https://doi.org/10.4081/aiua.2024.12661

Single-component artificial urinary sphincter: Outcomes from one centre in Portugal

Vol. 96 No. 3 (2024)
Submitted: May 13, 2024
Accepted: June 6, 2024
Published: October 2, 2024
artificial urinary sphincter, Zephyr Surgical Implants 375, male stress urinary incontinence, radical prostatectomy, quality of life
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Authors

João Aragão Vital
joaopvital@gmail.com
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Miguel Marques Monteiro
https://orcid.org/0000-0002-8222-0511
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Bernardo Lobão Teixeira
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Gonçalo Grilo Mendes
https://orcid.org/0000-0001-5306-1200
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Alexandra Rocha
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Mariana Madanelo
https://orcid.org/0000-0001-8429-7785
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Sofia Mesquita
https://orcid.org/0000-0001-8482-5314
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Nuno Vinagre
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Beatriz Oliveira
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Martinha Magalhães
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Ana Isabel Lopes
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Carlos Ferreira
https://orcid.org/0000-0003-1879-0189
Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.
Paulo Príncipe
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
Avelino Fraga
Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.

Purpose: Radical prostate cancer treatment is the predominant cause of iatrogenic stress urinary incontinence (SUI) in men, significantly impacting their quality of life (QoL). This prospective single-center study in Portugal aimed to evaluate the outcomes of men with moderate-to-severe SUI treated with a single-component artificial urinary sphincter (AUS).
Materials and methods: Male patients with iatrogenic moderate-to-severe SUI, determined by a 24-hour pad weight test, were included. The single-component device comprises a cuff linked to a pump unit through a kink-resistant tube. The implantation involved perineal incision for cuff placement and an inguinal incision for pump and tank positioning within the scrotum. Complications, pad usage, perioperative complications (Clavien-Dindo classification), and quality of life assessment using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire were documented.
Results: Between May 2021 and March 2023, 20 consecutive single-component AUS insertions were conducted at a Portuguese urology department. Follow-up concluded in July 2023, with a mean follow-up duration of 15 months (range: 5-27). Four patients experienced complications necessitating device revision or removal (erosion = 2, infection = 1, mechanical failure = 1). Social continence (0/1 pad/day) was achieved in 70% (14/20 patients), while 30% (6/20 patients) experienced incontinence. Perioperatively, one patient was classified as grade 2, while the remaining were grade 0/1 in the Clavien-Dindo classification. The mean ICIQ-SF score reduction was 10.5 points.
Conclusions: The single-component AUS shows promising efficacy in managing moderate-to-severe male SUI, offering a good success rate, acceptable complications, improved QoL, and a straightforward surgical procedure.

