Artificial Urinary Sphincter for Post-Prostatectomy Incontinence in Men Who Had Prior Radiotherapy: A Risk and Outcome Analysis

Gomha, Mohamed A.; Boone, Timothy B.

doi:10.1016/s0022-5347(01)69091-8

Cited by 103 publications

(63 citation statements)

References 11 publications

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“…Few contemporary studies have reported rates of erosion alone, whereas many combine infection and erosion together, probably because one event probably initiates the other, and they are not necessarily distinct. In studies that reported rates of erosion alone, 7-20% [10,11,13] of irradiated patients and 1.8-5.1% of unirradiated patients had erosion of their AUS [8,11]. Overall, the present outcomes using a singleincision, transverse-scrotal technique in highrisk patients are well within the range of those in contemporary publications.…”

Section: Discussionsupporting

confidence: 68%

“…In other reports of high-risk patients, 64-73% of those irradiated used one or fewer pads, compared with 60-89% of unirradiated patients [10,11]. In the present study, revision was required in 37.5% of irradiated and 8.5% of unirradiated patients; the respective reported rates of revision in modern series was 20-64% [8,[10][11][12] and 15.8-38.5% [8,11,12]. The total explantation/ revision rate for all patients in the present series was 16.8%, which is also comparable to similar studies in which the overall revision rate was 27.1% [12].…”

Section: Discussionmentioning

confidence: 82%

“…Furthermore, these queries have not been clarified in high-risk patients. Several investigators have reviewed the outcomes after placing AUS in high-risk patients, including those who have had RT; all of these studies primarily used a perineal, two-incision approach for placing the AUS [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes related to placing an artificial urinary sphincter using a single‐incision, transverse‐scrotal technique in high‐risk patients

Sotelo

Westney

2008

BJU International

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OBJECTIVETo determine, in a retrospective review, whether the single‐incision technique for placing an artificial urinary sphincter (AUS) is as effective and as safe as the traditional two‐incision approach in high‐risk patients, as there have been questions about the efficacy and safety of a single incision, transverse‐scrotal technique for placing the AUS.PATIENTS AND METHODSFrom January 2000 to May 2006, 83 patients had an AUS placed using a single‐incision, transverse‐scrotal approach. Emphasis was put on placing the cuff around the proximal aspect of the bulbar urethra. The charts of the patients were reviewed retrospectively and the patients completed standardized questionnaires during the follow‐up.RESULTSOf the 83 patients, 24 (29%) had a history of radiation therapy and four had cryotherapy of the prostate. The mean follow‐up was 18.8 months and 14 (17%) patients required revision or explantation (for any reason), nine of whom had had previous radiation therapy. The mean (sd) number of pads used per day before and after surgery was 6.7 (4.0) and 1.1 (1.6), respectively. Overall, 83% of the patients (79% of the irradiated and 85% of the unirradiated) used one or fewer pads per day after surgery.CONCLUSIONSEven in high‐risk patients there is no greater risk associated with using the single‐incision, transverse‐scrotal technique than in related series. Outcomes for pad use after surgery, rate of erosion, infections and mechanical malfunctions were similar to those in other series using the traditional technique.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

Outcomes related to placing an artificial urinary sphincter using a single‐incision, transverse‐scrotal technique in high‐risk patients

Sotelo

Westney

2008

BJU International

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“…Success rates for AUS as defined by a continence status of 0 to 1 pads per day range from 59% to 90%, 6,7 as shown in Table 1. 2,6,[8][9][10][11][12][13][14][15][16][17] Just as with reported rates of incontinence following prostate cancer surgery depend on the definition of incontinence, continence rates with the AUS can vary with the definition of continence, the method of evaluation and the length of follow-up.…”

Section: Reported Resultsmentioning

confidence: 99%

The artificial urinary sphincter is the treatment of choice for post–radical prostatectomy incontinence

Herschorn

2013

CUAJ

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“…12 A review of the literature is documented in Table 3, with continence rates ranging from 59-90%. [12][13][14][15][16][17][18][19][20] To make a more meaningful comparison, only studies defining continence as requiring ≤1 pad/day were included. Sacco and colleagues demonstrated that the criterion of pad usage discriminates well between a limited reduction and markedly affected quality of life, noting that it is clinically valid to consider ≤1 pad/day as continent.…”

Section: Discussionmentioning

confidence: 99%

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

Hoy

Rourke

2014

CUAJ

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Introduction: The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI. Methods: A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day. Results: There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs. 16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006). Conclusions: For mild to moderate PPI there is no difference in continence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

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Artificial Urinary Sphincter for Post-Prostatectomy Incontinence in Men Who Had Prior Radiotherapy: A Risk and Outcome Analysis

Cited by 103 publications

References 11 publications

Outcomes related to placing an artificial urinary sphincter using a single‐incision, transverse‐scrotal technique in high‐risk patients

Outcomes related to placing an artificial urinary sphincter using a single‐incision, transverse‐scrotal technique in high‐risk patients

The artificial urinary sphincter is the treatment of choice for post–radical prostatectomy incontinence

Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

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