Long term use of hydraulic artificial urethral sphincters in nine dogs from New Zealand with urethral sphincter mechanism incompetence.

AIMS: To report on the long-term outcomes of hydraulic artificial urethral sphincter (HAUS) placement for the correction of urethral sphincter mechanism incompetence (USMI) in New Zealand dogs. METHODS: Retrospective data were obtained from cases of dogs which had a HAUS placed after failed medical and/or surgical management of USMI between August 2012 and November 2016. Owner assessment of urinary incontinence was evaluated by an online survey in May 2017 using a visual analogue scale (0 being normal, 100 being severely affected) for the frequency, volume and severity of any straining to urinate, immediately prior to the placement of the HAUS and at the time of the survey. The number of days between surgery and the completion of survey were recorded. RESULTS: Seven females and two male dogs, which were all desexed except for one female, were eligible for inclusion in the study. The period of follow-up following HAUS placement ranged from 206-1,685 days. Following HAUS placement, frequency and volume of urinary incontinence decreased for six dogs and were practically unchanged for three dogs. The median frequency score decreased from 70 to 13 and the volume score decreased from 73 to 12. There was no consistent change in the perceived degree of straining to urinate. Complications occurred in three dogs; one required repositioning of a dislodged injection port, one required management for haematuria and a hypoplastic bladder, and one required surgical removal of fibrous tissue around the HAUS cuff. CONCLUSIONS AND CLINICAL RELEVENCE: HAUS placement was an effective method for the treatment of persistent USMI in most dogs and provided good clinical results based on owner assessment. The technique was associated with few complications and allowed successful long-term control of urinary incontinence without the need for medical management.

Instrumentación transuretral en portadores de esfínter urinario artificial. Presentación y discusión de tres casos clínicos / Transurethral instrumentation in patients with artificial urinary sphincter. Presentation and discussion of three clinical cases

El tratamiento para la incontinencia urinaria masculina de esfuerzo severa es la colocación de un esfínter urinario artificial (EUA). La etiología de la incontinencia con frecuencia es la cirugía prostática previa. Los resultados funcionales son buenos con una tasa aceptable de complicaciones. Las complicaciones son más frecuentes si existe radioterapia previa o se realizan procedimientos transuretrales sin tener en cuenta la presencia del manguito del EUA. Cuando es necesaria la cirugía transuretral, por ejemplo por tumor vesical, es necesario realizar el desabrochado del manguito esfinteriano. Los sondajes uretrales precisan también desactivar el manguito y manipular la uretra con sumo cuidado, evitando su manipulación siempre que sea posible. Se presentan tres casos muy complejos de pacientes portadores de EUA que han precisado diversas soluciones ante manipulación uretral y presencia de complicaciones como estenosis de uretra (AU)

Artificial urinary sphincter (AS) is the gold standard treatment for severe male urinary stress incontinence. The etiology of incontinence is often previous prostate surgery as a radical prostatectomy. Functional results are good with an acceptable rate of complications. If there is prior radiotherapy complications are more frequent. When transurethral surgery, for example for bladder tumor is needed, it is necessary unbuttoned the sleeve. Urethral soundings need also turn off the sleeve and manipulate the urethra carefully, avoiding handling whenever possible. We present three very complex cases of patients with US showing several solutions to urethral manipulation and to resolve complications such as urethral perforation and stricture (AU)

The long-term outcome of artificial urinary sphincters.

PURPOSE: We reviewed the outcome of artificial urinary sphincters inserted more than 10 years ago. MATERIALS AND METHODS: We analyzed the records of 100 patients and mailed a questionnaire to those without recent followup. RESULTS: Overall 84 patients were continent, including 36 with the original artificial urinary sphincter in place who were dry at a median followup of 11 years and 27 in whom the device was successfully replaced due to mechanical failure who were previously continent for a median of 7 years. In 21 patients it was removed due to infection or erosion and reimplantation was successful 3 to 6 months later or they remained dry without another artificial urinary sphincter. Of the male patients with a bulbar and bladder neck sphincter 92% and 84%, respectively, were continent at 10 years as well as 73% of the females. Device survival was 66% at 10 years. Overall 37% of the prostheses were removed due to infection or erosion in the 10-year period with the highest risk in females (56%) and lowest in males with a bulbar sphincter (23%). CONCLUSIONS: The artificial urinary sphincter is effective long-term treatment for incontinence in male patients. In female patients the risk of erosion is high, although overall long-term continence is satisfactory.

El esfínter anal artificial. Nuestra experiencia / The artifical bowel sphincter. Our experience

Introducción. Una alternativa para el tratamiento de la incontinencia fecal severa es el esfínter anal artificial. Presentamos los resultados obtenidos en nuestra unidad tras la implantación de seis de estos dispositivos. Pacientes y métodos. Desde septiembre de 1997 hasta febrero de 1999 se han implantado 6 esfínteres anales artificiales a 4 mujeres y 2 varones diagnosticados de incontinencia fecal. Todos ellos fueron refractarios al tratamiento médico-dietético y al biofeedback. A todos se les realizaron en el preoperatorio estudios funcionales y radiológicos. La valoración de la continencia se efectuó con la escala de Miller. Los pacientes fueron intervenidos por el mismo cirujano. Resultados. Durante el postoperatorio no se presentó ninguna complicación inmediata que obligara al explante del dispositivo. Cuatro pacientes presentaron una dehiscencia de la herida perineal y uno un hematoma escrotal. En un caso fue necesario realizar un estoma de derivación por una diarrea refractaria al tratamiento médico. La tasa de infección ha sido nula. En 3 pacientes ha aparecido un cuadro de obstrucción a la defecación. Se ha retirado el dispositivo a una paciente 10 meses después de la intervención debido al dolor que presentaba en todas las zonas donde estaba situado el mismo. En cuanto a la continencia, hemos obtenido una mejoría, pasando los pacientes de un grado III a un grado l (puntuación de 17,6 a 4,6). Conclusiones. El esfínter anal artificial es una alternativa para el tratamiento de la incontinencia anal severa, ya que sus resultados en cuanto a morbilidad y a restauración de la continencia son alentadores (AU)