What is the place of the Artificial Urinary Sphincter in 2012? Introduction There are an increasing...
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What is the place of the Artificial Urinary Sphincter in 2012? Introduction There are an increasing array of surgical options for the treatment of post-prostatectomy
What is the place of the Artificial Urinary Sphincter in 2012?
Introduction There are an increasing array of surgical options for
the treatment of post-prostatectomy incontinence, including bulking
agents, peri- urethral balloons and a variety of male sub-urethral
slings. We have reviewed the results of men treated with AdVance
slings or artificial urinary sphincters (AUS) in order to better
define the indications for these respective procedures and predict
optimal clinical outcomes. Conclusions AdVance slings offer a safe,
effective treatment of mild-mod post- prostatectomy continence with
the vast majority of men remaining improved in the medium term,
although the pad-free rate declines over time, particularly in
irradiated men AUS remains the most effective treatment for severe
post- prostatectomy stress incontinence, with high satisfaction
rates even though most men still use a pad when validated
questionnaires used Urethral strictures are more common after
radiotherapy and often cannot be stabilised, however can still be
maintained through an AUS or AdVance sling Results outcomes
Peri-operative complications AdVance sling - 14 (25.9%) temporary
urinary retention, 2 (3.7%) lasting more than two weeks and
requiring cystoscopy/dilatation - 2 (3.7%) transient hip pain
resolving spontaneously - No pelvic haematoma or sling infection
AUS (Approach 11 [23.4%] perineal, 36 [76.6%] penoscrotal) - 1
(2.1%) infection requiring explantation - 1 (2.1%) scrotal
haematoma - 1 (2.1%) urethral injury - 1 (2.1%) pulmonary embolism
Functional outcomes AdVance sling 50 men (92.6%) immediately
pad-free Mean F/U 9.7 mths (1-36) At follow-up - 40/52 (76.9%) men
with mild-mod incontinence pad- free vs 0/2 men with severe
Incontinence Of those men with prior RT 4/7 (57.1%) pad-free Of
those men with minimum 12 mth F/U (mean 21.6, 12-36mth) - mild-mod
incontinence (n=14): All improved, 9 (64%) pad-free, - severe
incontinence (n=2): 1 improved, 1 failed and had AUS Functional
outcomes Artificial urinary sphincter Mean F/U 23 months (3-60) AUS
revision rate 17% - Early: 4 (8.5%) tandem cuff for persisting
incontinence - Late: 4 (8.5%), 1 erosion, 1 mechanical failure, 2
cuff atrophy Methods Peri-operative data of consecutive patients
operated on for post- prostatectomy incontinence by a single
surgeon were recorded on a prospective database Short and
medium-term outcomes were reviewed Patients who had undergone
insertion of an artificial urinary sphincter were asked to complete
a questionnaire amalgamated from 4 validated existing instruments:
the international Consultation on Incontinence Questionnaire-Short
Form (ICIQ-SF), Post- Operative Global Impression of Improvement
(PGI-I), Incontinence Impact Questionnaire- Short Form (IIQ-SF) and
Urogenital Distress index (UDI-SF) Level of incontinence was
defined as: Mild (1 pad/day or 3 pads/day or >400ml pad weight)
Aim To evaluate peri-operative and functional outcomes of men
undergoing surgery for post-prostatectomy incontinence To assess
short-medium term results of the artificial urinary sphincter and
AdVance suburethral sling and their relative roles in the
management of post-prostatectomy incontinence Figure 1. Continence
outcomes for all men at mean F/U 9.7mth after AdVance sling. 74%
pad free, 22% requiring a pad but improved, 4% recurrent
incontinence Figure 2. Continence outcomes at mean 23 mth after I/O
AUS Dr Daniel Moon and Ms Kay Talbot Australian Urology Associates,
Melbourne, Victoria Poster presentation sponsor No. 057 Results
pre-operative 101 men underwent surgery between 2007-2011; 47
underwent insertion of AUS and 54 an AdVance sling The AdVance
sling was generally only offered to patients with mild- mod
incontinence, only 2 being inserted for patients with more
significant leakage Of patients with severe incontinence undergoing
AUS: - Mode of RP: 53% open, 45% robotic, 2% lap - Prior
radiotherapy was predictive of co-existing stricture present in
53.8% of irradiated men vs 8.8% who had undergone surgery alone
AdVance sling (n=54) Age67 (54-84) Prior bulking agent 5 (9.3%)
Prior RT7 (12.9%) Incontinence: Mild26 (48.1%) Moderate26 (48.1%)
Severe2 (3.7%) AUS (n=47) Age68 (58-85) Prior surgery Macroplastiqu
e 18 (15 men) 9 (19.1%) ProACT2 (4.3%)* Sling3 (6.4%) AUS5 (10.6%)#
Prior RT13 (27.7 %) Stricture10 (21.3%) * 1 eroded # 2 eroded Table
1. Pre-operative patient parameters Figure 3. Quality of life
measures post AUS 26%26% 67%67% 2%2% 5%5%