13 Years Of Experience With Artificial Urinary Sphincter Implantation At Baylor College Of Medicine
A recent report by Timothy Boone and colleagues from Baylor report on a 13 year experience implanting 270 AUS devices. Follow-up data was available on 218 patients. Outcomes and complications were reviewed in the study that was published in the March 2007 issue of the Journal of Urology.
A closer look at the study population showed that 60 of the 218 patients underwent prostatectomy and radiation therapy, 116 underwent prostatectomy without radiation, 11 had a neurogenic bladder and 31 underwent secondary AUS implantation. These four groups were examined more closely and compared. Mean follow-up was 36.5 months. All patients received a single narrow-backed cuff implanted through two incisions. The AUS was activated at 4 weeks and patients were not required to deactivate the device at night.
Analysis of the results showed that post-AUS pad use did not differ among the 4 patient groups. Men required 1.1 pads per day post-op versus 5.3 pads pre-op. In addition, there was no difference among the 4 groups (irradiated, nonirradiated, neurogenic, and secondary) in the rate of complications, including wound or AUS infection, cuff erosion, urethral atrophy, mechanical failure, or need for surgical revision or removal. The overall incidence of cuff erosion was 6.0%, 5.5% infection, 9.6% for urethral atrophy and 6.0% for mechanical failure. Of the patients 59 (22%) underwent a total of 91 revisions/removals to correct complications. Half of the patients had undergone AUS revision or removal by 89.4 months (median durability). At five years, 75% of patients were free from revision or removal.
Additionally, the rate of bladder neck contractures was high in AUS candidates, especially in irradiated patients (36% and 57% respectively). Patients with prior pelvic radiation continued to be at risk for contracture recurrence after AUS implantation (12%). Two stage Urolume stent placement and AUS placement (at least 3 months later) offered long-term contracture and continence control in 8 of 11 patients with recurrent anastomotic contracture.
Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB
J Urol. 2007 Mar. 177(3): 1021-25
Reviewed by UroToday.com Contributing Editor Michael J. Metro, MD
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