Using stress-relief cuff to improve urine leakage after artificial urinary sphincter implantation

Weibl P1, Ameli G1, Rutkowski M1, Huebner W A1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 104
Open Discussion ePosters
Scientific Open Discussion ePoster Session 7
Wednesday 29th August 2018
12:35 - 12:40 (ePoster Station 4)
Exhibition Hall
Male Incontinence Surgery Retrospective Study
1. Department of Urology, Teaching Hospital, Landesklinikum Korneuburg, Korneuburg, Austria
Presenter
P

Peter Weibl

Links

Poster

Abstract

Hypothesis / aims of study
Men undergoing radical prostatectomy for prostate cancer frequently report the troublesome symptom of stress urinary incontinence (SUI). Prevalence estimates vary widely between 5% and 57% depending on definition, timing of assessment after surgery, and population characteristics. The rate of recovery of continence plateaus at around 12 months after surgery. The artificial urinary spincter (AUS) AMS 800 (American Medical Systems, Minnetonka, MN) has been proven and achieved the gold standard status for the treatment of stress urinary incontinence in men with regard to the long term follow up outcomes [1].  
However, some patients report about urine leakage during higher intraabdominal pressure after AUS-placement. To improve the continent results of these patients, we placed in additional to the occluding cuff (OC) and the pressure regulating balloon, in a second procedure a stress-relief cuff (SRC) in lower abdomen to provide additional pressure to the OC. As the stress-relief cuff we used a standard cuff from (AMS800™, AmericanMedicalSystems, Minnetonka , MN, USA). To the best of our knowledge, we are the first referral center for male SUI, who investigated placing a stress-relief cuff after AUS.
Study design, materials and methods
In total 211 AUS were placed in the time between 1/2008 and 12/2017. SRC was indicated in 9 (4,3%) patients with persistence involuntary leakage of urine that occurs when intraabdominal pressure rises. We used a telephone questionnaire to collect postoperative data as daily pad use and satisfaction rate. Average age at time of the SRC-placement was 70.7 (  9.6) years. The device was placed at an average time of 18.2 months (M = 18.5) after the AUS-implantation and the mean follow-up time was 21 (M= 6) months (range 2 to 80 months).
Results
In all 10 cases the device was easily implanted and there were no intraoperative complications. Pad use per day (p/d) after placing the SRC improved from 3.1 ( 1,3) to 2.0 (  1,4); p/d (p = .001). 2 patients with neurogenic bladder disorder and multiple previous abdominal surgeries used an equal number of pads after SRC, however an improvement when sneezing and during physical exertion was reported. Continence was rated as "good" or "satisfactory" by 6 patients (60%) and the satisfaction rate was 80% (n =8). 7 patients (70%) would undergo the procedure again and 8 (80%) would recommend it to others.
Interpretation of results
Our objective findings can be explained as follows: a) in almost  1/4  of patients we did not observe any significant improvement, because of the selection bias and the fact that patients with neurogenic voiding disorders and not ideal candidates; b) secondly patient's after multiple abdominal surgeries are probably not able to obtain  a sufficient intraabdominal pressure. And consequently do not influence the pressure inside the stress cuff.
Concluding message
The persistence of urinary incontinence after AUS-implantation is a challenging topic. Implantation of a stress-relief cuff after AUS in selected patients with urine leakage during higher intraabdominal pressure is minimally invasive and offers new options to improve the proven long-term record of AUS. Certainly, more investigations are needed to determine the clinical relevance of this approach.
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References
  1. Léon P, Chartier-Kastler E, Rouprêt M, Ambrogi V, Mozer P, Phé V. Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence. BJU Int. 2015 Jun;115(6):951-7.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Institutional board approval Helsinki Yes Informed Consent Yes