Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra

El Akri M1, Bentellis I2, Tricard T3, Brierre T4, Cousin T5, Dupuis H6, Hermieu N7, Gaillard V3, Poussot B3, Robin D8, Bertrand-Léon P8, Chevallier D2, Bruyere F9, Biardeau X10, Monsaint H11, Corbel L12, Saussine C3, Hermieu J7, Lecoanet P13, Capon G5, Cornu J6, Game X4, Ruffion A14, Peyronnet B1

Research Type

Clinical

Abstract Category

Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)

Best in Category Prize: Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)
Abstract 3
Live Urology 1 - Surgical Insights
Scientific Podium Session 1
Thursday 14th October 2021
08:20 - 08:30
Live Room 1
Incontinence Stress Urinary Incontinence Surgery
1. CHU de Rennes, 2. CHU de Nice, 3. CHU de Strasbourg, 4. CHU de Toulouse, 5. CHU de Bordeaux, 6. CHU de Rouen, 7. APHP, 8. CHU de Reims, 9. CHU de Tours, 10. CHU de Lille, 11. Clinique Océane, 12. Centre Hospitalier Privé des Côtes d'Armor, 13. CHU de Nancy, 14. HCL
Presenter
M

Mehdi El Akri

Links

Abstract

Hypothesis / aims of study
Transcorporal approach for artificial urinary sphincter (AUS) implantation has been developed to lower the risk of urethral erosion. To date, its safety remains poorly known. The aim of our study was to compare transcorporal vs bulbar AUS implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this patient population.
Study design, materials and methods
The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. . Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal. The primary endpoint was device explantation-free survival. Explantation was defined as any surgical intervention requiring complete removal of the AUS without immediate reimplantation (infection, erosion, decreased bladder capacity/compliance). Another study’s endpoint was reoperation-free survival. Reoperation was defined as explantation and/or revision. Revision was defined as any surgical intervention consisting in replacing one or more components of the device.
Results
Out of 1363 male patients who underwent an AUS implantation over the study period, 464 patients were included for analysis. Eighty-eight patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. The proportion of patients who experienced at least one post-operative complications was comparable in both groups (13.5% vs. 17.7%; p=0.33). The explantation-free survival in the transcorporal group paralleled the one of the bulbar group (estimated 5-year explantation-free survival rates 55.3% vs. 58.4%; p=0.98). The reoperation-free survivals did not differ significantly between both groups (estimated 5-year reoperation-free survival rates: 44.6% vs. 42%; p=0.51). In the subgroup of patients with an history of previous AUS explantation, patients of the transcorporal group tended to have a longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate Cox regression analysis, the only risk factor of shorter explantation free survival was the history of previous AUS explantation (HR=2.65; p=0.01)
Interpretation of results
In the present multicenter cohort, transcorporal AUS implantation was not associated with longer explantation-free nor reoperation-free survival in male patients with fragile urethras compared to bulbar implantation. Transcorporal and bulbar AUS implantation brought similar functional and perioperative outcomes. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival in the transcorporal group. In other subgroups (e.g. irradiated patients, history of urethroplasty) in the light of our findings and given that transcorporal implantation after failure of a bulbar AUS has been proven feasible but not the opposite, transcorporal AUS might be regarded solely as a back-up plan when bulbar dissection appears technically impossible intraoperatively.
Concluding message
Transcorporal AUS does not lower the risk of urethral erosion in men with fragile urethras. However, patients with history of previous AUS explantation might draw benefits from this approach. Further studies are needed to elucidate the exact benefits of transcorporal approach for each subgroup of patients with fragile urethras.
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Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee CNIL2216559 Helsinki not Req'd This is not an interventionnal study Informed Consent No
31/05/2022 19:23:26