A Multicenter Study on the Perineal Versus Penoscrotal Approach for Implantation of an Artificial Urinary Sphincter: Cuff Size and Control of Male Stress Urinary Incontinence

Henry, Gerard D.; Graham, Stephen M.; Cornell, Robert J.; Cleves, Mario A.; Simmons, Caroline J.; Vakalopoulos, Ioannis; Flynn, Brian J.

doi:10.1016/j.juro.2009.07.068

Cited by 57 publications

(39 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a retrospective 4-center study by the same working group, postoperative complication rates of 49 patients were analyzed. The authors found slightly lower total complication rates after penoscrotal compared to initial perineal AUS implantation [12]. However, in the above-mentioned studies, complications included only device malfunction, erosion/infection, and urethral atrophy rates.…”

Section: Discussionmentioning

confidence: 99%

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Kretschmer

Hüsch²,

Thomsen³

et al. 2016

Urol Int

View full text Add to dashboard Cite

Background/Aims/Objectives: To analyze perioperative complication and short-term explantation rates after perineal or penoscrotal single-cuff and double-cuff artificial urinary sphincter (AUS) implantation in a large middle European multi-institutional patient cohort. Methods: 467 male patients with stress urinary incontinence underwent implantation of a perineal single-cuff (n = 152), penoscrotal single-cuff (n = 99), or perineal double-cuff (n = 216) AUS between 2010 and 2012. Postoperative complications and 6-month explantation rates were assessed. For statistical analysis, Fisher's exact test and Kruskal-Wallis rank sum test, and a multiple logistic regression model were used (p < 0.05). Results: Compared to perineal single-cuff AUS, penoscrotal single-cuff implantation led to significantly increased short-term explantation rates (8.6% (perineal) vs. 19.2% (penoscrotal), p = 0.019). The postoperative infection rate was significantly higher after double-cuff compared to single-cuff implantation (6.0% (single-cuff) vs. 13.9% (double-cuff), p = 0.019). The short-term explantation rate after primary double-cuff placement was 6.5% (p = 0.543 vs. perineal single-cuff). In multivariate analysis, the penoscrotal approach (p = 0.004), intraoperative complications (p = 0.005), postoperative bleeding (p = 0.011), and perioperative infection (p < 0.001) were independent risk factors for short-term explantation. Conclusions: Providing data from a large contemporary multi-institutional patient cohort from high-volume and low-volume institutions, our results reflect the current standard of care in middle Europe. We indicate that the penoscrotal approach is an independent risk factor for increased short-term explantation rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Kretschmer

Hüsch²,

Thomsen³

et al. 2016

Urol Int

View full text Add to dashboard Cite

show abstract

“…For male patients, the data do not agree upon a preferred surgical technique. Henry et al report improved continence rates with the perineal approach, while other data demonstrate similar outcomes with either a penoscrotal or perineal approach [32,33]. They hypothesize that the more proximal cuff placement afforded by the perineal could account for their outcomes [32].…”

Section: Incontinencementioning

confidence: 98%

“…Henry et al report improved continence rates with the perineal approach, while other data demonstrate similar outcomes with either a penoscrotal or perineal approach [32,33]. They hypothesize that the more proximal cuff placement afforded by the perineal could account for their outcomes [32]. In the pediatric population, the cuff is most commonly placed at the bladder neck and often the intrinsic compression from the cuff, without activation or cycling, is adequate to provide enough resistance for continence.…”

Section: Incontinencementioning

confidence: 99%

Evaluation and Management of Failed Bladder Reconstructions

Jordan¹,

Palmer

Kielb³

2015

Curr Bladder Dysfunct Rep

View full text Add to dashboard Cite

Bladder reconstructions are commonly performed in patients with neurogenic bladders with a high rate of complications. We seek to help guide the evaluation and management of these complications by reviewing the available data. Augmentation cystoplasty and concomitant procedures such as continent catheterizable channels, bladder neck closure, and bladder neck sling can provide long-term solutions for patients with poorly compliant, high-pressure bladders or refractory detrusor overactivity. While these techniques improve symptoms and protect against upper tract deterioration, patients are exposed to new risks including bladder perforation, increased malignancy rates, urolithiasis, surgical failures, and persistent symptoms. The overall rate of reoperation is high. Evaluation with urodynamics and endoscopy, when indicated, remain critical tools to protect this patient population. Use of clean intermittent catheterization has helped popularize bladder reconstructive surgery, but a strict regimen is required to minimize postoperative risks in the long term. Additionally, various surgical techniques can be utilized to manage complications after bladder reconstruction, and concurrent use of anticholinergics and onabotulinum toxin injections can further mitigate these reconstructive failures. Bladder reconstruction can provide excellent long-term solutions, but patients are at a high risk of long-term complications. Appropriate patient counseling, close follow-up, and timely evaluation are crucial in managing the long-term complications of bladder reconstruction surgery.

show abstract

“…The transscrotal approach for implantation of an AUS is reportedly more rapid and easier than the traditional perineal incision. Nonetheless, some authors have reported a higher completely dry rate and fewer tandem cuff additions with the perineal approach, a finding they attribute to the more proximal placement of the AUS cuff [40,41].…”

Section: Prb For the Ausmentioning

confidence: 99%

Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon

Reznicek

Bryson

Kramer

2015

Sexual Medicine Reviews

View full text Add to dashboard Cite

A Multicenter Study on the Perineal Versus Penoscrotal Approach for Implantation of an Artificial Urinary Sphincter: Cuff Size and Control of Male Stress Urinary Incontinence

Cited by 57 publications

References 17 publications

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Complications and Short-Term Explantation Rate Following Artificial Urinary Sphincter Implantation: Results from a Large Middle European Multi-Institutional Case Series

Evaluation and Management of Failed Bladder Reconstructions

Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon

Contact Info

Product

Resources

About