Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon

Amy Marcia Pearlman; Alison Marie Rasper; Ryan Patrick Terlecki

doi:10.4111/icu.2018.59.4.275

Back

Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon

Journal article

Open access

Peer reviewed

Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon

Amy Marcia Pearlman, Alison Marie Rasper and Ryan Patrick Terlecki

Investigative and clinical urology, Vol.59(4), pp.275-279

07/2018

DOI: 10.4111/icu.2018.59.4.275

PMCID: PMC6028470

PMID: 29984343

Files and links (1)

url

https://doi.org/10.4111/icu.2018.59.4.275View

Published (Version of record) Open Access

Abstract

Rate of continence after artificial urinary sphincter (AUS) placement appears to decline with time. After appropriate workup to exclude inadvertent device deactivation, development of urge or overflow incontinence, and fluid loss, many assume recurrent stress urinary incontinence (rSUI) to be secondary to nonmechanical failure, asserting urethral atrophy as the etiology. We aimed to characterize the extent of circumferential urethral recovery following capsulotomy and that of pressure regulating balloon (PRB) material fatigue in men undergoing AUS revision for rSUI. Retrospective review of a single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessments were identified. The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75 years. Mean time between AUS placement and revision was 103 months. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1 cm; range 0.5-2.5 cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Six of 7 patients underwent PRB interrogation. Four of these 6 PRBs (66.7%) demonstrated pressures in a category below the reported range of the original manufacturer rating. Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and/or morbidity.

Recurrence

Prospective Studies

Urinary Incontinence, Stress - etiology

Humans

Middle Aged

Male

Transurethral Resection of Prostate - adverse effects

Atrophy - etiology

Prostatectomy - adverse effects

Pressure

Urinary Sphincter, Artificial - adverse effects

Urethra - pathology

Prosthesis Failure

Reoperation - statistics & numerical data

Aged, 80 and over

Aged

Retrospective Studies

Urinary Incontinence, Stress - surgery

Details

Title: Subtitle: Proof of concept: Exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon
Creators: Amy Marcia Pearlman - Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
Alison Marie Rasper - Department of Urology, University of Kentucky, Lexington, KY, USA
Ryan Patrick Terlecki - Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
Resource Type: Journal article
Publication Details: Investigative and clinical urology, Vol.59(4), pp.275-279
DOI: 10.4111/icu.2018.59.4.275
PMID: 29984343
PMCID: PMC6028470
NLM abbreviation: Investig Clin Urol
ISSN: 2466-0493
eISSN: 2466-054X
Publisher: Korea (South)
Grant note: name: American Medical Systems/Boston Scientific
Language: English
Date published: 07/2018
Academic Unit: Urology
Record Identifier: 9984051764102771

Metrics

27 Record Views

20 Times Cited - Web of Science

See more details