Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

Abstract

This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

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“…All these treatments may benefit patients; Although, it cannot be denied that the selective serotonin reuptake inhibitor drugs such as duloxetine, which is often accompanied by symptoms of insomnia, nausea, loss of appetite, irritability, and other side effects [ 11 , 17 ]. Further, surgical interventions are traumatic forms of treatment and are also costly [ 18 ]. Pelvic floor muscle training is the most used conservative treatment for urinary incontinence, but for elderly male patients with prostate cancer, whether functional training is carried out correctly is difficult to evaluate and assess, and it is challenging to implement.…”

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“…Nevertheless, incidence of postoperative urinary incontinence cannot be ignored. Although the occurrence of urinary control disorder after radical prostatectomy differs among countries and studies [ 7 , 8 ], overall incidence of this postoperative complication is higher than other side effects [ 8 ]. When postoperative urinary incontinence occurs, patients frequently develop psychological problems, including decreased self-esteem, irritability, and fear, which severely impair their quality of life [ 9 ].…”