Prior Placement of Male Urethral Slings Can Increase the Need for Revision of Artificial Urinary Sphincters

Background: Recurrent stress urinary incontinence (SUI) following male sling can be managed surgically with artificial urinary sphincter (AUS) insertion. Prior small, single-center retrospective studies have not demonstrated an association between having failed a sling procedure and worse AUS outcomes. The aim of this study was to compare outcomes of primary AUS placement in men who had or had not undergone a previous sling procedure. Methods: A retrospective review of all AUS devices implanted at a single academic center during 2000–2018 was performed. After excluding secondary AUS placements, revision and explant procedures, 135 patients were included in this study, of which 19 (14.1%) patients had undergone prior sling procedures. Results: There was no significant difference in demographic characteristics between patients undergoing AUS placement with or without a prior sling procedure. Average follow up time was 28.0 months. Prior sling was associated with shorter overall device survival, with an increased likelihood of requiring revision or replacement of the device (OR 4.2 (1.3–13.2), p = 0.015) as well as reoperation for any reason (OR 3.5 (1.2–9.9), p = 0.019). While not statistically significant, patients with a prior sling were more likely to note persistent incontinence at most recent follow up (68.8% vs. 42.7%, p = 0.10). Conclusions: Having undergone a prior sling procedure is associated with shorter device survival and need for revision or replacement surgery. When considering patients for sling procedures, patients should be counseled regarding the potential for worse AUS outcomes should they require additional anti-incontinence procedures following a failed sling.

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Stemming the tide of mild to moderate post-prostatectomy incontinence: A retrospective comparison of transobturator male slings and the artificial urinary sphincter

Canadian Urological Association Journal ◽

10.5489/cuaj.2108 ◽

2014 ◽

Vol 8 (7-8) ◽

pp. 273 ◽

Cited By ~ 5

Author(s):

Nathan Y. Hoy ◽

Keith F. Rourke

Keyword(s):

Patient Satisfaction ◽

Artificial Urinary Sphincter ◽

Complication Rates ◽

Retrospective Comparison ◽

Urinary Sphincter ◽

Significant Difference ◽

Comorbidity Scores ◽

Clavien Grade ◽

Grade 3

Introduction: The AUS remains the gold standard treatment for post-prostatectomy incontinence (PPI), although most patients with mild-moderate PPI prefer a sling without strong evidence of procedural equivalence. This study compares outcomes of 2 procedures for the treatment of mild-moderate PPI.Methods: A retrospective review of 124 patients (76 transobturator sling, 48 AUS) with mild-moderate PPI requiring intervention over an 8-year period. The primary outcome was continence. Secondary outcomes included global patient satisfaction, improvement, and complication rates. Mild to moderate incontinence was defined as requiring ≤5 pads/day.Results: There was no significant difference in age (66.2 vs. 68.1 years; p = 0.17) or prostate cancer characteristics for slings and AUS, respectively. AUS patients had higher Charlson comorbidity scores and were more likely to have previous radiotherapy. Median length of follow up was 24 months for slings and 42 months for AUS. There was no difference in continence rates, 88.2% vs. 87.5% (p = 0.79), rate of improvement, 94.7% vs. 95.8% (p = 1.00), or patient satisfaction, 93.4% vs. 91.7% (p = 0.73), for slings and AUS, respectively. Complication rates were equivalent (19.7% vs.16.7%; p = 1.00), though a significantly higher proportion of complications with AUS were Clavien Grade 3 (0% vs. 75%; p = 0.006).Conclusions: For mild to moderate PPI there is no difference incontinence, satisfaction, or improvement rates, between AUS and slings. AUS complications tend to be more severe. Our study supports the use of slings as first-line treatment for mild-moderate PPI.

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Management of recurrent post-prostatectomy incontinence after previous failed retrourethral male slings

Canadian Urological Association Journal ◽

10.5489/cuaj.595 ◽

2013 ◽

Vol 5 (2) ◽

pp. 107

Author(s):

Amr Al-Najar ◽

Sascha Kaufmann ◽

Soenke Boy ◽

Carsten Maik Naumann ◽

Peter-Klaus Jünemann ◽

...

