Neurourology and Urodynamics最新文献

{"title":"Intravesical Botulinum Toxin Injection for Treating Detrusor Overactivity and Poor Compliance in Posterior Urethral Valves-A Preliminary Experience.","authors":"Sharon Mohan Kunnath, Eskinder Solomon, Pankaj Mishra, Anne J Wright, Joanna Clothier, Massimo Garriboli","doi":"10.1002/nau.70039","DOIUrl":"https://doi.org/10.1002/nau.70039","url":null,"abstract":"<p><strong>Purpose: </strong>To report our preliminary experience on the use of Botulinum toxin A in boys with posterior urethral valves for treating detrusor overactivity and/or reduced bladder compliance not responsive to medical treatment.</p><p><strong>Material and methods: </strong>Primary outcome measures studied were change in baseline end fill pressure (pDet), compliance, maximum Detrusor overactivity pressure (DO), fractional bladder capacity (FBC), vesicoureteric reflux (VUR) grade/resolution. Secondary outcome measures were serum creatinine and estimated glomerular filtration rate (eGFR). Low compliance group was defined as rise in baseline pDet > 20 cmH₂O. High pressure DO was defined as maximum pDet > 40 cmH₂0.</p><p><strong>Results: </strong>A total of 15 children were included in the analysis. The median decrease in end fill pDet in the whole cohort was from 20 cmH₂O (14.5-30) to 16 cmH₂O (10.5-22) (p = 0.065). By analyzing the patients with low compliance, we identified a median decrease in end fill pDet from 32 cmH₂O (26.5-44.5) to 19 cmH₂O (16.5-25.5) (p = 0.028). The median change in compliance for all the boys was from 6 mL/cmH₂O (4.51-7.3) to 12.1 mL/cmH₂O (7.44-17.3) (p < 0.001). The median change in compliance in the low compliance group was from 5.5 mL/cmH₂O (4.42-7.1) to 8.8 mL/cmH₂O (7.39-13.3) (p = 0.018). The median change in fractional bladder capacity for all the boys was from 0.70 (0.55-0.92) to 0.98 (0.79-1.42) (p = 0.061). A complete resolution of DO was observed in 7 out of 11 patients. Complete resolution of VUR was observed in 5 out of 8 renal units.</p><p><strong>Conclusion: </strong>Botulinum toxin A can be considered in the treatment strategy for reduced bladder compliance and detrusor overactivity in boys with PUV.</p><p><strong>Trial registration: </strong>15894.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Potential for Misdiagnosis of Detrusor Underactivity Due to Urodynamic Voiding Position and Seating Characteristics. Vancavage R Et Al. Neurourol Urodyn 2025 Jan 27. Doi: 10.1002/Nau.25650\".","authors":"Juan Pablo Valdevenito, Alejandro Mercado-Campero","doi":"10.1002/nau.70021","DOIUrl":"https://doi.org/10.1002/nau.70021","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing our Understanding of the Urothelium and Lamina Propria, Hormone Receptors, Vascular Supply, and Sensory Aspects of the Female Human Urethra.","authors":"Margaret Mueller, Bernard T Drumm, Johanna L Hannan, Hannah Ruetten","doi":"10.1002/nau.70003","DOIUrl":"https://doi.org/10.1002/nau.70003","url":null,"abstract":"<p><strong>Objective: </strong>Urinary continence is important for women's health and wellbeing. The female urethra has been understudied and mechanisms of continence remain poorly understood. Our objective is to provide a summary of current knowledge of the epithelium and lamina propria, hormone receptors, vascular supply, and sensory aspects of the female urethra and highlight continued gaps in knowledge.</p><p><strong>Methods: </strong>In October of 2020, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored a virtual seminar series entitled \"Female Urethral Function and Failure: Advancing Basic and Translational Research for Genitourinary Conditions\". We summarize the information presented during session 3 presentations, provide additional information from recent studies, and highlight continued gaps in knowledge.</p><p><strong>Results: </strong>A sensory role for urethral mucosa seems apparent based on the dense innervation of sensory afferent neurons but how the sensory afferents contribute to continence remains poorly understood. There is a complex relationship with behavior that comes into play when evaluating the contribution of sex hormones to urinary physiology. We need to update our understanding of where hormone receptors are located in the female urinary tract. Many causes of impaired urethral blood flow are also common risk factors for urinary dysfunction but we don't know how vasculature contributes to continence. Altered afferent urethral function has been implicated in several disease states, but is largely understudied.