LONG-TERM EFFICACY OF ARTIFICIAL URINARY SPHINCTER FOR PURE STRESS AND MIXED INCONTINENCE: MULTI-INSTITUTIONAL ANALYSIS

De Rienzo G1, Chiarulli E2, Gaboardi F2, Centemero A2, Rigatti L2, Sandri S3, mantica g2

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Abstract 302
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:10 - 13:15 (ePoster Station 2)
Exhibition Hall
Incontinence Mixed Urinary Incontinence Urodynamics Techniques Urodynamics Equipment
1.Policlinico di Bari, 2.San Raffaele Turro Hospital, 3.Villa Igea Clinic
Presenter
G

Gaetano De Rienzo

Links

Poster

Abstract

Hypothesis / aims of study
The Artificial Urinary Sphincter (AUS) represents the most effective and evidence based treatment for patients with stress urinary incontinence (SUI). Even if labelled for SUI, in clinical practice AUS is often inserted even in case of mixed incontinence (MUI), and the role of preoperative urodynamic studies is still debatable. The aim of our study is to verify if the early and long-term outcomes of AUS implantation are influenced by the consensual presence of urgency/urge incontinence at the preoperative urodynamic study.
Study design, materials and methods
The data of all consecutive patients referred to two tertiary care centres for urinary incontinence after prostatic surgery and who underwent AUS implantation (AMS 800) from January 2006 to December 2018 has been retrospectively evaluated. All patients underwent a pre-operative assessment with physical examination, urinalysis, cystoscopy, pad test as well as complete urodynamic evaluation. Mixed urinary incontinence (MUI) was defined as the presence of detrusor hyperactivity at urodynamics. The AUS were implanted with either one or two cuffs according to the surgeon’s preference. The follow-up included a pad test, urinalysis and physical examination every three months for the first year and annually thereafter. Peri-, early and late post-operative complications were recorded during the whole follow-up period. Complete continence was defined as either the need of no pads or the use of one safety pad. Data were entered into a Microsoft Excel (Version 14.0) database and then transferred to Sofastat TM 1.4.6 for Windows. Descriptive statistics were reported as mean and median (first to third quartile). Chi-squared t-test was used to analyze difference in the continence outcome in patients with SUI and MUI, a p value < 0.05 was considered statistically significant.
Results
One hundred and one consecutive patients were enrolled in the study. Mean and median (IQR) age was 67.8 and 69 (64 - 72) years, respectively. Pre-operatively, 28 (21.5%) patients wore ≤ 3 pads/daily, while 73 (56.2%) ≥ 4. Eighty-seven patients had urinary incontinence (UI) after radical prostatectomy and fourteen after surgery for benign prostatic hyperplasia (BPH). Twenty-eight patients underwent adjuvant or salvage radiation therapy. At urodynamics, 63 (62.4%) and 38 (37.6%) patients had pure SUI and MUI, respectively. A single cuff was inserted in 73 (72.3%) patients and two cuffs in 25 (24.8%). Mean and median follow-up was 47.2 and 50 months, respectively. During follow-up, 21 (20.8%) patients required AUS revision without need of AUS explantation. However, AUS explantation was necessary in 8 cases (7.9%) due to infection (4) or urethral erosion (4). Overall, 10 (9.9%) and 20 (19.8%) patients reported early and late complications, respectively. The main early complications were scrotal hematomas and urinary retention while the late main complications were infections and erosions. Eleven patients were lost to follow-up and 8 had undergone AUS explantation, resulting in 85 patients for UI evaluation. Of these, complete continence was reported in 71 (83.5%) while 8 (7.9%) and 6 (7.1%) patients were using ≤ 2 and ≥ 3 pads/daily, respectively. In 2 of these 6 patients the AUS was deactivated, even if functioning, due to other medical issues. The rate of complete continence was not different between patients with pre-operative pure SUI vs. those with MUI (85.5% vs. 80.0%, respectively, p=0.7).
Interpretation of results
In our series, patients with MUI showed a similar outcome in terms of continence recovery compared to patients with pure SUI after prostatic surgery.
Concluding message
Artificial urinary sphincter (AUS) implantation represents a valid treatment for male patients with severe incontinence after prostatic surgery. Our data show that this surgical approach is equally effective in both patients with pure SUI as well as in patients with detrusor activity. The utility of pre-operative urodynamic evaluation remains questionable and should be further investigated.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Our Institution does not require the approvation of an Ethical Committee for retrospective studies Helsinki Yes Informed Consent No