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Transcorporal artificial urinary sphincter implantation as a salvage surgical procedure for challenging cases of male stress urinary incontinence: surgical technique and functional outcomes in a contemporary series
Author(s) -
Wiedemann Laura,
Cornu JeanNicolas,
Haab Emilie,
Peyrat Laurence,
Beley Sébastien,
Cathelineau Xavier,
Haab François
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12386
Subject(s) - medicine , artificial urinary sphincter , urinary incontinence , surgery , stress incontinence , sexual function , erectile dysfunction , urinary system , urology
Objectives To describe the surgical technique of transcorporal artificial urinary sphincter ( AUS ) implantation. To assess the efficacy of the AUS on continence and erectile function.Patients and Methods A prospective evaluation was conducted between D ecember 2007 and O ctober 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS ( AMS 800™, A merican M edical S ystems, M innetonka, MN , USA ) implantation for stress urinary incontinence ( SUI ) recurrence, after failure of previous anti‐incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire – Short‐Form. Erectile function was evaluated using the five‐item International Index of Erectile Function ( IIEF ‐5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview.Results A total of 23 patients were included. Their mean ( sd ; range) age was 70 (7; 60–85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri‐operative complications. Follow‐up data over 1 year were available for 17 patients. After a median ( sd ; range) follow‐up of 20 (15; 2–59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF ‐5 score.Conclusions Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body.