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Daniel S. Elliott - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Male Stress Urinary Incontinence: Artificial Urinary Sphincter
Textbook of Male Genitourethral Reconstruction, 2019Co-Authors: Roy Lipworth, Brian J. Linder, Daniel S. ElliottAbstract:Many treatment options are available for male stress Urinary incontinence, ranging from pelvic floor physical therapy to male urethral sling insertion or Artificial Urinary Sphincter placement. In cases of severe incontinence, prior pelvic radiation therapy, or previous failed urethral sling placement, implanting an Artificial Urinary Sphincter is typically preferred. Here, we review the preoperative considerations, operative technique, postoperative outcomes and potential complications of Artificial Urinary Sphincter placement.
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Can time to failure predict the faulty component in Artificial Urinary Sphincter device malfunctions
International journal of urology : official journal of the Japanese Urological Association, 2017Co-Authors: David Y. Yang, Brian J. Linder, Laureano J. Rangel, Adam R. Miller, Daniel S. ElliottAbstract:OBJECTIVE Artificial Urinary Sphincter malfunctions can occur in any of the individual components. Preoperative identification of the malfunctioning component can be valuable for patient counseling and surgical planning. The optimal strategy for repair of failed Artificial Urinary Sphincter components is debated given the relative rarity of the situation. The aim of the present study was to evaluate the relationship of time to failure with failed Artificial Urinary Sphincter component and to compare our outcomes of specific component versus complete device replacement. METHODS From 1983 to 2011, 1805 Artificial Urinary Sphincter procedures were carried out at Mayo Clinic (Rochester, Minnesota, USA), of which 1072 patients underwent primary Artificial Urinary Sphincter placement. Clinical variables, including time to failure, were evaluated for association with component failure. Bootstrap analysis was used to estimate the differences in time to reach a fixed percentage of component failure. RESULTS A total of 115 patients experienced device failure at a median follow up of 4.2 years. Urethral cuff, abdominal reservoir, scrotal pump and tubing malfunction occurred in 53 (4.9%), 26 (2.4%), 11 (1%) and 25 (2.3%) patients, respectively. Increasing age at the time of primary surgery was protective of cuff malfunction (hazard ratio 0.97, P = 0.04). Time to 3% urethral cuff failure outpaced other component failures (P 3 years, as this represents the most likely component to fail.
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Use of the Artificial Urinary Sphincter in the Management of Post-prostatectomy Incontinence
Post-Prostatectomy Incontinence, 2017Co-Authors: Brian J. Linder, Daniel S. ElliottAbstract:Despite advances in surgical techniques for radical prostatectomy, post-prostatectomy incontinence affects many men and can have a large impact on quality of life. Many treatments options are available for this condition, ranging from pelvic floor physical therapy to male urethral sling insertion or Artificial Urinary Sphincter placement. In cases of severe incontinence, prior pelvic radiation therapy or previous failed urethral sling placement, implanting an Artificial Urinary Sphincter is typically preferred. Here, we review the preoperative considerations, operative technique, postoperative outcomes, and potential complications of Artificial Urinary Sphincter placement.
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long term quality of life and functional outcomes among primary and secondary Artificial Urinary Sphincter implantations in men with stress Urinary incontinence
The Journal of Urology, 2016Co-Authors: Boyd R Viers, Brian J. Linder, Matthew Ziegelmann, Marcelino E. Rivera, Laureano J. Rangel, Daniel S. ElliottAbstract:Purpose: There remains a paucity of data regarding subjective and functional outcomes after Artificial Urinary Sphincter implantation. Therefore, we evaluated long-term differences in quality of life after primary and secondary Artificial Urinary Sphincter surgery.Materials and Methods: Men were invited to participate in a mail-in survey assessing Artificial Urinary Sphincter status, patient satisfaction and Urinary control. Patients with primary (467) and secondary (122) Artificial Urinary Sphincter devices without an event were included in the study. Differences between the cohorts including quality of life (10-point scale, maximum 100) and functional outcomes were evaluated.Results: Overall 229 (49%) patients with primary and 49 (40%) with secondary Artificial Urinary Sphincters completed the survey at a median of 8.3 years. Patients with primary and secondary Artificial Urinary Sphincter devices reported similar Artificial Urinary Sphincter quality of life (score 74 vs 74). There were no significant d...
