Performance and safety of transverse scrotal vs transperineal AUS for PPUI: A retrospective cohort study

IF 1.9 Q3 UROLOGY & NEPHROLOGY
BJUI compass Pub Date : 2025-05-21 DOI:10.1002/bco2.70027
Christine R. Reus, Izabelle Brattås, Daniela Volz, Filip Sydén, Renata Zelic, Katarina Hallén Grufman, Lotta Renström Koskela
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引用次数: 0

Abstract

Objectives

To primarily compare efficacy and safety of transverse scrotal (TS) versus transperineal (TP) artificial urinary sphincter (AUS) implantation for post-prostatectomy urinary incontinence (PPUI). The AUS is the gold standard for managing severe refractory male SUI.

Patients and Methods

This single-centre, retrospective, cohort study, analyses 179 consecutive patients who underwent primary AUS implantation for PPUI between 2005 and 2018. Data on 24-h pad weight tests (PWT), validated quality of life questionnaires (I-QoL), surgical technique, related complications, salvage radiation and transcorporeal cuff placement (TC) were collected.

Results

The TP approach was performed in 43 cases, whilst 136 patients underwent TS incision, of which 31 benefited from TC placement. The median PWT reduction was 458 g (320, 701) in the TP and 479 g (258, 745) in the TS group (p = 0.807). The median I-QoL index increase was 40 (26, 52) in the TP and 48 (36, 60) in the TS group, showing a significant difference in favour of the TS group (p = 0.012). The overall postoperative infection rate was 3.9%, with a lower risk in the TS group (RR = 0.23, p = 0.049). Erosion occurred in 9.0% of patients, with a higher relative risk observed in the TS group (RR = 1.34, p = 0.636); however, we found that the TC patients (consisting of salvage radiation patients) in the TS group drove this higher risk. Mechanical failure and subsequent revision were lower in the TS cohort (RR = 0.43, p = 0.004) and (RR = 0.42, p = 0.002), respectively.

Conclusion

TS and TP approaches resulted in similar improvements in continence but a greater increase in quality of life in the TS group. While post-operative erosion rates and device survival were comparable, the TP group had higher rates of infection and mechanical failure, which may be relevant for surgical decision-making.

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横向阴囊与经会阴AUS治疗PPUI的疗效和安全性:一项回顾性队列研究
目的初步比较经阴囊(TS)与经会阴(TP)人工尿括约肌(AUS)植入术治疗前列腺切除术后尿失禁(PPUI)的疗效和安全性。AUS是治疗严重难治性男性SUI的金标准。患者和方法本单中心、回顾性、队列研究分析了2005年至2018年间179例连续接受原发性AUS植入治疗PPUI的患者。收集24小时垫重试验(PWT)、有效生活质量问卷(I-QoL)、手术技术、相关并发症、抢救性放疗和经肺泡袖带置入术(TC)的数据。结果43例患者行TP入路,136例患者行TS切口,31例患者行TC置入。TP组中位PWT减少为458 g (320, 701), TS组中位PWT减少为479 g (258, 745) (p = 0.807)。TP组I-QoL指数中位数上升为40 (26,52),TS组为48(36,60),两者差异有统计学意义(p = 0.012)。术后总感染率为3.9%,TS组感染率较低(RR = 0.23, p = 0.049)。9.0%的患者发生糜烂,TS组相对风险较高(RR = 1.34, p = 0.636);然而,我们发现TS组的TC患者(包括补救性放疗患者)推动了这一更高的风险。机械故障和随后的翻修在TS队列中分别较低(RR = 0.43, p = 0.004)和(RR = 0.42, p = 0.002)。结论:TS组和TP组对尿失禁的改善效果相似,但生活质量的提高更大。虽然术后糜烂率和器械存活率相当,但TP组感染和机械故障的发生率更高,这可能与手术决策有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.30
自引率
0.00%
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0
审稿时长
12 weeks
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