Transcorporal artificial urinary sphincter in radiated and non - radiated compromised urethra. Assessment with a minimum 2 year follow-up

Abstract

Purpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients.Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires.Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients.Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

Male urinary incontinence: Artificial sphincter

“…After the analysis of the full texts, six studies were included in our evaluation. 9,[51][52][53][54][55] The main reasons for exclusion were: studies aiming only to describe the surgical technique, a series of cases with a small number of patients included (n < 10), and a narrative review.…”

“…Erection preservation was reported in half of the potent patients. 54 (C) A before-and-after study included 18 patients who had implanted AUS with dual cuff, being one or both cuffs placed using the TC approach. Ten patients had a distal cuff implanted transcorporally to complement a proximal bulbar urethral cuff implanted using standard technique.…”

Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study

“…The transcorporal approach, in which the tunica albuginea is interposed between the AUS cuff and the urethra, is intended to limit the risk of complications. Le Long et al 20 find that revision‐free survival was significantly higher in patient with previous radiation ( p = 0.006) who had a transcorporal AUS replacement. This technique can be used as a salvage treatment for patients with urethral atrophy as well as previous AUS erosion of infection.…”

“…There was no secondary erectile dysfunction despite the proximity to the corpora cavernosa. [20][21][22] In our study, we did not modify the surgical…”

Early Revision after Artificial Urinary Sphincter Implantation Does Not Impair the Long-Term Treatment Success

“…TC placement has been recommended in the current literature for patients presenting with a "fragile urethra" including those with prior radiotherapy, AUS failure, urethroplasty, or urethral atrophy [23][24][25][26]. In these patients, who are considered to be at a higher risk of AUS failure and urethral erosion, TC placement has been shown to provide comparable outcomes to other AUS types [23] and lower rates of revision and erosion [24].…”