</p><p><strong>Conclusion: </strong>There is much that remains to be learned about the urothelium and lamina propria, expression and influence of sex hormones and hormone receptors, vascular supply, and sensory aspects of the female urethra.</p><p><strong>Trial registration: </strong>No new data was generated for this manuscript, no clinical trial was conducted, and therefore clinical trial registration was not necessary.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Gentamicin Intravesical Bladder Instillations on Decreasing Urinary Tract Infections After Spinal Cord Injury and Disease.","authors":"Denise G Tate, Gianna M Rodriguez, Elizabeth Sullivan, Martin Forchheimer, Jonathan Troost, Misty Gravelin, Anne P Cameron","doi":"10.1002/nau.70037","DOIUrl":"https://doi.org/10.1002/nau.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent urinary tract infections (UTIs) are common and source of significant morbidity for patients with spinal cord injury/disease (SCI/D) who require clean intermittent catheterization (CIC) bladder management. The purpose of this study was to examine the effectiveness of gentamicin bladder instillations in reducing recurrent UTIs and their impact on neurogenic bladder and bowel (NBB) symptoms and common complications; on quality of life (QOL) and community participation for patients with SCI/D performing CIC.</p><p><strong>Materials and methods: </strong>This is a Prospective single arm feasibility trial of gentamicin bladder instillations. The 6 month intervention consisted of nightly bladder instillations of 30 mg of gentamicin diluted in 50 mL of normal saline. Participants underwent blood and urine testing and completed patient reported measures, both before and after treatment. The primary outcome was the count of UTIs compared across time points (pre-, during and post-treatment) using an UTI incidence rate ratio and paired t tests. Qualitative data was collected post-treatment.</p><p><strong>Results: </strong>Twenty-one participants enrolled and 11 completed the trial. The rate of UTIs per person per month decreased significantly over time. Before treatment, the total number of UTIs was 35 (0.53 UTI per person per month); during treatment was 6 (0.09 per person per month) and at follow up, 13 (0.18 per person per month). QOL improved significantly with exception of satisfaction with role activities and community participation. There were no significant changes in NBB symptoms and related complications. Participants reported few adverse events (AEs) and qualitative data indicated high overall treatment satisfaction.</p><p><strong>Conclusions: </strong>Gentamicin instillations were effective in reducing the rate of UTIs by 83% and improving QOL. Findings helped identify potential challenges and opportunities for future studies.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Gonadotropin-Releasing Hormone Receptor Improves Voiding Hyperreflexia and Detrusor Sphincter Dyssynergia in Male Rats With Severe Spinal Cord Injury.","authors":"Daniel Medina-Aguinaga, Alvaro Munoz, Moises Altamira-Camacho, Jorge Arellano, Ricardo Juarez, Martín Humberto Muñoz-Ortega, Charles Hubscher, Yolanda Cruz, J Luis Quintanar","doi":"10.1002/nau.70031","DOIUrl":"https://doi.org/10.1002/nau.70031","url":null,"abstract":"<p><strong>Aims: </strong>The objective of the current study was to test the beneficial effects of a GnRH analog, leuprolide acetate (LA), over the urinary function in a rat model of lower urinary dysfunction by cystometry and electromyography in fully awake conditions in males with and without SCI.</p><p><strong>Methods: </strong>Male Wistar rats that underwent spinal cord compression at T10 level were divided into three groups consisting of (1) SHAM, (2) SCI, and (3) SCI + LA 10 μg/kg i.m. (once a day for 3 days, then every 72 h until complete 13 doses). We then conducted awake cystometrograms and electromyograms of the external urethral sphincter (EUS) and compared urodynamic parameters between the three groups. The expression of Gonadotropin-releasing hormone receptor (GnRH-R) on the urinary bladder was evaluated and compared among three groups by real-time polymerase chain reaction (qPCR). Additionally, the hind limb movements related to micturition were analyzed.