Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.

IF 1.8 3区医学 Q3 UROLOGY & NEPHROLOGY

International Neurourology Journal Pub Date : 2023-06-01 Epub Date: 2023-06-30 DOI:10.5213/inj.2346030.015

Sylvia Weis, Tim A Ludwig, Omar Bahassan, Philipp Gild, Malte W Vetterlein, Margit Fisch, Roland Dahlem, Valentin Maurer

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Abstract

Purpose: This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS).

Methods: Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed.

Results: Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months.

Conclusion: Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.

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人工尿道括约肌植入术后缩小袖带以治疗恶化或持续性尿失禁的疗效和并发症发生率。

目的：本研究调查了在植入人工尿道括约肌（AUS）后，袖带缩小用于治疗男性复发性或持续性压力性尿失禁（SUI）的功能结果和并发症发生率：我们对本机构 AUS 数据库中 2009 年至 2020 年期间的数据进行了回顾性分析。结果：在接受人工尿道括约肌（AUS）手术的477名患者中，有477人出现了术后并发症：在研究期间接受AUS植入术的477名患者中，25人（5.2%）接受了袖带缩小术（中位年龄77岁；四分位距[IQR]74-81岁；中位随访4.4年；IQR 3-6.9年）。缩减规模前，80% 的患者 SUI 为非常严重（ICIQ 评分 19-21 分）或严重（ICIQ 评分 13-18 分），12% 为中度（ICIQ 评分 6-12 分），8% 为轻度（ICIQ 评分 1-5 分）。缩小规模后，52% 的患者在 21 分中改善了 5 分以上。但仍有 28% 的患者有非常严重或严重的 SUI，48% 的患者有中度 SUI，20% 的患者有轻度 SUI。一名患者不再有 SUI。52%的患者每天使用尿垫的次数减少了≥50%。56%的患者的 QoL 在 6 分中提高了 2 分以上。36%的患者出现了需要更换设备的并发症（感染/尿道糜烂），发生并发症的中位时间为14.5个月：结论：尽管缩小充气罩囊有可能导致AUS拆卸，但对于AUS植入后出现持续性或复发性SUI的特定患者来说，这不失为一种有价值的治疗选择。超过一半的患者在症状、满意度、ICIQ 评分和尿垫使用方面都有所改善。重要的是要让患者了解 AUS 的潜在风险和益处，以管理他们的期望并评估个人风险。

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

International Neurourology Journal UROLOGY & NEPHROLOGY-

CiteScore

4.40

自引率

21.70%

发文量

审稿时长

4 weeks

期刊介绍： The International Neurourology Journal (Int Neurourol J, INJ) is a quarterly international journal that publishes high-quality research papers that provide the most significant and promising achievements in the fields of clinical neurourology and fundamental science. Specifically, fundamental science includes the most influential research papers from all fields of science and technology, revolutionizing what physicians and researchers practicing the art of neurourology worldwide know. Thus, we welcome valuable basic research articles to introduce cutting-edge translational research of fundamental sciences to clinical neurourology. In the editorials, urologists will present their perspectives on these articles. The original mission statement of the INJ was published on October 12, 1997. INJ provides authors a fast review of their work and makes a decision in an average of three to four weeks of receiving submissions. If accepted, articles are posted online in fully citable form. Supplementary issues will be published interim to quarterlies, as necessary, to fully allow berth to accept and publish relevant articles.