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Girard C, El-Akri M, Durand M, Guérin O, Cornu JN, Brierre T, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Leon P, Chevallier D, Bruyere F, Biardeau X, Hermieu JF, Lecoanet P, Capon G, Game X, Saussine C, Rambaud C, Peyronnet B, Bentellis I. Efficacy, Safety, and Reoperation-free Survival of Artificial Urinary Sphincter in Non-neurological Male Patients over 75 Years of Age. EUR UROL SUPPL 2023; 53:23-30. [PMID: 37441348 PMCID: PMC10334236 DOI: 10.1016/j.euros.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 07/15/2023] Open
Abstract
Background Artificial urinary sphincter (AUS) is a gold standard treatment in male stress urinary incontinence but remains poorly used in elderly patients. Objective To assess the efficacy, safety, and reoperation-free survival of AUS implantation in male patients over 75 yr of age. Design setting and participants We retrospectively reviewed the charts of all 1233 non-neurological male AUS implantations between 2005 and 2020 at 13 French centers. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75-) at the time of AUS implantation. Outcome measurements and statistical analysis Our primary endpoint was social continence at 3 mo defined as the use of one or fewer pad daily. We used Kaplan-Meier analyses to assess reoperation-free survival. We sought factors of erosion using logistic regression. Results and limitations Early postoperative continence was comparable in both groups (74.4% vs 80.1%, p = 0.114). We observed a higher rate of postoperative complications in GROUP75+ (18.8% vs 12.6%, p = 0.014), but the complications were more frequently of low grade in GROUP75+ (p = 0.025). The overall reoperation-free survival was similar (p = 0.076) after a median follow-up of 2 yr. However, patients in GROUP75+ had poorer explantation-free survival (p < 0.0001). A history of radiotherapy was a predictive factor of erosion (odds ratio [OR] = 5.31, p < 0.01), but age was not (OR = 1.08, p = 0.87). Unfortunately, our dataset did not include a systematic geriatric evaluation. Conclusions AUS in elderly patients appears to be an effective option to treat stress urinary incontinence. However, we observed more postoperative complications and explantations, although age was not associated with the onset of erosion. A prospective study is required to determine whether a geriatric evaluation would be an effective strategy to select patients before surgery. Patient summary In this study, we looked at outcomes of artificial urinary sphincter in elderly men in a large population. We found satisfying efficacy but slightly more postoperative complications and device infections.
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Affiliation(s)
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- University Hospital of Toulouse, Toulouse, France
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Long-term functional outcomes of artificial urinary sphincter (AMS 800™) implantation in women aged over 75 years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency. World J Urol 2021; 39:3897-3902. [PMID: 33938979 DOI: 10.1007/s00345-021-03702-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess the outcomes after artificial urinary sphincter (AUS) implantation in older women aged over 75 years. METHODS A monocentric retrospective study included all non-neurological women aged over 75 years suffering from stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and undergoing an AUS placement between 1991 and 2015. Early postoperative complications were reported according to Clavien-Dindo classification. Continence, defined as no pad use, was assessed at the end of follow-up. Explantation, revision and deactivation rates of the AUS were reported. A Kaplan-Meier survival curve was generated to evaluate the survival rate of the device without revision or explantation. RESULTS Among 393 AUS implantations, a total of 45 patients, median age 77 years (IQR 75-79), were included. Twenty-six early postoperative complications occurred in 18 patients (40%) patients. All were minor Clavien grades (I-II) except one (grade IVa). Median follow-up was 36 months (IQR 16-96). Overall, 32 women (71.1%) still had their AUS in place at the end of the follow-up, without revision or explantation. The AUS was definitively removed in four (8.9%). The AUS required revisions in nine (20%) women. The 5- and 10-year survival rates of the device without revision or explantation were 78 and 50%, respectively. Three patients (6.7%) had their AUS deactivated. At last follow-up, in an intention-to-treat analysis, the continence rate was 68.9%. CONCLUSION In women aged over 75-years-old, suffering from SUI, the AUS provides satisfactory functional results comparable to the general population.
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Gill BC. EDITORIAL COMMENT. Urology 2021; 147:248-249. [PMID: 33390206 DOI: 10.1016/j.urology.2020.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Bradley C Gill
- Department of Urology, Cleveland Clinic Lerner College of Medicine, Education Institute, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Keles A, Onur R, Aydos M, Dincer M, Koca O, Coskun B, Imamoglu A, Karakeci A. AUTHOR REPLY. Urology 2021; 147:249. [PMID: 33390207 DOI: 10.1016/j.urology.2020.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmet Keles
- Istanbul Esenyurt State Hospital, Department of Urology, Istanbul, Turkey.
