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World Journal of Urology
Published in: World Journal of Urology 1/2020

01-01-2020 | Urethrotomy | Original Article

Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation

Authors: Khalid Sayedahmed, Roberto Olianas, Bjoern Kaftan, Mohamed Omar, Mohamed El Shazly, Maximilian Burger, Roman Mayr, Bernd Rosenhammer

Published in: World Journal of Urology | Issue 1/2020

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Abstract

Purpose

To evaluate the impact of previous urethroplasty on complication rates and postoperative continence after primary artificial urinary sphincter (AUS) implantation in male patients with severe stress urinary incontinence.

Patients and methods

A prospective evaluation of patients undergoing primary AUS implantation was conducted. Patients with previous radiotherapy, AUS implantation or urethral stent placement were excluded. Main endpoints were postoperative continence and complication rates including necessity of AUS explantation. Kaplan–Meier analysis evaluated explantation-free survival. Logistic regression analyses were performed to identify potential predictors for AUS explantation.

Results

105 patients were included with a mean follow-up of 76.6 months (SD 15.9). 30 of these patients had a history of urethroplasty. Postoperatively, 96.2% of all patients were objectively continent (≤ 1 pad/day). No differences in postoperative continence and early complication rates were observed. Concerning long-term complications, infection, mechanical implant failure, and tissue atrophy were also comparable. Overall sphincter erosion rate was 12.3%, but significantly higher in urethroplasty patients (23.3% vs. 8.0%, p = 0.038) and sphincter explantation rate was threefold higher (p = 0.016) in the urethroplasty group. Furthermore, explantation-free survival was reduced compared to the non-urethroplasty group (p = 0.044). On logistic regression analysis, the previous urethroplasty was the only significant predictor for AUS explantation (p = 0.016).

Conclusion

AUS implantation in patients with former urethroplasty can provide satisfying results. Compared to patients without the previous urethroplasty, the higher risk of cuff erosion and AUS explantation has to be addressed during preoperative consultation. Patients with the previous urethroplasty with grafting, long strictures and previous visual internal urethrotomy might be at highest risk.
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Metadata
Title
Impact of previous urethroplasty on the outcome after artificial urinary sphincter implantation: a prospective evaluation
Authors
Khalid Sayedahmed
Roberto Olianas
Bjoern Kaftan
Mohamed Omar
Mohamed El Shazly
Maximilian Burger
Roman Mayr
Bernd Rosenhammer
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 1/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-019-02756-0

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