Transcorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer

doi:10.1016/j.urology.2008.06.065

Urology

Volume 72, Issue 4, October 2008, Pages 825-827

https://doi.org/10.1016/j.urology.2008.06.065 Get rights and content

Objectives

To investigate the transcorporal (TC) vs standard (ST) approach of artificial urinary sphincter (AUS) placement for incontinence after treatment of prostate adenocarcinoma (PCa) with radiotherapy or surgery, or both.

Methods

A database was created to include the data from all patients who had undergone AUS placement from January 2000 to August 2005 at the University of California, San Francisco, Medical Center. We noted the demographic features, comorbidities, PCa therapy, technique for AUS placement, and postoperative outcome. The continence and failure rates were recorded for TC AUS placement in patients previously treated for PCa.

Results

A total of 30 patients underwent aus surgery during the study period: 26 for incontinence after PCa treatment. Of the 26 patients, 18 had undergone ST (ST group) and 8 had undergone TC (TC group) AUS placement, with a minimal follow-up of 12 months and a mean follow-up of 31 and 28 months, respectively. The 2 groups did not differ widely in age or comorbidities. Of the patients in the ST and TC groups, 44% and 50% had undergone external beam radiotherapy or brachytherapy and 78% and 100% had undergone radical prostatectomy, respectively. Of the patients in the ST and TC groups, 22% and 89% had undergone ≥2 types of urethral surgery before AUS placement, respectively. A total of 50% of TC group underwent TC placement without having undergone a previous sling or ST AUS procedure. The AUS removal rates were equivalent between the 2 groups at 2 years. Finally, the success rate for social continence was 69% and 81% for ST and TC group, respectively.

Conclusions

The results of our study, with 2 years of follow-up, have shown that TC AUS placement is an effective salvage or primary incontinence treatment for high-risk patients after PCa therapy.

