco, California View All Author Informationhttps://doi.org/10.1016/j.juro.2014.06.088AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although long-term outcomes after initial placement of artificial urinary sphincters are established, limited data exist comparing sphincter survival in patients with compromised urethras (prior radiation, artificial urinary sphincter placement or urethroplasty). We evaluated artificial urinary sphincter failure in patients with compromised and noncompromised urethras. Materials and Methods: We performed a retrospective analysis of 86 sphincters placed at a single institution between December 1997 and September 2012. We assessed patient demographic, comorbid disease and surgical characteristics. All nonfunctioning, eroded or infected devices were considered failures. Results: Of the 86 patients reviewed 67 (78%) had compromised urethras and had higher failure rates than the noncompromised group (34% vs 21%, p=0.02). Compared to the noncompromised group, cases of prior radiation therapy (HR 4.78; 95% CI 1.27, 18.04), urethroplasty (HR 8.61; 95% CI 1.27, 58.51) and previous artificial urinary sphincter placement (HR 8.14; 95% CI 1.71, 38.82) had a significantly increased risk of failure. The risk of artificial urinary sphincter failure increased with more prior procedures. An increased risk of failure was observed after 3.5 cm cuff placement (HR 8.62; 95% CI 2.82, 26.36) but not transcorporal placement (HR 1.21; 95% CI 0.49, 2.99). Conclusions: Artificial urinary sphincter placement in patients with compromised urethras from prior artificial urinary sphincter placement, radiation or urethroplasty had a statistically significant higher risk of failure than placement in patients with noncompromised urethras. Urethral mobilization and transection performed during posterior urethroplasty surgeries likely compromise urethral blood supply, predisposing patients to failure. Patients with severely compromised urethras from multiple prior procedures may have improved outcomes with transcorporal cuff placement rather than a 3.5 cm cuff. References 1 : Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance. Prog Urol2011; 21: 625. Google Scholar 2 : Treatment of postprostatectomy male urinary incontinence with the transobturator retroluminal repositioning sling suspension: 3-year follow-up. Eur Urol2012; 62: 140. 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Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byOrtiz N, Wolfe A, Baumgarten A, Ward E, VanDyke M, Hudak S and Morey A (2020) Artificial Urinary Sphincter Cuff Erosion Heat Map Shows Similar Anatomical Characteristics for Transcorporal and Standard ApproachJournal of Urology, VOL. 204, NO. 5, (1027-1032), Online publication date: 1-Nov-2020.Fuller T, Ballon-Landa E, Gallo K, Smith T, Ajay D, Westney O, Elliott S, Alsikafi N, Breyer B, Cohen A, Vanni A, Broghammer J, Erickson B, Myers J, Voelzke B, Zhao L and Buckley J (2020) Outcomes and Risk Factors of Revision and Replacement Artificial Urinary Sphincter Implantation in Radiated and Nonradiated CasesJournal of Urology, VOL. 204, NO. 1, (110-114), Online publication date: 1-Jul-2020.Doiron R, Saavedra A, Haines T, Nadeau G, Tu L, Morisset J, Steele S, Valiquette L, Elterman D, Maciejewski C and Rourke K (2019) Canadian Experience with the Adjustable Transobturator Male System for Post-Prostatectomy Incontinence: A Multicenter StudyJournal of Urology, VOL. 202, NO. 5, (1022-1028), Online publication date: 1-Nov-2019.Ziegelmann M, Linder B, Avant R and Elliott D (2019) Bacterial Cultures at the Time of Artificial Urinary Sphincter Revision Surgery in Clinically Uninfected Devices: A Contemporary SeriesJournal of Urology, VOL. 201, NO. 6, (1152-1157), Online publication date: 1-Jun-2019.Moser D, Kaufman M, Milam D, Johnsen N, Cleves M, Broghammer J, Brant W, Jones L, Brady J, Gross M, Jani K and Henry G (2018) Impact of Radiation and Transcorporeal Artificial Sphincter Placement in Patients with Prior Urethral Cuff Erosion: Results from a Retrospective Multicenter AnalysisJournal of Urology, VOL. 200, NO. 6, (1338-1343), Online publication date: 1-Dec-2018.Kaufman M, Milam D, Johnsen N, Cleves M, Broghammer J, Brant W, Jones L, Brady J, Gross M and Henry G (2017) Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional AnalysisJournal of Urology, VOL. 199, NO. 4, (1037-1041), Online publication date: 1-Apr-2018.Santucci R (2017) Editorial CommentaryUrology Practice, VOL. 4, NO. 6, (485-485), Online publication date: 1-Nov-2017.Mock S, Dmochowski R, Brown E, Reynolds W, Kaufman M and Milam D (2015) The Impact of Urethral Risk Factors on Transcorporeal Artificial Urinary Sphincter Erosion Rates and Device SurvivalJournal of Urology, VOL. 194, NO. 6, (1692-1696), Online publication date: 1-Dec-2015. Volume 192Issue 6December 2014Page: 1756-1761 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsurinary incontinenceartificialurinary sphincterradiationMetricsAuthor Information James B. McGeady Department of Urology, University of California, San Francisco, San Francisco, California Urologic Specialists of Oklahoma, Tulsa, Oklahoma Nothing to disclose. More articles by this author Jack W. McAninch Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Mathew D. Truesdale Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Sarah D. Blaschko Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Stacey Kenfield Department of Urology, University of California, San Francisco, San Francisco, California Nothing to disclose. More articles by this author Benjamin N. Breyer Department of Urology, University of California, San Francisco, San Francisco, California Financial interest and/or other relationship with AMS. More articles by this author Expand All Advertisement PDF downloadLoading ...