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  • 1
    Online Resource
    Online Resource
    Retropubic vs transobturator Argus adjustable male sling: Results from a multicenter study
    Wiley ; 2020
    In:  Neurourology and Urodynamics Vol. 39, No. 3 ( 2020-03), p. 987-993
    Details
    In: Neurourology and Urodynamics, Wiley, Vol. 39, No. 3 ( 2020-03), p. 987-993
    Abstract: To comparatively analyse outcomes after ARGUS classic and ArgusT adjustable male sling implantation in a real‐world setting. Methods Inclusion criteria encompassed: non‐neurogenic, moderate‐to‐severe stress urinary incontinence (≥2 pads), implantation of an ARGUS classic or ArgusT male sling between 2010 and 2012 in a high‐volume center ( 〉 150 previous implantations). Functional outcomes were assessed using daily pad usage, 24‐hour pad testing, and International Consultation on Incontinence (ICIQ‐SF) questionnaires. Continence was defined as zero pads per 24 hours. Complications were graded using Clavien‐Dindo scale. For multivariate analysis, binary logistic regression models were used ( P   〈  .05). Results A total of 106 patients (n = 74 [ARGUS classic], n = 32 [ArgusT] ) from four centers were eligible. Median follow‐up was 44.0 months (24‐64). Patient cohorts were well‐balanced. We observed a statistical trend in favor of ARGUS classic regarding postoperative urine loss based on standardized 24‐hour pad test (71 ± 162 g [ARGUS classic] vs 160 ± 180 g [ArgusT] ); P  = .066]. Dry rates were 33.3% (ARGUS classic) and 11.8% (ArgusT, P  = .114). In multivariable analysis, ArgusT male sling could not be confirmed as an independent predictor of decreased success (OR, 0.587; 95% CI; 0.166‐2.076, P  = .408). There were no Clavien IV and V complications. Inguinal pain was significantly higher after ArgusT implantation ( P  = .033). Explantation rates were higher for ArgusT compared to ARGUS classic (14.0 vs 23.3%; P  = .371). Longer device survival for the ARGUS classic male sling was observed in Kaplan‐Meier analysis ( P  = .198). Conclusions In the largest comparative analysis of ARGUS classic and ArgusT male sling with the longest follow‐up to date, we observed low continence rates with superior functional outcomes and decreased explantation rates after ARGUS classic implantation.
    Type of Medium: Online Resource
    ISSN: 0733-2467 , 1520-6777
    URL: Issue
    URL: Article
    DOI: 10.1002/nau.v39.3
    DOI: 10.1002/nau.24316
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1500793-5
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  • 2
    Online Resource
    Online Resource
    High/low‐volume center experience predicts outcome of AMS 800 in male stress incontinence: Results of a large middle European multicenter case series
    Wiley ; 2020
    In:  Neurourology and Urodynamics Vol. 39, No. 6 ( 2020-08), p. 1856-1861
    Details
    In: Neurourology and Urodynamics, Wiley, Vol. 39, No. 6 ( 2020-08), p. 1856-1861
    Abstract: To analyze the influence of implantation volume of artificial sphincters (AMS 800) on outcome in a large central European multicenter cohort study. Methods As part of the DOMINO (Debates on Male Incontinence) project, the surgical procedures and outcomes were retrospectively analyzed in a total of 473 patients who received an artificial sphincter (AMS 800) between 2010 and 2012. Clinics that implanted at least 10 AMS 800 per year were defined as high‐volume centers. Results Sixteen centers had a mean rate of 9.54 AMS 800/y of which five clinics were identified as high‐volume centers. They implanted significantly more double cuffs (55% vs 12.1%; P   〈  .001), used the perineal approach significantly more often (78% vs 67.7%; P  = .003) and chose larger mean cuff sizes (4.63 cm vs 4.42 cm; P  = .002). With a mean follow‐up of 18 months, the revision rate was significantly higher at low‐volume centers (38.5% vs 26.7%; P  = .037), urethral erosion being the main reason for revision. Social continence (0‐1 pads/24 h) was achieved significantly more often in high‐volume centers (45.5% vs 24.2%; P  = .002). Conclusions Our study showed significantly better continence results and lower revision rates at high‐volume centers, confirming earlier results that are still true in this decade. We, therefore, recommend surgery for male incontinence at qualified centers.
