Continence from here beyond artificial urinary sphincter
DOI: 10.22591/magyurol.2023.1.molnara.3
Authors:
Molnár Ágnes dr., Kenyeres Balázs dr., Pytel Ákos dr.
PTE KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
Summary
Introduction: Severe male stress incontinence is the most common complication after radical prostatectomy, and the “gold standard” in its surgical treatment is artificial sphincter implantation. The device was first developed and implanted by Dr. Brantley Scott in 1972 and has undergone many improvements over the decades. The form still used today was marketed in 1982 under the name AMS 800, which has since been implanted in more than 250,000 cases. Based on literature data, the most common complications are failure of the device itself, uroinfection, urethral lesion, and incorrect size selection. In these cases, the replacement or removal of the artificial sphincter is necessary. Despite the relatively high complication rate, surgical therapy is the first choice in severe cases, as a significant improvement in continence can be achieved in 79% of patients.
Patients and methods: Between 2010 and 2022, our working group implanted an AMS 800 artificial sphincter in 21 patients. The purpose of our summary was to compare the complications of the interventions we performed with literature data.
Results: We followed up 21 patients, AMS 800 implantation was performed after radical prostatectomy in 16 and after transurehtral prostate resection in 5 cases. 6 patients also received adjuvant irradiation. We detected an infectious complication in 9% of cases, and urethral atrophy and urethral erosion were detected in 9-9% of cases. Device failure was detected in 19% of cases. Surgical reintervention became necessary significantly more often in patients who underwent adjuvant irradiation.
Conclusions: Due to the significant and permanent improvement of continence, artificial sphincter implantation is the “gold standard” solution in the treatment of severe male stress incontinence, despite of the frequent complications. Due to the frequent complication rate, regular follow-up of these patients is essential.