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outcomes of Artificial Urinary Sphincter placement in octogenarians
International Journal of Urology, 2016Co-Authors: Matthew Ziegelmann, Brian J. Linder, Marcelino E. Rivera, Laureano J. Rangel, Boyd R Viers, Daniel S. ElliottAbstract:Objective To evaluate the impact of patient age on device outcomes among patients undergoing primary Artificial Urinary Sphincter. Methods A total of 1081 male patients who underwent primary Artificial Urinary Sphincter placement from 1983 to 2011 were analyzed, including 91 men (8%) who were aged >80 years at the time of surgery. Revisions and explanations were compared between men stratified by decade of life. Hazard ratios adjusting for competing risks were used to determine the association with age and Artificial Urinary Sphincter device outcomes (infection/erosion, urethral atrophy and malfunction), while overall device failure was estimated using Kaplan–Meier and Cox regression analysis. Results Patients aged >80 years were more likely to have coronary disease (P = 0.009), diabetes mellitus (P = 0.04), hypertension (P = 0.002) and lower body mass index (P 80 years were significantly more likely to experience device erosion or infection compared with a reference of patients aged <60 years (hazard ratio 4.13; P = 0.046), whereas there was no difference in those patients aged 60–70 years or 70–80 years compared with the reference group (P = 0.56 and 0.45). There was no significant difference in overall device survival between the age-stratified groups (P = 0.26). Conclusions Although overall Artificial Urinary Sphincter device survival is similar, patients aged >80 years are more likely to experience erosion or infection compared with younger patients. Despite this, the overall device failure rate is low, and Artificial Urinary Sphincter might be considered for appropriately selected and counseled octogenarians.
Allen F. Morey - One of the best experts on this subject based on the ideXlab platform.
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does pressure regulating balloon location make a difference in functional outcomes of Artificial Urinary Sphincter
The Journal of Urology, 2015Co-Authors: Nirmish Singla, Jay Simhan, Timothy J. Tausch, Jordan Siegel, Alexandra Klein, Gregory R Thoreson, Allen F. MoreyAbstract:Purpose: We compared functional outcomes in patients who received an Artificial Urinary Sphincter in the space of Retzius vs the same device placed at a high submuscular location.Materials and Methods: We reviewed a prospectively maintained database of patients who received an Artificial Urinary Sphincter between July 2007 and December 2014. After cuff placement was completed via a perineal incision, a 61 to 70 cm H2O pressure regulating balloon was placed through a separate high scrotal incision in the space of Retzius or in a high submuscular tunnel. Demographics, perioperative comorbidities and functional outcomes were compared between the groups.Results: A total of 294 consecutive patients underwent Artificial Urinary Sphincter placement. Mean followup was 23 months. Space of Retzius and high submuscular placement was performed in 140 (48%) and 154 patients (52%), respectively. Functional outcomes were similar between the groups, including the continence rate (defined as 0 or 1 pad daily) in 81% vs 88...
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3.5 cm Artificial Urinary Sphincter Cuff Erosion Occurs Predominantly in Irradiated Patients
The Journal of urology, 2014Co-Authors: Jay Simhan, Allen F. Morey, Nirmish Singla, Timothy J. Tausch, J. Francis Scott, Gary E. Lemack, Claus G. RoehrbornAbstract:Purpose: We analyzed our initial 100-case experience with the 3.5 cm Artificial Urinary Sphincter cuff to identify risk factors for cuff erosion.Materials and Methods: We reviewed the records of a single surgeon, consecutive series of patients treated with 3.5 cm Artificial Urinary Sphincter cuff placement from September 2009 to August 2013. Each patient underwent single perineal cuff placement via standardized technique. Preoperative characteristics, technical considerations and postoperative outcomes were analyzed and compared to those in a cohort of patients in whom a larger (4.0 cm or greater) Artificial Urinary Sphincter cuff was placed during the same period. We identified clinical factors associated with an increased risk of 3.5 cm Artificial Urinary Sphincter cuff erosion.Results: Of the 176 men who met study inclusion criteria during the 4-year period 100 (57%) received the 3.5 cm Artificial Urinary Sphincter cuff and 76 (43%) received a larger cuff (4.0 cm or greater). The continence rate (83% v...
