Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

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Vol. 43 (1): 150-154, January – February, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0244


ORIGINAL ARTICLE

Augusto Cesar Soares dos Santos Junior 1,2, Luíza de Oliveira Rodrigues 1,2, Daniela Castelo Azevedo 1,2, Lélia Maria de Almeida Carvalho 1,2, Mariana Ribeiro Fernandes 1,2, Sandra de Oliveira Sapori Avelar 1,2, Maria da Glória Cruvinel Horta 1,2, Silvana Márcia Bruschi Kelles 1,2

1 Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil; 2 Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil

ABSTRACT

This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS im­plant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On to­tal, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explanta­tion of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the ob­served high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

Keywords: Urinary Incontinence; Prostatectomy; Prostatic Neoplasms; Urinary Sphincter, Artificial

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