Overactive Bladder Syndrome After Artificial Urinary Sphincter Implantation – Is It Harder to Treat?

Persu C1, Chirca N1, Buzescu B2, Jinga V1

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Abstract 382
ePoster 6
Scientific Open Discussion Session 25
On-Demand
Stress Urinary Incontinence Detrusor Overactivity Male Overactive Bladder
1. "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 2. "Prof. Dr. Th. Burghele" Clinical Hospital, Bucharest, Romania
Presenter
C

Cristian Persu

Links

Abstract

Hypothesis / aims of study
The overactive bladder syndrome developed after implanting and artificial urinary sphincter seems to be more challenging from a therapeutic perspective if compared to idiopathic cases. Our aim is to compare the clinical features of the overactive bladder (OAB) in the patient with an artificial urinary sphincter (AUS) implant with a similar population with non-neurogenic OAB.
Study design, materials and methods
We performed a retrospective study focused on the evolution of post-surgical treatment of OAB in patients with an AUS implant. For analysis purpose we used data from our experience with a similar series of patients with OAB after prostate surgery (non-neurogenic) and no AUS. In the AUS group, urodynamic studies were available before and twice after the implant. The OABq questionnaire was used. After the diagnosis of de novo OAB, treatment was started as per our standard of care, with antimuscarinics alone or in combination with β3 agonists. T-test analysis was performed for comparison of QABq and urodynamic parameters in both series.
Results
A total of 12 patients with OAB post AUS implantation were included, aged 49 to 88 years old. In all cases, an overactive detrusor was confirmed by urodynamics. We could not identify any predictive factor for de novo OAB in the pre-implant urodynamic evaluation. After treatment, in the AUS group, we noticed no statistical significant variation of the OABq and urodynamic parameter, while in the control group all parameters were improved.
Interpretation of results
Post prostatectomy urinary incontinence in the male patient is one of the most bothersome late complications of this surgery. Our experience shows that severe incontinence might develop regardless of the initial indication for surgery, e.g. prostate cancer or BOO. The AUS remains the ultimate treatment in this case, even if some significant drawbacks still persist. Post AUS complications include this particular and redutable type of OAB syndrome, which has suboptimal response to treatment. Unfortunately, even if the AUS has been around for almost half a century, the experience with it remains limited and there is an almost desperate need for large studies of metanalyses in order to better understand its long term behavior.
Concluding message
De novo OAB has a poor response to treatment when compared to typical OAB cases. In some cases, the lack of response is confirmed both by the questionnaire (symptoms) and urodynamics (objective parameters). We were unable to identify predicting factors for de novo OAB. Pre-operative OAB does not correlate with any postoperative parameter. The patient has to be informed about the possibility that he will develop treatment refractory OAB after the AUS implant.
References
  1. Lecamwasam HS, Yalla SV, Cravalho EG, Sullivan MP. Themaximum watts factor as a measure of detrusor contractilityindependent of outlet resistance.Neurourol Urodyn1998;17(6):621e35
  2. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R,et al. Summary of European association of urology (EAU)guidelines on neuro-urology.Eur Urol2016;69(2):324e33
  3. Palleschi G, Pastore AL, Ripoli A, Silvestri L, Petrozza V,Carbone A. Videourodynamic evaluation of intracorporeallyreconstructed orthotopic U-shaped ileal neobladders.Urology2015;85(4):883e9.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Local Helsinki Yes Informed Consent No
13/10/2021 17:02:28