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immediate urethral repair during explantation prevents stricture formation after Artificial Urinary Sphincter cuff erosion
The Journal of Urology, 2014Co-Authors: Alexander Rozanski, Jay Simhan, Timothy J. Tausch, Daniel Ramirez, Francis J Scott, Allen F. MoreyAbstract:Purpose: We compare stricture outcomes in patients with Artificial Urinary Sphincter cuff erosion managed with and without synchronous urethral repair.Materials and Methods: Records of patients who underwent Artificial Urinary Sphincter removal for cuff erosion from 2007 to 2013 were retrospectively reviewed. Two cohorts of patients were evaluated, with those in group 1 treated with in situ urethroplasty and those in group 2 treated with a Foley catheter only. We compared demographic, clinical and radiological data to assess resultant stricture disease, and compared operative times between the cohorts.Results: Of the 26 Artificial Urinary Sphincter cuff erosion cases identified 13 underwent in situ urethroplasty while 13 did not. Mean patient age was 73 years (range 61 to 83) with a mean followup of 24 months (range 8 to 69). The rate of urethral stricture formation after Artificial Urinary Sphincter explantation was significantly reduced among patients treated with in situ urethroplasty (5 of 13, 38%) co...
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Decreasing Need for Artificial Urinary Sphincter Revision Surgery by Precise Cuff Sizing in Men with Spongiosal Atrophy
The Journal of urology, 2014Co-Authors: Jay Simhan, Allen F. Morey, Timothy J. Tausch, J. Francis Scott, Steven J. Hudak, Lee C. Zhao, Brian C. MazzarellaAbstract:Purpose: Many patients with persistent incontinence after an Artificial Urinary Sphincter procedure gain improved continence after cuff downsizing. In 2010 a new, smaller (3.5 cm) Artificial Urinary Sphincter cuff was introduced. We hypothesized that men with spongiosal atrophy previously treated with a 4.0 cm cuff would now show a decreased rate of revision surgery due to more accurate cuff sizing.Materials and Methods: We evaluated the outcome in men who received identical 4.0 cm cuff sizes in 2 eras, before (2007 to 2009) and after (2010 to 2013) the introduction of the 3.5 cm Artificial Urinary Sphincter cuff. Patients with a history of cuff erosion or those undergoing tandem, transcorporal, or 4.5 cm or greater cuff placement were excluded from analysis. We validated our institutional results using the nationwide AMS® PIF (Patient Information Form) database from identical time frames.Results: Of 236 men who underwent Artificial Urinary Sphincter placement at our institution during the study period 17...
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Impact of 3.5 cm Artificial Urinary Sphincter cuff on primary and revision surgery for male stress Urinary incontinence
The Journal of urology, 2011Co-Authors: Steven J. Hudak, Allen F. MoreyAbstract:Purpose: We report our initial clinical experience with the new 3.5 cm Artificial Urinary Sphincter cuff.Materials and Methods: We reviewed the records of all men who underwent Artificial Urinary Sphincter placement done by a single surgeon since September 2009. A perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement with a redesigned measuring tape. Clinical factors and cuff sizes were analyzed.Results: During the 14-month study period 45 of 67 patients (67%) with an Artificial Urinary Sphincter received the 3.5 cm cuff with no difference between primary and revision surgery (73% vs 58%, p = 0.29). Transcorporal cuff placement was reserved for 8 select patients (12%) after prior Artificial Urinary Sphincter cuff erosion or complex urethroplasty. A tandem cuff Artificial Urinary Sphincter was not used. Erectile dysfunction (89% vs 77%, p = 0.28) and prior radiation (47% vs 27%, p = 0.12) were more common in men who received a 3....
Brian J. Linder - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Male Stress Urinary Incontinence: Artificial Urinary Sphincter
Textbook of Male Genitourethral Reconstruction, 2019Co-Authors: Roy Lipworth, Brian J. Linder, Daniel S. ElliottAbstract:Many treatment options are available for male stress Urinary incontinence, ranging from pelvic floor physical therapy to male urethral sling insertion or Artificial Urinary Sphincter placement. In cases of severe incontinence, prior pelvic radiation therapy, or previous failed urethral sling placement, implanting an Artificial Urinary Sphincter is typically preferred. Here, we review the preoperative considerations, operative technique, postoperative outcomes and potential complications of Artificial Urinary Sphincter placement.