Keyword(s):

Minimally Invasive ◽

Artificial Urinary Sphincter ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Male Sling ◽

Pelvic Irradiation ◽

Urinary Sphincter ◽

Sling Placement

Objective: Our objective was to establish the feasibility of combining2 minimally invasive procedures in patients with failed primarytreatment (male sling) in post-prostatectomy incontinence(PPI) patients.Methods: From January 2007 to July 2008, 40 men with PPI wereimplanted with a suburethral tape (2 patients with Seratim, 3 withI-Stop and 35 with Advance). The median preoperative pad countwas 4 (range 2-10). Prior to sling placement, 6 patients had undergoneProACT implantation. Of these, 4 patients required explantationdue to balloon migration and 2 patients had their balloonskept in situ, with the balloons deflated.Results: Twenty-five patients were socially continent at this time.Fifteen patients (37.5%) did not improve or their improvementwas not significant. These patients had a preoperative pad countbetween 7 and 10. Two of these patients had prostate adjustablecontinence therapy (ProACT) systems still in place. By graduallyfilling the balloons to 3 mL, both of these patients achieved completecontinence, which was maintained at a mean follow-up of8.5 months. Three patients with prior pelvic irradiation receivedan artificial urinary sphincter and achieved continence at meanfollow-up of 8.3 months. The remaining 10 patients received aProACT system in addition to the already implanted sling. Afterappropriate healing and filling of the balloons (average balloonvolume 5 mL), all 10 patients reached complete continence; theywere pad-free at a mean follow-up of 6 months (range 3-9).Conclusions: The combination of ProACT and a suburethral tapewas demonstrated to be a possible treatment option in recurrentor persistent PPI.Objectif : Notre objectif était d’établir la faisabilité d’une associationde 2 interventions minimalement invasives chez des patients ayantsubi un échec thérapeutique primaire (bandelettes sous-urétrales)chez des patients atteints d’incontinence post- prostatectomie.Méthodologie : De janvier 2007 à juillet 2008, on a placé une bandelettesous-urétrale chez 40 hommes atteints d’incontinence postprostatectomie(2 patients ont reçu le dispositif de marque Seratim,3 patients, de marque I-Stop et 35, de marque Advance). Le nombremédian de protections absorbantes avant l’opération était de 4 (2 à10). Avant la mise en place de la bandelette, 6 patients avaient subiune implantation d’un système ProACT. De ce nombre, 4 patientsont dû se faire retirer les ballonnets en raison de leur déplacement;chez 2 patients, les ballonnets sont restés en place mais se sontdégonflés.Résultats : Vingt-cinq patients présentaient une continence socialeà ce moment. Quinze patients (37,5 %) n’ont présenté aucuneamélioration, ou une amélioration non significative. Ces patientsutilisaient de 7 à 10 protections absorbantes avant l’opération. Deuxde ces patients étaient toujours porteurs d’un système ProACT. Enremplissant graduellement les ballonnets de 3 mL, ces deux patientsont atteint une continence totale, maintenue après un suivi moyende 8,5 mois. Trois patients ayant reçu antérieurement un traitementpelvien par rayonnement ont reçu un sphincter urinaire artificielet ont atteint la continence après un suivi moyen de 8,3 mois.Chez les 10 derniers patients, on a implanté un système ProACTen plus de la bandelette déjà en place. Après un temps suffisant deguérison et le remplissage des ballonnets (volume moyen : 5 mL),les 10 patients ont atteint une continence complète. Ils n’avaientplus besoin de protection absorbante après un suivi moyen de6 mois (entre 3 et 9 mois).Conclusions : L’association d’un système ProACT et d’une bandelettesous-urétrale s’est révélée une option thérapeutique possibleen présence d’incontinence post-prostatectomie récurrenteou persistante.

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Risk factors for urological prosthetic infection

Urologia Journal ◽

10.1177/039156039706400115 ◽

1997 ◽

Vol 64 (1) ◽

pp. 65-69 ◽

Cited By ~ 1

Author(s):

P. Fortunato ◽

M. Schettini ◽

M. Gallucci

Keyword(s):