</p><p><strong>Results: </strong>SCI induces detrusor sphincter dyssynergia, urinary malfunction, increased mRNA expression for the GnRH receptor in the urinary bladder in injured rats and increased hind limb movements related to micturition. Meanwhile, treatment with LA partially reverses these changes.</p><p><strong>Conclusion: </strong>The potential of LA for the treatment of urinary disorders associated with SCI opens the way to a new therapeutic option for individuals with SCI who would like to have an impact on their daily lives.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Benefits of Pelvic Floor Muscles Exercises Combined With Biofeedback Therapy for Improving Functional Urinary Incontinence in Children.","authors":"Lida Sharifi-Rad, Mazyar Zahir, Seyedeh-Sanam Ladi-Seyedian, Abdol-Mohammad Kajbafzadeh","doi":"10.1002/nau.70026","DOIUrl":"https://doi.org/10.1002/nau.70026","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor muscles training (PFMT), with or without biofeedback (BF), is widely utilized as an alternative treatment for various refractory lower urinary tract dysfunctions in adults and children. This study aimed to compare the efficacy of PFMT alone versus in combination with BF on functional urinary incontinence (UI) in children.</p><p><strong>Patients and methods: </strong>Medical records of children who had undergone pelvic floor rehabilitation for non-neuropathic intermittent UI from 2018 to 2022 were retrieved. Patients were categorized based on their treatment regimen. Group I had undergone standard urotherapy and PFMT, twice weekly for 5 weeks. Group II had undergone a similar 5-week treatment with addition of 10 BF sessions conducted at the end of each appointment. All children had been evaluated with kidney and bladder ultrasounds, uroflowmetry/EMG, and a 7-day voiding and bowel diary before and after treatment. Response to treatment was defined according to International Children's Continence Society (ICCS) protocols.</p><p><strong>Results: </strong>A total of 32 patients (71.9% female) with a mean age of 8.4 ± 2.1 (range: 5-13) years were included in the analyses (each group N = 16). In group I, nine (56.2%) and two (12.5%) patients demonstrated complete (100% reduction in UI episodes) and partial (50%-100% reduction in UI episodes) clinical response, respectively. In group II, 11 (68.7%) and 3 (18.8%) patients showed complete and partial response, respectively. The two groups were not significantly different with regard to clinical response (p = 0.430). No significant difference was observed between the two groups in terms of enuresis, urgency, constipation, and uroflowmetry parameters.</p><p><strong>Conclusions: </strong>PFMT under the supervision of an expert physical therapist appears to be as effective as combined PFMT and BF in improving UI in children without underlying neurologic disease.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Percutaneous Tibial Nerve Stimulation in the Treatment of Female Sexual Dysfunction.","authors":"Zhenyue Huang, Sina Mehraban Far, Jonathan Aronov, Arshia Aalami Harandi, Kuemin Hwang, Xiaoyue Zhang, Varun Talanki, Heng Ruan, Tal Meir Cohen, Steven Weissbart, Justina Tam, Jason Kim","doi":"10.1002/nau.70032","DOIUrl":"https://doi.org/10.1002/nau.70032","url":null,"abstract":"<p><strong>Background: </strong>Female sexual dysfunction (FSD) is a prevalent and multifaceted condition affecting women's sexual well-being. This randomized controlled trial aimed to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) compared to a validated sham control in the treatment of FSD.</p><p><strong>Methods: </strong>We conducted a single-center randomized controlled trial. Participants with FSD were recruited and randomly assigned at a 1:1 allocation ratio to either PTNS or a validated sham control using transcutaneous nerve stimulation (TENS). Treatment was performed through weekly 30-min session for 12 weeks total. Sexual function was assessed at baseline, 6 weeks, and 12 weeks primarily using the Female Sexual Function Index (FSFI) questionnaire. Urogenital distress inventory-6 was collected to evaluate for any baseline urinary incontinence/voiding dysfunction. Linear mixed-effect models for longitudinal data were used to compare FSFI scores across different time points. