Reconstructive UrologyTranscorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer
Section snippets
Material and Methods
After approval from the internal review board, we performed a retrospective review of all patients who had undergone AUS placement by a single surgeon from January 2000 to August 2005. We limited our review to those patients with ≥1 year of follow-up. AUS surgery was performed by way of a perineal incision with a proximal bulbar urethral cuff (in all primary cases) using the AMS 800 device (American Medical Systems, Minnetonka, MN) with a reservoir of 61-70 mL.
The TC approach has been
Results
Of the 30 patients who had received an AUS for the treatment of urinary incontinence, 26 had been previously treated for PCa. The etiology of the incontinence in the other 4 patients included trauma in 3 and open simple prostatectomy in 1. The present observational report focused on the 26 patients with previous PCa therapy. Of the 26 patients, 18 had undergone an ST approach to cuff placement (ST group) and 8 had undergone a TC approach (TC group). The mean follow-up was 31 months for ST group
Comment
When one is faced with the task of AUS reimplantation after previous urethral erosion or atrophy, it is important to select a site for cuff placement that is distant from the previous cuff location. Because the original cuff location will have been around the proximal bulbar urethra, the reimplantation is generally performed at the distal bulbar urethra. The more distal urethra is relatively narrower, and thus does not allow for an occlusive seal with the smallest available cuff (4 cm). At
Conclusions
We have introduced expanded indications for the TC approach to AUS placement. The TC approach to primary AUS cuff placement adds a margin of safety in patients who have undergone previous urethroplasty or radiotherapy and who are at greater risk of cuff erosion. The short-term results indicate reasonable efficacy and safety compared with the ST approach, despite the greater risk patient population. Additional follow-up is needed to confirm these encouraging results.
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2022, Urologic Clinics of North America