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Can time to failure predict the faulty component in Artificial Urinary Sphincter device malfunctions
International journal of urology : official journal of the Japanese Urological Association, 2017Co-Authors: David Y. Yang, Brian J. Linder, Laureano J. Rangel, Adam R. Miller, Daniel S. ElliottAbstract:OBJECTIVE Artificial Urinary Sphincter malfunctions can occur in any of the individual components. Preoperative identification of the malfunctioning component can be valuable for patient counseling and surgical planning. The optimal strategy for repair of failed Artificial Urinary Sphincter components is debated given the relative rarity of the situation. The aim of the present study was to evaluate the relationship of time to failure with failed Artificial Urinary Sphincter component and to compare our outcomes of specific component versus complete device replacement. METHODS From 1983 to 2011, 1805 Artificial Urinary Sphincter procedures were carried out at Mayo Clinic (Rochester, Minnesota, USA), of which 1072 patients underwent primary Artificial Urinary Sphincter placement. Clinical variables, including time to failure, were evaluated for association with component failure. Bootstrap analysis was used to estimate the differences in time to reach a fixed percentage of component failure. RESULTS A total of 115 patients experienced device failure at a median follow up of 4.2 years. Urethral cuff, abdominal reservoir, scrotal pump and tubing malfunction occurred in 53 (4.9%), 26 (2.4%), 11 (1%) and 25 (2.3%) patients, respectively. Increasing age at the time of primary surgery was protective of cuff malfunction (hazard ratio 0.97, P = 0.04). Time to 3% urethral cuff failure outpaced other component failures (P 3 years, as this represents the most likely component to fail.
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Use of the Artificial Urinary Sphincter in the Management of Post-prostatectomy Incontinence
Post-Prostatectomy Incontinence, 2017Co-Authors: Brian J. Linder, Daniel S. ElliottAbstract:Despite advances in surgical techniques for radical prostatectomy, post-prostatectomy incontinence affects many men and can have a large impact on quality of life. Many treatments options are available for this condition, ranging from pelvic floor physical therapy to male urethral sling insertion or Artificial Urinary Sphincter placement. In cases of severe incontinence, prior pelvic radiation therapy or previous failed urethral sling placement, implanting an Artificial Urinary Sphincter is typically preferred. Here, we review the preoperative considerations, operative technique, postoperative outcomes, and potential complications of Artificial Urinary Sphincter placement.
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long term quality of life and functional outcomes among primary and secondary Artificial Urinary Sphincter implantations in men with stress Urinary incontinence
The Journal of Urology, 2016Co-Authors: Boyd R Viers, Brian J. Linder, Matthew Ziegelmann, Marcelino E. Rivera, Laureano J. Rangel, Daniel S. ElliottAbstract:Purpose: There remains a paucity of data regarding subjective and functional outcomes after Artificial Urinary Sphincter implantation. Therefore, we evaluated long-term differences in quality of life after primary and secondary Artificial Urinary Sphincter surgery.Materials and Methods: Men were invited to participate in a mail-in survey assessing Artificial Urinary Sphincter status, patient satisfaction and Urinary control. Patients with primary (467) and secondary (122) Artificial Urinary Sphincter devices without an event were included in the study. Differences between the cohorts including quality of life (10-point scale, maximum 100) and functional outcomes were evaluated.Results: Overall 229 (49%) patients with primary and 49 (40%) with secondary Artificial Urinary Sphincters completed the survey at a median of 8.3 years. Patients with primary and secondary Artificial Urinary Sphincter devices reported similar Artificial Urinary Sphincter quality of life (score 74 vs 74). There were no significant d...