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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Artificial urinary sphincter in patients following major pelvic surgery and/or radiotherapy: Are they less favorable candidates?
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M.A. Gomha et al.
Artificial urinary sphincter for post-prostatectomy incontinence in men who had prior radiotherapy: A risk and outcome analysis
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The 51-60 cm H<inf>2</inf>O Artificial Urinary Sphincter Pressure Regulating Balloon: Indications and Outcomes
2024, Urology
To describe the role and long-term outcomes of using the 51-60 cm H₂O pressure regulating balloon (PRB) in male patients with an artificial urinary sphincter (AUS).
From 2005-2021, 90 patients with a variety of urethral risk factors underwent AUS placement with use of the low-pressure 51-60 cm H₂O PRB to treat stress incontinence. Patient demographics, indication for use of the 51-60 cm H₂O PRB, perioperative data, and postoperative outcomes were examined and Pearson’s chi squared test and Wilcoxon rank sum test were used to identify associations with future revisions, erosion, and mechanical failure.
Ninety patients were included in the study. After median follow-up of 46.6 months (range: 6-146 months), 4 (4.44%) patients developed an erosion-related complication that required device removal, 4 developed an infection, and 3 underwent surgery for pump relocation. One patient had a reported mechanical failure of unknown source. Thirty patients underwent revision surgery to reduce incontinence. Of the 4 patients with erosion, 1 was due to iatrogenic catheterization. The remaining 3 had numerous urethral risk factors. Univariate analysis was performed to identify predictors of cuff erosion, infection, and revision in patients with a 51-60 cm H₂O PRB. No significant associations were found including prior pelvic radiation, age at AUS placement, presence of inflatable penile prosthesis (IPP), prior AUS erosion, or previous urethroplasty.
The low-pressure 51-60 cm H₂O PRB can be used in high-risk male patients with urinary incontinence with low rates of complications including erosion, infection, and mechanical failure. While patients may choose to undergo future revisional surgery to improve continence, the 51-60 cm H₂O PRB should be considered as the initial PRB in patients with urethral risk factors.
Transcorporal Artificial Urinary Sphincter Technique Video
2023, Urology
The artificial urethral sphincter (AUS) is the gold standard treatment for male stress urinary incontinence which commonly results from prostatectomy or pelvic radiation for prostate cancer. Patients with prior pelvic radiation history experience increased risk of developing urethral erosion. Transcorporal AUS (TAUS) placement can be used as an alternative for compromised urethras to incorporate a small portion of the corporal bodies for additional support. The inclusion of an additional tissue barrier has been shown to improve outcomes. Patients who undergo this technique require device explanation and AUS revision less often than those with AUS devices placed in the standard fashion. Additionally, TAUS placement has been shown to improve functional urinary outcomes such as postoperative Internal prostate symptom score (IPSS), and postoperative IPSS Quality of Life (QoL) scores.
A 67-year-old male with a past medical history of prostate cancer treated with surgery and radiation underwent a TAUS placement which was filmed to demonstrate placement technique and tips. Informed consent was obtained prior to filming this video.
This technique can serve as a successful primary or salvage AUS placement technique as seen in this video.
This video is used to demonstrate the technique of TAUS placement.
Male Stress Urinary Incontinence
2022, Urologic Clinics of North America
Distal Double Cuff Vs Transcorporal Cuff as Salvage Options—A Prospective Analysis of Different Artificial Urinary Sphincter (AMS 800) Implantation Sites
2019, Urology
To analyze functional outcomes and complication rates of distal double cuffs (DC) or transcorporal cuffs (TC) as salvage approaches in high-risk patients, since there is an ongoing debate about optimal cuff-placement in a salvage setting (SV). Existing studies analyzing DC or TC are controversial with respect to functional outcomes and complication rates. Studies directly comparing both approaches in SV are scarce.
Prospective data collection was performed since 2009. DC/TC were applied according to a standardized protocol in SV. Salvage DC was chosen in case of a membranous single cuff explantation due to erosion or infection. TC were implanted after bulbar urethroplasty or DC explantation. Activation was performed 6 weeks postoperatively. Further follow-up was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were continence/complication rates.
In total, 71 high-risk patients were available for analysis (58 DC, 13 TC). Median age was 70 years. Median follow-up was 24 months. Objective/social continence were 88%/94% in the DC and 72%/100% in the TC cohort, respectively (P = .37/P = 1). Overall, there were no significant differences with respect to infections, erosions, mechanical failure, and explantation rates. The times of explantation-free survival were similar in Kaplan-Meier analysis (Log-rank 0.399).
Complication and continence rates were not significantly different between both cohorts. Hence, a DC in SV can be considered as equally safe and effective. A sequential implantation (first DC, second TC) may be a viable approach to extend overall AUS incontinence therapy.
Impact of Radiation and Transcorporeal Artificial Sphincter Placement in Patients with Prior Urethral Cuff Erosion: Results from a Retrospective Multicenter Analysis
2018, Journal of Urology
Many providers elect to use a transcorporeal approach for artificial urinary sphincter placement in an attempt to minimize risks, given the increased risk of complications in revision cases. We present outcomes in a multicenter retrospective analysis of artificial urinary sphincter cuff reimplantation in patients with prior cuff erosion with special consideration given to the transcorporeal approach.
We compiled a multi-institutional database of patients who underwent artificial urinary sphincter reimplantation after prior urethral erosion. Of the 34 identified patients 24 underwent transcorporeal cuff replacement. Patients with transcorporeal cuff replacement were further analyzed with specific stratification for radiation therapy.
The rate of subsequent complications after eroded cuff reimplantation was 32.4% (11 of 34 patients). The most frequent complication was recurrent erosion, which developed in 9 of the 34 patients (26.4%). Repeat artificial urinary sphincter complications developed more frequently in patients with history of radiation compared to nonirradiated patients (8 of 16 or 50% vs 3 of 18 or 16.7%). However, this difference was not statistically significant (p = 0.066). The transcorporeal technique was applied in 24 of 33 patients (70.5%) and relative to the nontranscorporeal group there was no difference in the complication rate (p = 0.438). On subgroup analysis of the transcorporeal group there was a higher rate of repeat complications in irradiated patients (p = 0.006).
These data suggest that transcorporeal cuff reimplantation may not decrease the incidence of repeat complications after prior cuff erosion. However, radiation therapy is associated with a worse outcome even when transcorporeal cuff placement is performed.
Predictive Factors of De Novo Overactive Bladder After Artificial Urinary Sphincter Implantation in Men With Postprostatectomy Incontinence
2018, Urology
To investigate the rates and predictive factors associated with the development of de novo overactive bladder (OAB) and to assess the effects of de novo OAB on surgical outcomes after an artificial urinary sphincter (AUS).
We performed a retrospective review of 132 patients with postprostatectomy incontinence who underwent AUS surgery. Urodynamic studies were performed during preoperative visits in all patients, and patients with OAB or neurogenic bladder were excluded. We assessed the development of de novo OAB based on patient symptoms. Treatment success was defined as no need for pads, and social continence was defined as the need for ≤1pad per day at the end of the follow-up. A multivariate analysis was performed using a logistic regression model to assess predictors of de novo OAB.
The rate of development of de novo OAB after surgery was 37.5%. The treatment success rate was significantly higher in the no-OAB group (72.4%) than in the de novo OAB group (55.4%) (P = .038). A low preoperative cystometric capacity of less than 300 mL (odds ratio 5.27, confidence interval 1.02-27.28; P = .048) and pelvic irradiation (odds ratio 3.18, confidence interval 1.01-10.03; P = .049) were predictive factors of de novo OAB after AUS surgery.
De novo OAB occurs commonly after AUS surgery, and the presence of de novo OAB adversely impacts treatment success. Low preoperative cystometric capacity of less than 300 mL and pelvic irradiation predict the occurrence of de novo OAB after AUS implantation.

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Reconstructive UrologyTranscorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer

Objectives

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Conclusions

J Urol

J Urol

J Urol

Reconstructive Urology
Transcorporal Artificial Urinary Sphincter Placement for Incontinence in High-risk Patients After Treatment of Prostate Cancer