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc. Cary, NC).</p><p><strong>Results: </strong>In total, 34 PTNS and 31 TENS subjects were included in our final analysis. Overall, 48% (16/34) of PTNS subjects versus 29% (11/33) of TENS subjects were no longer at risk for FSD (FSFI > 26.55) after 12 weekly treatments. Both PTNS and TENS subjects demonstrated similar improvements in FSFI total scores after 12 weeks of treatments. Interestingly, patients who did not present with baseline urogenital distress symptoms reported a statistically significant larger improvement in sexual satisfaction after PTNS treatments as compared to placebo (p = 0.017).</p><p><strong>Conclusion: </strong>This study demonstrated a sustained efficacy of PTNS in improving sexual function. Specifically, patients who did not have coexisting urinary dysfunction reported significant improvement in sexual satisfaction after PTNS. Our study suggested that PTNS may have a direct neuromodulation effect on sexual dysfunction and may hold promise as a treatment modality for FSD.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"United Kingdom Continence Society: Certification and Recertification in Urodynamics.","authors":"Paul Abrams, Sharon Eustice, Andrew Gammie, Chris Harding, Rohna Kearney, Angie Rantell, Sheilagh Reid, Eskinder Solomon, Philip Toozs-Hobson, Mark Woodward","doi":"10.1002/nau.70020","DOIUrl":"https://doi.org/10.1002/nau.70020","url":null,"abstract":"<p><strong>Aims: </strong>Patients coming for urodynamics expect those delivering the service to be fully trained, with assurance of competence and quality. This document proposes a single UKCS Certification and Re-certification process for all health care professionals who perform or interpret urodynamics.</p><p><strong>Methods: </strong>The Working Group of the United Kingdom Continence Society engaged with stakeholders in relevant professional societies and institutions, recirculating drafts until consensus was reached.</p><p><strong>Results: </strong>A process of Certification has been designed to ensure that patients attending urodynamics undergo high quality investigations, the results of which are accurately interpreted, in order to guide both the patient and their clinicians in the patient's future management.</p><p><strong>Conclusions: </strong>The United Kingdom Continence Society strongly recommends that all urodynamic investigations are carried out by, or under the supervision of, certified individuals. This document presents such a process of Certification and Re-certification that aims to ensure that quality standards are maintained and that patients have high quality urodynamics.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urodynamic Changes Following a Staged Trial of Sacral Neuromodulation in Patients With Detrusor Underactivity.","authors":"Stewart Whalen, Jaraspong Vuthiwong, Liang G Qu, Johan Gani","doi":"10.1002/nau.70035","DOIUrl":"https://doi.org/10.1002/nau.70035","url":null,"abstract":"<p><strong>Objective: </strong>Sacral neuromodulation (SNM) is an established treatment for detrusor underactivity (DU) and nonobstructive urinary retention. The mechanism of action for SNM in DU, however, remains poorly understood. The objective of this study was to investigate the urodynamic study (UDS) changes in DU patients during the trial period following first stage tined-lead placement (FSTLP).</p><p><strong>Materials and methods: </strong>Retrospective chart review was performed to identify patients diagnosed with DU on initial UDS, who had repeat UDS during the 2-week trial period following FSTLP by a single clinician. Urodynamic parameters including maximum flow rate (Qmax), detrusor pressure at maximum flow (PdetQmax), post-void residual (PVR), voiding efficiency (VE), and detrusor contractility index (DCI) were collected. Using the definition of improvement in baseline VE of ≥ 50% post-FSTLP or improvement in DCI of ≥ 50% in complete voiders, patients were divided into \"responders\" and \"nonresponders.