Continence and Complication Rates of Artificial Urinary Sphincter Devices (AMS 800) for Parkinson and Stroke Patients with Incontinence after Prostate Surgery: Retrospective Analysis of a Prospective Database.

OBJECTIVES: The artificial urinary sphincter (AUS) is the gold standard treatment for severe stress urinary incontinence (SUI). According to the literature, patients suffering from Parkinson's disease (PD) or stroke (ST) show adverse continence outcomes after prostate surgery and, therefore, constitute a challenging cohort for continence surgery. However, little is known with respect to the results of AUS surgery in these patients. A retrospective analysis of our institutional, prospectively maintained AUS database aims to address this aspect with a focus on surgical and functional outcomes. METHODS AND PATIENTS: All data of patients with an AUS implantation were prospectively collected in our database since 2009. The AUS was implanted according to a standardized protocol and activated at 6 weeks postoperatively at our institution. Further follow-up (FU) consisted of pad-test, uroflowmetry, residual urine, and radiography as well as a standardized questionnaire including the Incontinence Quality of Life questionnaire (I-Quol) and International Consultation on Incontinence questionnaire (ICIQ-SF) and is scheduled at 6 and 24 months and every 2 years thereafter. Patients received a preoperative urodynamic evaluation (UD). Patients with normal voiding and storage function were considered for AUS implantation. All patients performed a preoperative test for manual dexterity. Patients with a history of ST or PD were grouped and compared to nonneurological patients. Primary/secondary endpoints of the study were complications/continence. RESULTS: 234 patients were available for analysis. The median FU was 24 months (interquartile range 7-36). Twenty-four patients (10%) had a neurological history (PD and ST). Neurological patients showed significantly worse outcomes regarding continence (objective/subjective/social continence; p = 0.04/p = 0.02/p = 0.1). Significant differences concerning explantation rates were not observed (p = 1). Kaplan-Meier analysis showed no significant difference regarding explantation-free survival (log-rank p = 0.53). CONCLUSION: AUS implantation shows significantly worse continence rates for neurological patients, despite the fact that all patients showed normal UD results and sufficient manual dexterity. Although neurological patients showed worse outcomes for continence, AUS implantation seems to be a safe and viable treatment for patients with a history of neurological disease.

The Impact of Surgical Sequence on Stricture Recurrence after Anterior 1-Stage Buccal Mucosal Graft Urethroplasty: Comparative Effectiveness of Initial, Repeat and Secondary Procedures.

PURPOSE: We compared the results of initial buccal mucosal graft urethroplasty to the results of repeat and secondary cases of previous urethroplasty done by any technique other than buccal mucosal graft urethroplasty. MATERIALS AND METHODS: We performed a retrospective study of patients who underwent buccal mucosal graft urethroplasty between January 2009 and December 2016 at a high volume center. Patients were stratified according to surgical sequence and characteristics were compared. We plotted Kaplan-Meier curves to compare stricture recurrence-free survival according to the surgical sequence. Multivariable Cox regression analyses were performed to delineate the impact of the surgical sequence on recurrence-free survival after adjusting for known clinical and surgical confounders. RESULTS: Of 534 men with a median followup of 33 months (IQR 17-52) 436 (81.6%), 64 (12.0%) and 34 (6.4%) underwent an initial, a repeat and a secondary procedure, respectively. Patient characteristics were comparable (each p ≥0.2). Patients with reoperative procedures had received more previous endoscopic interventions and were more often operated on by high volume surgeons (each p ≤0.021). Operative time, graft length, stricture location and surgical techniques were comparable (each p ≥0.1). The success rate of initial, repeat and secondary procedures was 87.4%, 87.5% and 70.6%, respectively. On survival analyses patients who underwent secondary procedures fared worse than those who underwent repeat or initial procedures (p = 0.010). Similarly a secondary procedure was an independent risk factor for recurrence (HR 2.42, 95% CI 1.03-5.68, p = 0.043). CONCLUSIONS: We found excellent results for repeat anterior 1-stage buccal mucosal graft urethroplasty, comparable to those of initial procedures. Patients who underwent secondary procedures were at higher risk for recurrence. However, when performed at a specialized center, the success rate was still high.