Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet?

Autor: Queissert F; Department of Urology and Pediatric Urology, University Hospital Münster, 48149 Münster, Germany., Huesch T; Department of Urology, University Medical Center of Johannes Gutenberg University, 55131 Mainz, Germany., Kretschmer A; Department of Urology, Ludwig-Maximilians University, Campus Großhadern, 80539 Munich, Germany., Kirschner-Hermanns R; Department of Urology, University Hospital Bonn, 53127 Bonn, Germany., Pottek T; Department of Urology, Vivantes Hospital Am Urban, 10117 Berlin, Germany., Olianas R; Department of Urology, Hospital Lüneburg, 21339 Lüneburg, Germany., Friedl A; Department of Urology, Göttlicher Heiland Vienna, 1170 Vienna, Austria., Homberg R; Department of Urology and Pediatric Urology, St. Barbara Hospital Hamm, 59075 Hamm, Germany., Pfitzenmaier J; Department of Urology, Evangelic Hospital Bethel, 42240 Bielefeld, Germany., Naumann CM; Department of Urology and Pediatric Urology, St. Elisabeth Hospital, 56564 Neuwied, Germany., Nyarangi-Dix J; Department of Urology and Pediatric Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany., Hofmann T; Department of Urology, Diakonie Hospital Schwaebisch Hall, 74523 Schwaebisch Hall, Germany., Rose A; Department of Urology and Pediatric Urology, Helios Hospital Duisburg, 47166 Duisburg, Germany., Weidemann C; Department of Urology and Pediatric Urology, Catholic Hospital St. Johann Nepomuk, 99097 Erfurt, Germany., Wotzka C; Department of Urology, Diakonie Hospital Stuttgart, 70176 Stuttgart, Germany., Hübner W; Department of Urology, Hospital Weinviertel Korneuburg, 2100 Korneuburg, Austria., Loertzer H; Department of Urology and Pediatric Urology, Westpfalz Medical Center, 67655 Kaiserslautern, Germany., Abdunnur R; Department of Urology, Helios Hospital Schwelm, 58332 Schwelm, Germany., Grabbert M; Department of Urology, University Hospital Freiburg, 79106 Freiburg, Germany., Anding R; Department of Urology, University Hospital Basel, 4031 Basel, Switzerland., Bauer RM; Department of Urology, Ludwig-Maximilians University, Campus Großhadern, 80539 Munich, Germany., Haferkamp A; Department of Urology, University Medical Center of Johannes Gutenberg University, 55131 Mainz, Germany., Schrader AJ; Department of Urology and Pediatric Urology, University Hospital Münster, 48149 Münster, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Jun 12; Vol. 12 (12). Date of Electronic Publication: 2023 Jun 12.
DOI: 10.3390/jcm12124002
Abstrakt: Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes.
Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan-Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant.
Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003).
Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.
Databáze: MEDLINE
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