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outcomes of Artificial Urinary Sphincter placement in octogenarians
International Journal of Urology, 2016Co-Authors: Matthew Ziegelmann, Brian J. Linder, Marcelino E. Rivera, Laureano J. Rangel, Boyd R Viers, Daniel S. ElliottAbstract:Objective To evaluate the impact of patient age on device outcomes among patients undergoing primary Artificial Urinary Sphincter. Methods A total of 1081 male patients who underwent primary Artificial Urinary Sphincter placement from 1983 to 2011 were analyzed, including 91 men (8%) who were aged >80 years at the time of surgery. Revisions and explanations were compared between men stratified by decade of life. Hazard ratios adjusting for competing risks were used to determine the association with age and Artificial Urinary Sphincter device outcomes (infection/erosion, urethral atrophy and malfunction), while overall device failure was estimated using Kaplan–Meier and Cox regression analysis. Results Patients aged >80 years were more likely to have coronary disease (P = 0.009), diabetes mellitus (P = 0.04), hypertension (P = 0.002) and lower body mass index (P 80 years were significantly more likely to experience device erosion or infection compared with a reference of patients aged <60 years (hazard ratio 4.13; P = 0.046), whereas there was no difference in those patients aged 60–70 years or 70–80 years compared with the reference group (P = 0.56 and 0.45). There was no significant difference in overall device survival between the age-stratified groups (P = 0.26). Conclusions Although overall Artificial Urinary Sphincter device survival is similar, patients aged >80 years are more likely to experience erosion or infection compared with younger patients. Despite this, the overall device failure rate is low, and Artificial Urinary Sphincter might be considered for appropriately selected and counseled octogenarians.
Sender Herschorn - One of the best experts on this subject based on the ideXlab platform.
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Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results
The Journal of urology, 2018Co-Authors: Sidney B. Radomski, Vladimir Ruzhynsky, Christopher J.d. Wallis, Sender HerschornAbstract:Purpose: The Artificial Urinary Sphincter is a common treatment of male Urinary incontinence. We sought to characterize long-term rates of Artificial Urinary Sphincter revision/removal and reimplantation, and associated risk factors.Materials and Methods: We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent Artificial Urinary Sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of Artificial Urinary Sphincter reimplantation and revision/removal, and identify risk factors, respectively.Results: A total of 1,632 male patients underwent initial implantation of an Artificial Urinary Sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or betwe...
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The Artificial Urinary Sphincter for Post-Radical Prostatectomy Incontinence: Impact on Urinary Symptoms and Quality of Life
The Journal of urology, 1996Co-Authors: Neil Fleshner, Sender HerschornAbstract:AbstractPurpose: We addressed the impact of the Artificial Urinary Sphincter on the health related quality of life and Urinary symptoms in men with post-radical prostatectomy incontinence.Materials and Methods: A total of 30 men with an AMS800* Artificial Urinary Sphincter following radical prostatectomy responded to a questionnaire dealing with the impact of the symptoms on activities of daily living and quality of life. We compared these results to those of 31 patients who underwent radical prostatectomy but did not require an Artificial Urinary Sphincter.*American Medical Systems, Minnetonka, Minnesota.Results: Incontinence was minimal in both groups. Irritative symptoms were noted in the Artificial Urinary Sphincter group, as well as some impairment in activities of daily living. No significant differences were noted with respect to quality of life.Conclusions: The Artificial Urinary Sphincter is an effective form of therapy for post-radical prostatectomy incontinence but irritative voiding symptoms o...
Sidney B. Radomski - One of the best experts on this subject based on the ideXlab platform.
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Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results
The Journal of urology, 2018Co-Authors: Sidney B. Radomski, Vladimir Ruzhynsky, Christopher J.d. Wallis, Sender HerschornAbstract:Purpose: The Artificial Urinary Sphincter is a common treatment of male Urinary incontinence. We sought to characterize long-term rates of Artificial Urinary Sphincter revision/removal and reimplantation, and associated risk factors.Materials and Methods: We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent Artificial Urinary Sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of Artificial Urinary Sphincter reimplantation and revision/removal, and identify risk factors, respectively.Results: A total of 1,632 male patients underwent initial implantation of an Artificial Urinary Sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or betwe...
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Artificial Urinary Sphincter Reimplantation Following Cuff Erosion: Use Of The Vaginal Approach
The Journal of urology, 1992Co-Authors: Anthony R. Stone, Sidney B. RadomskiAbstract:AbstractWe describe the successful reimplantation of an Artificial Urinary Sphincter via the vaginal route 6 months after cuff erosion.
