Treatment of Anastomotic Stricture and Incontinence after Radical Prostatectomy with Dilating Mesh Urolume and AMS-800 Artificial Sphincter

Purpose: To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor. Patients and Methods: Using 1997 to 1998 claims data from a national 5% random sample of Medicare beneficiaries, we identified 2,292 men who underwent radical prostatectomy at 1,210 hospitals by 1,788 surgeons. Hospitals were classified as high (≥ 60 per year) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high (≥ 40 per year) or low (< 40 per year) volume. Multivariate logistic regression was performed to control for patient demographics and comorbidities when assessing the association of hospital and surgeon volume with in-hospital complications, length of stay, and anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and miscellaneous surgical and medical conditions. Results: High-volume surgeons had half the complication risk (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.32 to 0.89) and shorter lengths of stay (4.1 v 5.2 days, P = .03) compared with low-volume surgeons. High-volume hospital patients tended to have fewer anastomotic strictures (OR = 0.72; 95% CI, 0.49 to 1.04). Patient age (≥ 75 years) was associated with more complications (OR = 1.9; 95% CI, 1.39 to 2.70), more anastomotic strictures (OR = 2.2; 95% CI, 1.54 to 3.15), and longer hospital stays (parameter estimate = 2.26; 95% CI, 1.75 to 2.77). Conclusion: Surgeon volume is inversely related to in-hospital complications and length of stay in men undergoing radical prostatectomy. Hospital volume is not significantly associated with outcomes after adjusting for physician volume. Further study is necessary to elucidate the mechanism of the volume-outcome effect.

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1096 PERINEAL POSTERIOR URETHROPLASTY IN THE MANAGEMENT OF ANASTOMOTIC STRICTURE AFTER RADICAL PROSTATECTOMY

The Journal of Urology ◽

10.1016/j.juro.2010.02.2293 ◽

2010 ◽

Vol 183 (4S) ◽

Author(s):

Andre Cavalcanti ◽

Daniel Hampl ◽

Ricardo Almeida ◽

Daibes Rachid Filho ◽

Luciano Favorito

Keyword(s):

Radical Prostatectomy ◽

Anastomotic Stricture

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SINGLE STEP IMPLANTATION OF AN ARTIFICIAL SPHINCTER OF THE BLADDER AND PENILE PROSTHESIS AS A METHOD OF CORRECTING OF ERECTILE DYSFUNCTION AND URINARY INCONTINENCE

Research n Practical Medicine Journal ◽

10.17709/2409-2231-2017-4-2-10 ◽

2017 ◽

Vol 4 (2) ◽

pp. 75-79

Author(s):

P. S. Kyzlasov ◽

M. M. Sokol’shchik ◽

N. A. Goncharov ◽

S. V. Porowski ◽

V. P. Sergeev ◽

...

Keyword(s):

Prostate Cancer ◽

Urinary Incontinence ◽

Erectile Dysfunction ◽

Radical Prostatectomy ◽

Erectile Function ◽

Single Step ◽

Optimal Method ◽

Acceptable Result ◽

Simultaneous Treatment ◽

Artificial Sphincter

This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.

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