\" Pre- and post-FSTLP urodynamic findings were compared using Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>A total of 17 patients were identified who met the inclusion criteria. Repeat UDS were done on account of inability or unwillingness to perform clean intermittent catheterization and thus inability to chart an accurate bladder diary. There were 9 female and 8 male patients. Four patients (23.5%) had pure DU while the other 13 (76.5%) had concurrent detrusor overactivity (DO-DU). Among all patients, there was a statistically significant improvement in PdetQmax (14 vs. 29 cmH₂O, p < 0.01) and DCI (62 vs. 92, p < 0.01). Six patients (35.3%) responded to the trial of SNM for DU. Among responders, statistically significant improvements in Qmax (5 vs. 15.5 mL/s, p = 0.03), PVR (215 vs. 80 mLs, p = 0.04), VE (22.9% vs. 82.5%, p = 0.04), and DCI (29 vs. 97.5, p = 0.03) were observed. Nonresponders had improvement in PdetQmax (14 vs. 29 cmH₂O, p = 0.02), but not in Qmax (9 vs. 10 mL/s, p = 0.89).</p><p><strong>Conclusions: </strong>Among all patients, an improvement in PdetQmax and DCI was observed. Responders exhibited improvement in Qmax, PVR, VE, and DCI without statistically significant improvement in PdetQmax. Nonresponders had statistically significant improvement in PdetQmax, but not in Qmax. Possible mechanisms of action of SNM in DU patients based on our data are inhibition of the guarding reflex/relaxation of the urethra (shown by improvement in Qmax in responders only) and direct strengthening of bladder contractility (shown by improvement in PdetQmax in all patients). Improvement in Qmax was observed exclusively in responders suggesting the former mechanism is the predominant one. Further larger prospective studies are required to confirm these findings.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Third Artificial Urinary Sphincter Cuff Placement Following Two Failures in Males: A Real-World Multicenter Study.","authors":"Francois Meyer, Juliette Cotte, Lucas Bento, Guillaume Nicaud, Hubert Werth, Alexandre Dubois, Christian Saussine, François Desgranchamps, Emmanuel Chartier-Kastler, Xavier Gamé, Jean-François Hermieu, Jean-Nicolas Cornu, Benoît Peyronnet","doi":"10.1002/nau.70030","DOIUrl":"https://doi.org/10.1002/nau.70030","url":null,"abstract":"<p><strong>Introduction: </strong>The reoperation rate for artificial urinary sphincters (AUS) in men is about 25%, with poorer survival rates when reimplantation occurs after urethral erosion or infection. Data on the outcomes of second AUS implants are rare, and no data exist for third AUS implants. We aimed to evaluate the functional and survival outcomes of a third AUS after two previous explantations.</p><p><strong>Methods: </strong>The records of all patients implanted with a third AUS between 2006 and 2023 in seven French university hospitals were reviewed retrospectively. Only AUS implants following two previous AUS cuff explantations or revisions were included. The primary endpoint was the reoperation-free survival of the third AUS. Secondary endpoints included functional outcomes at 6 months and at the last follow-up, and overall functional outcomes after possible subsequent AUS implants, as well as reoperations.</p><p><strong>Results: </strong>A total of 75 patients were included. Early complications occurred in 16.7% of patients. Median follow-up was 11 months (1-122), 28 explantations were required (37.3%). The 5-year reoperation-free survival rate was 34.8%. The only significant predictive factor for explantation was smoking. At 6 months, 66.2% of patients were socially continent (0-1 protection per day), 10.8% were improved, and 23% were unchanged or worsened. At the last follow-up of the third AUS, these results were 40%, 5.3%, and 54.7%, respectively. However, at the last overall follow-up (median 12 months, 1-183), social continence was 54.8%, improvement 9.6%, and failure 35.6%, with 23 patients (30.7%) receiving a fourth or fifth AUS.</p><p><strong>Conclusion: </strong>Early functional outcomes of a third AUS are similar to primary AUS, but survival rates and late functional outcomes are inferior. Predictive factors for outcomes were related to patients, not the surgery itself. A third AUS may be suitable for motivated patients with limited therapeutic options. Further studies are needed to refine patient selection and assess the impact of reimplantation techniques on outcomes.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}