| | - Rahmi Onur
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Murat Aydos
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Murat Dincer
- University of Health Sciences, Bagcilar Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Orhan Koca
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Burhan Coskun
- Uludag University School of Medicine, Department of Urology, Bursa, Turkey
| | - Abdurrahim Imamoglu
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Ahmet Karakeci
- Firat University School of Medicine, Department of Urology, Elazig, Turkey
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Ballantyne CC, Sharma D, Rapp DE, Boatman KR, Krzastek SC, Costabile RA. Prevalence of Cognitive Impairment and Sphincter Misuse Among Men With Artificial Urinary Sphincters. Urology 2020; 148:292-296. [PMID: 33115618 DOI: 10.1016/j.urology.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To define the prevalence of cognitive impairment and sphincter misuse among men who had undergone AUS placement. METHODS Men who had previously undergone AUS placement from 2004 to 2019 were assessed through comprehensive telephone surveys. The primary survey outcome was cognitive function, assessed via validated Telephone Mini-Mental State Examination. Secondary survey outcomes included rate of AUS misuse, surgical outcomes, and overall device satisfaction. Statistical analysis was performed to assess for differences between patients with and without cognitive impairment. RESULTS A total of 74 patients participated, with a mean age and follow-up of 75 and 7.8 years, respectively. Telephone Mini-Mental State Examination assessment revealed cognitive impairment in 18 (24%) patients, 13 (18%) with mild-moderate and 5 (7%) with severe impairment. Overall, 23 (31%) and 11 (15%) patients reported inconsistent use (not cycling AUS with every void) and device neglect, respectively. Patients with impaired cognition were more likely to report difficulty with AUS use compared to those with normal cognition (39% vs 9%, P= .01). There was no difference seen in rates of revision, rates of retention, or urinary tract infections between cognitive groups. CONCLUSIONS Our study revealed significant rates of cognitive impairment and sphincter misuse among men with AUS. These data suggest a role for long-term follow-up and monitoring for cognitive changes. Prospective study of cognitive decline and surgical outcomes in patients undergoing AUS is warranted.
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Affiliation(s)
| | - Devang Sharma
- Department of Urology, University of Virginia Health System, Charlottesville, VA
| | - David E Rapp
- Department of Urology, University of Virginia Health System, Charlottesville, VA.
| | | | - Sarah C Krzastek
- Department of Urology, University of Virginia Health System, Charlottesville, VA; Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA; Division of Urology, McGuire Veterans Association Medical Center, Richmond, VA
| | - Raymond A Costabile
- Department of Urology, University of Virginia Health System, Charlottesville, VA
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Keles A, Onur R, Aydos M, Dincer M, Koca O, Coskun B, Imamoglu A, Karakeci A. The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation. Urology 2020; 147:243-249. [PMID: 32890621 DOI: 10.1016/j.urology.2020.05.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODS Between January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients' overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTS AUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as "much better." Patients' education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSION AUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.
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Affiliation(s)
- Ahmet Keles
- Istanbul Esenyurt State Hospital, Department of Urology, Istanbul, Turkey.
| | - Rahmi Onur
- Marmara University School of Medicine, Department of Urology, Istanbul, Turkey
| | - Murat Aydos
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - Murat Dincer
- University of Health Sciences, Bagcilar Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Orhan Koca
- University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Burhan Coskun
- Uludag University School of Medicine, Department of Urology, Bursa, Turkey
| | - Abdurrahim Imamoglu
- University of Health Sciences, Diskapi Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Ahmet Karakeci
- Firat University School of Medicine, Department of Urology, Elazig, Turkey
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Toia B, Leung LY, Saigal R, Solomon E, Malde S, Taylor C, Sahai A, Hamid R, Seth JH, Sharma D, Greenwell TJ, Ockrim JL. Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence? World J Urol 2020; 39:1227-1232. [PMID: 32506387 PMCID: PMC8124059 DOI: 10.1007/s00345-020-03288-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. METHODS We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. RESULTS Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). CONCLUSION Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.
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Affiliation(s)
- Bogdan Toia
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK. .,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK.
| | - Lap Yan Leung
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Raveen Saigal
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Eskinder Solomon
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Claire Taylor
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Arun Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jai H Seth
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Davendra Sharma
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Tamsin J Greenwell
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jeremy L Ockrim
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Friedl A, Mühlstädt S, Zachoval R, Giammò A, Kivaranovic D, Rom M, Fornara P, Brössner C. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. BJU Int 2016; 119:785-792. [PMID: 27868328 DOI: 10.1111/bju.13684] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. PATIENTS AND METHODS In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (<10 mL/day and 0-1 pad/day), device durability, treatment failure, and device complications were recorded. Nonparametric tests were used for statistical analyses. RESULTS After a median (interquartile range [IQR]) follow-up of 31 (10-54) months and a median (IQR) of 3 (2-4) adjustments, the overall success rate was 90% (258 men) and the dry rate was 64% (184). Daily pad test and pad use decreased from a median of 400 mL/day and 4 pads/day to a median of 18 mL/day and 1 pad/day (both P < 0.001), concomitantly QoL ratings significantly improved and changed to a high level of satisfaction (PGI-I 4 to 2, ICIQ-SF 17 to 5; both P < 0.001). The UI results at 12 months were comparable to those at final follow-up. Chronic pain and intraoperative complications did not occur. Most of the postoperative complications were Clavien-Dindo grade I-III (no grade IV or V). At present, 231 (80%) of all the ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P < 0.001) were prognostic factors for beneficial treatment outcome. CONCLUSION The ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy.
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Affiliation(s)
- Alexander Friedl
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
| | - Sandra Mühlstädt
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Roman Zachoval
- Thomayer Hospital, Department of Urology and 1st and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Danijel Kivaranovic
- Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria
| | - Maximilian Rom
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Paolo Fornara
- Klinik and Poliklinik of Urology and Kidney Transplantation, University Hospital, Martin-Luther-University, Halle-Wittenberg, Halle/Saale, Germany
| | - Clemens Brössner
- Department of Urology, Hospital Göttlicher Heiland, Vienna, Austria
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