Causes of Artificial Urinary Sphincter Failure and Strategies for Surgical Revision: Implications of Device Component Survival.

Autor: Srivastava A; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: asrivas9@jhmi.edu., Joice GA; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA., Patel HD; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA., Manka MG; Department of Urology, Mayo Clinic, Rochester, MN, USA., Sopko NA; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA., Wright EJ; James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: European urology focus [Eur Urol Focus] 2019 Sep; Vol. 5 (5), pp. 887-893. Date of Electronic Publication: 2018 Mar 12.
DOI: 10.1016/j.euf.2018.02.014
Abstrakt: Background: Up to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management.
Objective: To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy.
Design, Setting, and Participants: We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5cm, with median size of 4.5cm.
Intervention: Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision.
Outcome Measurements and Statistical Analysis: We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique.
Results and Limitations: PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p=0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature.
Conclusions: PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision.
Patient Summary: Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision.
(Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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