Long term outcome following bladder neck artificial urinary sphincter implantation (AUS)
Author(s):
Mr Simon Bugeja
,
Mr Simon Bugeja
Affiliations:
Miss Stella Ivaz
,
Miss Stella Ivaz
Affiliations:
Miss Stacey Frost
,
Miss Stacey Frost
Affiliations:
Miss Mariya Dragova
,
Miss Mariya Dragova
Affiliations:
Miss Daniela E Andrich
,
Miss Daniela E Andrich
Affiliations:
Prof Anthony R Mundy
Prof Anthony R Mundy
Affiliations:
BAUS ePoster online library. Frost A. 06/27/17; 177372; P4-6
Dr. Anastasia Frost
Dr. Anastasia Frost
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Abstract
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Introduction

This study evaluates long-term outcomes of the AMS800™ implanted around the bladder neck (BN) in women (or prostate in men) with refractory sphincter weakness incontinence or neuropathic pathology.

Patients and methods

140 BN AUS were implanted in 111 patients over 20 years for various aetiologies. 73 were primary, 18 revision after infection/erosion and 49 replacement for malfunction. Mean follow-up was 112.8 months (12.4 – 243.7 months).

Results

56 of 140 (40%) devices were explanted at a mean of 39.1months for erosion (n=27), malfunction(n=22) and infection (n=7). 31 of 73 (42.4%) primary, 8 of 18 (44.4%) revision and 17 of 49 (34.7%) replacement implants were explanted. 118 devices were implanted in one stage (n=51;43.2% explanted) while 22 were done as a staged procedure (n=5;22.7% explanted). In 68 cases patients performed self-catheterisation(ISC) with the device explanted in 26 (38.2%) compared to 30 of 72 (41.4%) with no ISC. Cystoplasty was present in 67 cases of which 26 (38.8%) were explanted compared to 73 without cystoplasty in which 30 (41.1%) were explanted.
84 devices (60%) remain in situ (42 primary, 10 revision, 32 replacement). 78 (92.9%) are functioning normally. 2 are continent with just a cuff in-situ. The other 6 are incontinent due to implant failure or de-novo detrusor overactivity.


Conclusion

Apart from being surgically challenging, implantation of BN AUS is associated with excellent functional outcomes albeit with significantly higher explantation rates compared to bulbar AUS. We have shown no difference in explantation rate between primary and non-primary BN AUS. Overall explantation rate is no different whether a cystoplasty is present or not or whether patients perform ISC.
Introduction

This study evaluates long-term outcomes of the AMS800™ implanted around the bladder neck (BN) in women (or prostate in men) with refractory sphincter weakness incontinence or neuropathic pathology.

Patients and methods

140 BN AUS were implanted in 111 patients over 20 years for various aetiologies. 73 were primary, 18 revision after infection/erosion and 49 replacement for malfunction. Mean follow-up was 112.8 months (12.4 – 243.7 months).

Results

56 of 140 (40%) devices were explanted at a mean of 39.1months for erosion (n=27), malfunction(n=22) and infection (n=7). 31 of 73 (42.4%) primary, 8 of 18 (44.4%) revision and 17 of 49 (34.7%) replacement implants were explanted. 118 devices were implanted in one stage (n=51;43.2% explanted) while 22 were done as a staged procedure (n=5;22.7% explanted). In 68 cases patients performed self-catheterisation(ISC) with the device explanted in 26 (38.2%) compared to 30 of 72 (41.4%) with no ISC. Cystoplasty was present in 67 cases of which 26 (38.8%) were explanted compared to 73 without cystoplasty in which 30 (41.1%) were explanted.
84 devices (60%) remain in situ (42 primary, 10 revision, 32 replacement). 78 (92.9%) are functioning normally. 2 are continent with just a cuff in-situ. The other 6 are incontinent due to implant failure or de-novo detrusor overactivity.


Conclusion

Apart from being surgically challenging, implantation of BN AUS is associated with excellent functional outcomes albeit with significantly higher explantation rates compared to bulbar AUS. We have shown no difference in explantation rate between primary and non-primary BN AUS. Overall explantation rate is no different whether a cystoplasty is present or not or whether patients perform ISC.
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