Risk Factors ◽

Infection Rate ◽

Artificial Urinary Sphincter ◽

Prosthetic Infection ◽

Penile Prostheses ◽

Urinary Sphincter ◽

Significant Difference ◽

The Mean ◽

Revision Operations

We reviewed our experience of 91 procedures for implant and revision of urological prostheses from 1989 to 1996. The aim of the study was to determine the risk factors for urological prostheses. The procedures consisted of 48 implants of artificial urinary sphincters AMS 800 (35 primary implants and 13 revisions) and 43 penile prostheses (40 primary implants and 3 revisions). Simultaneous penile reconstruction was performed in 5 cases. The mean follow-up was 2 years (range 1-6 years) for artificial urinary sphincter and 1.8 years (range 1-4) for penile prostheses. Infection occurred in 7 cases (4 urinary sphincter and 3 penile prostheses). The infection rate after primary uncomplicated implant of AMS 800 was 8.5% compared to 7.6% for revision procedures (p=n.s.). The infection rate after primary implant of penile prostheses was 5% compared to 33% for revision procedures. There was a similar significant difference between the penile prostheses implant group with reconstruction of the corpora (2 out 5 patients) and the primary uncomplicated implant group (p=0.001). The risk of infection is significantly greater when penile reconstruction is required and is associated with revision operations.

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MP32-14 A COST-EFFECTIVENESS ANALYSIS OF ARTIFICIAL URINARY SPHINCTER VERSUS ADVANCE MALE SLING IN POST PROSTATECTOMY STRESS URINARY INCONTINENCE: A CANADIAN PERSPECTIVE

The Journal of Urology ◽

10.1016/j.juro.2017.02.989 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Samer Shamout ◽

Sara Nazha ◽

Alice Dragomir ◽

Noemie Prevost ◽

Lysanne Campeau

Keyword(s):

Urinary Incontinence ◽

Cost Effectiveness ◽

Stress Urinary Incontinence ◽

Cost Effectiveness Analysis ◽

Artificial Urinary Sphincter ◽

Male Sling ◽

Effectiveness Analysis ◽

Urinary Sphincter ◽

Canadian Perspective

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Urinary Artificial Sphincter ZSI 375 for Treatment of Stress Urinary Incontinence in Men: 5 and 7 Years Follow-Up Report

Urologia Journal ◽

10.5301/uj.5000243 ◽

2017 ◽

Vol 84 (4) ◽

pp. 263-266 ◽

Cited By ~ 4

Author(s):

Christophe Llorens ◽

Tobias Pottek

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Artificial Urinary Sphincter ◽

Minimal Period ◽

Artificial Sphincter ◽

Urethral Erosion ◽

Randomised Study ◽

Urinary Sphincter ◽

Male Patients

Study Design This is a retrospective, non-randomised study. Objectives The aim of this study was to evaluate safety and efficacy of artificial urinary sphincter ZSI 375 inserted in male patients with stress urinary incontinence (SUI). Methods Between May 2009 and January 2017, 45 men with SUI underwent ZSI 375 device insertion. Operations were performed in two French centres by one surgeon. Complications and pad used to manage continence were recorded. Results From May 2009 to January 2012, 45 patients with a mean age of 70.42 years underwent placement of the ZSI 375 device in France. The most common cause for incontinence was radical prostatectomy (RP, 33/45 patients, 73.33%). The minimal period of incontinence was 6 months. Twenty-seven out of 45 patients (60.00%) had a severe incontinence (at least four pads per day), 13 patients (28.89%) had moderate incontinence (three pads per day) and five patients (11.11%) had two pads per day. With a long follow-up, the ZSI 375 device was considered to be successful in 73.33% patients after 5 years (60 months) and 72% of patients after 7 years (84 months). The infection rate was 2.2 % affecting one in 45 patients. Six out of 45 patients presented a urethral erosion (13.33%). Mechanical failure with a revision occurred in three patients (6.67%). Conclusions The ZSI 375 device is a safe and effective device to treat severe SUI in men.

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The impact of prior urethral sling on artificial urinary sphincter outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.3922 ◽

2016 ◽

Vol 10 (11-12) ◽

pp. 405 ◽

Cited By ~ 6

Author(s):

Matthew J. Ziegelmann ◽

Brian J. Linder ◽

Marcelino E. Rivera ◽

Boyd R. Viers ◽

Daniel S. Elliott

Keyword(s):

Retrospective Chart Review ◽

Artificial Urinary Sphincter ◽

Device Failure ◽

Kaplan Meier ◽

Hazard Ratios ◽

Urinary Sphincter ◽

Device Infection ◽

Significant Difference ◽

History Of ◽

The Impact

Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS).Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis.Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy.Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

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