Tiffany M Sotelo1, O Lenaine Westney. 1. Department of Urology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Abstract
OBJECTIVE: To determine, in a retrospective review, whether the single-incision technique for placing an artificial urinary sphincter (AUS) is as effective and as safe as the traditional two-incision approach in high-risk patients, as there have been questions about the efficacy and safety of a single incision, transverse-scrotal technique for placing the AUS. PATIENTS AND METHODS: From January 2000 to May 2006, 83 patients had an AUS placed using a single-incision, transverse-scrotal approach. Emphasis was put on placing the cuff around the proximal aspect of the bulbar urethra. The charts of the patients were reviewed retrospectively and the patients completed standardized questionnaires during the follow-up. RESULTS: Of the 83 patients, 24 (29%) had a history of radiation therapy and four had cryotherapy of the prostate. The mean follow-up was 18.8 months and 14 (17%) patients required revision or explantation (for any reason), nine of whom had had previous radiation therapy. The mean (sd) number of pads used per day before and after surgery was 6.7 (4.0) and 1.1 (1.6), respectively. Overall, 83% of the patients (79% of the irradiated and 85% of the unirradiated) used one or fewer pads per day after surgery. CONCLUSIONS: Even in high-risk patients there is no greater risk associated with using the single-incision, transverse-scrotal technique than in related series. Outcomes for pad use after surgery, rate of erosion, infections and mechanical malfunctions were similar to those in other series using the traditional technique.
OBJECTIVE: To determine, in a retrospective review, whether the single-incision technique for placing an artificial urinary sphincter (AUS) is as effective and as safe as the traditional two-incision approach in high-risk patients, as there have been questions about the efficacy and safety of a single incision, transverse-scrotal technique for placing the AUS. PATIENTS AND METHODS: From January 2000 to May 2006, 83 patients had an AUS placed using a single-incision, transverse-scrotal approach. Emphasis was put on placing the cuff around the proximal aspect of the bulbar urethra. The charts of the patients were reviewed retrospectively and the patients completed standardized questionnaires during the follow-up. RESULTS: Of the 83 patients, 24 (29%) had a history of radiation therapy and four had cryotherapy of the prostate. The mean follow-up was 18.8 months and 14 (17%) patients required revision or explantation (for any reason), nine of whom had had previous radiation therapy. The mean (sd) number of pads used per day before and after surgery was 6.7 (4.0) and 1.1 (1.6), respectively. Overall, 83% of the patients (79% of the irradiated and 85% of the unirradiated) used one or fewer pads per day after surgery. CONCLUSIONS: Even in high-risk patients there is no greater risk associated with using the single-incision, transverse-scrotal technique than in related series. Outcomes for pad use after surgery, rate of erosion, infections and mechanical malfunctions were similar to those in other series using the traditional technique.