Periurethral constrictor: late results of the treatment of post prostatectomy urinary incontinence

Abstract

Objectives: We evaluated retrospectively, the long-term outcome of patients with post-prostatectomy urinary incontinence (PPUI) after placement of the Periurethral Constrictor (PUC). Materials and Methods: Fifty-six men with severe PPUI were studied, with a mean age of 68.5 years old. Fifty-one men had PPUI due to radical surgery having the device placed around the bulbous urethra, and five individuals with benign prostatic hypertrophy (BPH) had placement around the bladder neck. The mean follow-up was 82.2 months. Results: Twenty-two patients (39.28%) became continent (0 to 1 pad a day) and 34 (60.72%) were incontinent. Complications were as follows: urethral erosion in 15 (26.78%); mechanical malfunction in 2 (3.5%); infection in 2 (3.5%); urinary fistula in 1 (1.7%); Urinary tract infection1 (1.7%). Twenty-three patients needed to have the device removed (41.07%). Success rate (continent me) was 30.35%. Conclusion: In the present series the PUC was not effective for the treatment of severe PPUI in the long-term follow-up.

Long-Term Outcomes of the Implant of a Periurethral Constrictor for Stress Urinary Incontinence Following Radical Prostatectomy

“…Demographics, preoperative and postoperative urodynamic features and 24-hour pad test, postoperative complications and QoL scores based on the I-QoL questionnaire [8,9] were prospectively entered by a research fellow in a dedicated database protected by password.…”

“…This device has been subsequently explored in the adult population, but the effectiveness is still debated due to controversial outcomes reported in published series [7,8,9]. …”

New Artificial Urinary Sphincter Devices in the Treatment of Male Iatrogenic Incontinence

“…It is comprised of a constrictor cuff linked by a 20 cm silicone tube to a valve, which is elliptical in shape and rounded at the edges (Figure 2) [16]. The adjustable cuff is implanted around the bladder neck through suprapubic approach or bulbous urethra through perineal incision [17]. The valve is placed in a space accessible by percutaneous puncture, usually in the subcutaneous space between the umbilicus and the iliac crest.…”

“…An eighth patient remained incontinent after the device reactivation because of detrusor hyper-reflexia [16]. On the other hand, Lima et al presented a study with 82.2-month mean followup which reported a very high device removal rate 41.07% [17]. The average time between surgery and the removal of the device was 22.6 months.…”

Treatment of Post-Prostatic Surgery Stress Urinary Incontinence

“…For this, we used the periurethral constrictor, a two-part device with a constrictor cuff positioned around the bulbar urethra and hydraulically activated through a self-sealing valve with a tube. Previous studies had already presented the device as a safe and effective alternative for the treatment of neurogenic urinary incontinence (Lima SVC, et al 2000;Vilar FO, et al 2004). …”