    Type of Medium: Online Resource
    ISSN: 0733-2467 , 1520-6777
    URL: Issue
    URL: Article
    DOI: 10.1002/nau.v39.6
    DOI: 10.1002/nau.24444
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1500793-5
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  • 3
    Online Resource
    Online Resource
    Is the Standard Artificial Urinary Sphincter AMS 800 Still a Treatment Option for the Irradiated Male Patient Presenting with a Devastated Bladder Outlet?
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 12 ( 2023-06-12), p. 4002-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 12 ( 2023-06-12), p. 4002-
    Abstract: Background: Circular urethral compression with an artificial sphincter allows control of voiding, even in patients with severe stress urinary incontinence, but it heightens the risk of urethral atrophy and erosion. This study of one of the largest populations of patients treated with radiotherapy investigates the additive effect of the post-radiogenic stricture of the membranous urethra/bladder neck on AMS 800 artificial urinary sphincter outcomes. Methods: In a retrospective multicenter cohort study, we analyzed patients fitted with an AMS 800, comparing those who had received radiotherapy with patients presenting a devastated bladder outlet (stricture of the membranous urethra/bladder neck). We determined the correlation between these groups of patients using both univariate and stepwise adjusted multivariate regression. The revision-free interval was estimated by a Kaplan–Meier plot and compared by applying the log-rank test. A p value below 0.05 was considered statistically significant. Results: Of the 123 irradiated patients we identified, 62 (50.4%) had undergone at least one prior desobstruction for bladder-neck/urethra stenosis. After a mean follow-up of 21 months, the latter tended to achieve social continence less frequently (25.7% vs. 35%; p = 0.08). Revision was required significantly more often for this group (43.1% vs. 26.3%; p = 0.05) due to urethral erosion in 18 of 25 cases. A stenosis recurred in five cases; desobstruction was performed in two cases, leading to erosion in both. Multivariate analysis revealed a significantly higher risk of revision when recurrent stenosis necessitated at least two prior desobstructions (HR 2.8; p = 0.003). Conclusions: A devastated bladder outlet is associated with a lower proportion of men with social continence and a significantly higher need for revision compared with irradiated patients without a history of urethral stenosis. Alternative surgical procedures should be discussed beforehand, especially in cases of recurrent urethral stenosis.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12124002
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 4
    Online Resource
    Online Resource
    Secondary Sling Implantation after Failure of Primary Surgical Treatment for Male Stress Urinary Incontinence: A Retrospective Study
    S. Karger AG ; 2020
    In:  Urologia Internationalis Vol. 104, No. 7-8 ( 2020), p. 625-630
    Details
    In: Urologia Internationalis, S. Karger AG, Vol. 104, No. 7-8 ( 2020), p. 625-630
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The artificial urinary sphincter (AUS) is the surgical gold standard after previously failed surgical treatment for male urinary stress incontinence. The evidence for a male sling as salvage treatment is poor, but there is a proportion of patients that refuse implantation of an AUS or have a relative contraindication. The goal of our retrospective study was an analysis of outcome and complications of patients with a secondary sling after previously failed surgery for stress urinary incontinence (SUI). 〈 b 〉 〈 i 〉 Materials and Methods: 〈 /i 〉 〈 /b 〉 Data on 186 patients who had a prior incontinence surgery were extracted from the DOMINO database. 139 patients (74.7%) received an AUS and 41 patients (22.0%) who had received a secondary sling system between 2010 and 2012 after previously failed surgery for male urinary incontinence could be identified and were further analyzed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Eight patients (19.5%) received a secondary repositioning sling and 33 patients (80.5%) received a secondary adjustable sling system. A prior surgery for urethral stricture was performed in 4 patients (9.8%). No major intraoperative complications were reported. A simultaneous explantation was performed in 12 patients (29.3%). The mean number of pad reductions was 4.93 ( 〈 i 〉 p 〈 /i 〉 = 0.026). No intraoperative complications and no postoperative surgical revisions were reported. The mean follow-up of the patient cohort with a secondary sling was 16 months. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 We provide the largest cohort of male patients up to date with a secondary sling after primary failure of surgery for male SUI. Although the procedure is a rarely performed surgery and without a high level of evidence, a secondary adjustable male sling system might be a feasible option in selected patients with acceptable complication rates, whereas a valuable outcome regarding continence rates cannot be sufficiently supplied by our data.
    Type of Medium: Online Resource
    ISSN: 0042-1138 , 1423-0399
    URL: Article
    DOI: 10.1159/000508585
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1464417-4
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