Major Complications after Male Anti-Incontinence Procedures: Predisposing Factors, Management and Prevention
Urology Journal,
Vol. 18 No. 01 (2021),
17 March 2021
,
Page 92-96
https://doi.org/10.22037/uj.v18i01.5712
Abstract
Purpose: Significant post-prostatectomy incontinence (PPI) is a crippling condition and managed best through
sling or artificial urinary sphincter (AUS) implantation. These procedures are often associated with complications requiring surgical intervention. The aim of our retrospective study was to evaluate the occurrence of major complications and identify risk factors.
Materials and Methods: Between 2010 and 2018 ninety-one patients have been implanted with sling (22; 24.2%) or AUS (69; 75.8%) in our department. The cases where surgical revision was needed were examined regarding the etiology (mechanical failure (MF), urethral erosion (UE), urethral atrophy (UA), surgical site infection (SSI), combined reasons (COMB) and analyzed, using 16 possible perioperative risk factors.
Results: Surgical intervention was carried out by 19 / 91 (20.9%) patients. (In 16 / 69 cases after AUS (23.1%), 3 /
13 after slings (23%)). The indication was in 6 (31.6%) cases MF, in 3 (15.8 %) COMB, in 4 (21.1%) UE, in 5 (26.3
%) SSI, in 1 (5.2%) UA. The type of reoperation was either explantation (12 / 19), system replacement (6 / 19), or
cuff replacement (1 /19). Regarding the surgical intervention requiring complications only preoperative bacteriuria (P = .006) and postoperative surgical site oedema (P = .002) proved to be independent predictive factors.
Conclusion: Preoperative bacteriuria and surgical site oedema seemed to be good predictors for obligate surgical
revision. Patients with AUS were more prone to have major complications. In most cases it was mechanical failure,
infection or erosion. By reducing the frequency of these risk factors we might be able to decrease the amount of
complications.
- post-prostatectomy incontinence
- anti-incontinence surgery
- implantation
- sling
- artifitial urinary sphincter
- complication
How to Cite
References
Herschorn S. Update on management of post-prostatectomy incontinence in 2013. Can Urol Assoc J. 2013 Sep;7(9-10 Suppl 4):S189-91.
AngerJT, SaigalCS, Stothers L, et al. Theprevalence of urinary incontinence among community dwelling men: results from the National Health and Nutri- tion Examination Survey. J Urol 2006; 176:2103–2108.
Bianco FJ, Riedel ER, Begg CB, Kattan MW, Scardino PT, Scardino PT. Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 2005; 173: pp. 2099-2103
Bauer RM, Rutkowski M, Kretschmer A et al. Efficacy and complications of the adjustable sling system ArgusT for male incontinence: results of a prospective 2-center study. Urology. 2015 Feb;85(2):316-20.
Ravier E, Fassi-Fehri H, Crouzet S, Gelet A, Abid N, Martin X. Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy. BJU Int. 2015 Feb;115(2):300-7.
Gousse AE, Madjar S, Lambert MM, Fishman IJ. Artificial urinary sphincter for postradical prostatectomy urinary incontinence: long-term subjective results. J Urol, 2001, 166:1755-8.
Kretschmer A, Hüsch T, Thomsen F et al. Targeting moderate and severe male stress urinary inconetinence with adjustable male slings and the perineal artificial urinary sphincter: focus on perioperative complications and device explantations. Int Neurourol J 2017, 21:109-115
European Association of Urology, Urinary Incontinence guidelines, 2018
Pic G, Terrier JE, Ozenne B, Morel-Journel N, Paparel P. Impact of anastomotic strictures on treatment of post-prostatectomy stress incontinence by artificial urinary sphincter. Prog Urol. 2016 Sep - Oct;26(11-12):635-641.
McKibben MJ, Shakir N, Fuchs JS, Scott JM, Morey AF. Erosion rates of 3.5-cm artificial urinary sphincter cuffs are similar to larger cuffs. BJU Int. 2018 Jul 14. doi: 10.1111/bju.14483. [Epub ahead of print]
Comiter CV, Dobberfuhl AD. The artificial urinary sphincter and male sling for postprostatectomy incontinence: Which patient should get which procedure? Invest Clin Urol. 2016;57(1):3-13.
Kretschmer A , Thomsen F et al. Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study. Urol Int 03 Sep 2016, 99(1):14-21
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