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Scopus
Google Scholar
Europe PMC
Bauer RM, Gozzi C, Hübner W, et al. Contemporary management of postprostatectomy incontinence. Eur Urol. 2011;59:985-996. DOI: https://doi.org/10.1016/j.eururo.2011.03.020
Shamliyan TA, Wyman JF, Ping R, Wilt TJ, Kane RL. Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol. 2009;11:145-165.
Park HK, Chang S, Palmer MH, Kim I, Choi H. Assessment of the impact of male urinary incontinence on health-related quality of life: a population based study. Low Urin Tract Symptoms. 2015;7:22-26. DOI: https://doi.org/10.1111/luts.12043
Ostrowski I, Śledź E, Ciechan J, et al. Current interventional management of male stress urinary incontinence following urological procedures. Cent European J Urol. 2015;68:340-347. DOI: https://doi.org/10.5173/ceju.2015.616
James MH, McCammon KA. Artificial urinary sphincter for post-prostatectomy incontinence: a review. Int J Urol. 2014;21:536-543. DOI: https://doi.org/10.1111/iju.12392
Sousa-Escandón A, Cabrera J, Mantovani F, et al. Adjustable suburethral sling (male remeex system) in the treatment of male stress urinary incontinence: a multicentric European study. Eur Urol. 2007;52:1473-1479. DOI: https://doi.org/10.1016/j.eururo.2007.05.017
Leruth J, Waltregny D, de Leval J. The inside-out transobturator male sling for the surgical treatment of stress urinary incontinence after radical prostatectomy: midterm results of a single-center prospective study. Eur Urol. 2012;61:608-615. DOI: https://doi.org/10.1016/j.eururo.2011.10.036
Kim SW, Walsh R, Berger Y, Kim JH. Male Readjustable Sling (MRS) system for postprostatectomy incontinence: experiences of 2 centers. Urology. 2016;88:195-200. DOI: https://doi.org/10.1016/j.urology.2015.10.016
Van der Aa F, Drake MJ, Kasyan GR, et al. The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence. Eur Urol. 2013;63:681-689. DOI: https://doi.org/10.1016/j.eururo.2012.11.034
Ostrowski I, Blewniewski M, Neugart F, et al. Multicentre experience with ZSI 375 artificial urinary sphincter for the treatment of stress urinary incontinence in men. Urologia. 2017;84:148-152. DOI: https://doi.org/10.5301/uj.5000246
Hajivassiliou CA. A review of the complications and results of implantation of the AMS artificial urinary sphincter. Eur Urol. 1999;35:36-44. DOI: https://doi.org/10.1159/000019817
Herschorn S, Bruschini H, Comiter C, et al. Surgical treatment of stress incontinence in men. Neurourol Urodyn. 2010;29:179-190. DOI: https://doi.org/10.1002/nau.20844
Clemens JQ, Schuster TG, Konnak JW, et al. Revision rate after artificial urinary sphincter implantation for incontinence after radical prostatectomy: actuarial analysis. J Urol. 2001;166:1372-5. DOI: https://doi.org/10.1016/S0022-5347(05)65772-2
Petrou SP, Elliott DS, Barrett DM. Artificial urethral sphincter for incontinence. Urology. 2000;56:353-359. DOI: https://doi.org/10.1016/S0090-4295(00)00683-X
Elliott DS, Barrett DM. Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol. 1998;159:1206-8. DOI: https://doi.org/10.1016/S0022-5347(01)63557-2
Lai HH, Hsu EI, Teh BS, et al. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007;177:1021-1025. DOI: https://doi.org/10.1016/j.juro.2006.10.062
Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by an implantable prosthetic urinary sphincter. J Urol. 1974;112:75-80. DOI: https://doi.org/10.1016/S0022-5347(17)59647-0
Lucas MG, Bosch RJ, Burkhard FC, et al. EAU guidelines on surgical treatment of urinary incontinence. Eur Urol. 2012;62:1118-1129. DOI: https://doi.org/10.1016/j.eururo.2012.09.023
Herschorn S. The artificial urinary sphincter is the treatment of choice for post-radical prostatectomy incontinence. Can Urol Assoc J. 2008;2:536-539. DOI: https://doi.org/10.5489/cuaj.924
Vakalopoulos I, Kampantais S, Laskaridis L, et al. New artificial urinary sphincter devices in the treatment of male iatrogenic incontinence. Adv Urol. 2012;2012:439372. DOI: https://doi.org/10.1155/2012/439372
Wilson SK, Aliotta PJ, Salem EA, Mulcahy JJ. New enhancements of the scrotal one-incision technique for placement of artificial urinary sphincter allow proximal cuff placement. J Sex Med. 2010;7:3510-3515. DOI: https://doi.org/10.1111/j.1743-6109.2010.01933.x
Sandhu JS, Maschino AC, Vickers AJ. The surgical learning curve for artificial urinary sphincter procedures compared to typical surgeon experience. Eur Urol. 2011;60:1285-1290. DOI: https://doi.org/10.1016/j.eururo.2011.05.048
Ostrowski I, Golabek T, Ciechan J, et al. Preliminary outcomes of the European multicentre experience with the ZSI 375 artificial urinary sphincter for treatment of stress urinary incontinence in men. Cent European J Urol. 2019;72:263-269.
Staerman F, G-Llorens C, Leon P, Leclerc Y. ZSI 375 artificial urinary sphincter for male urinary incontinence: a preliminary study. BJU Int. 2013;111:E202-E206. DOI: https://doi.org/10.1111/j.1464-410X.2012.11468.x
Ostrowski I, Ciechan J, Sledz E, et al. Four-year follow-up on a Zephyr Surgical Implants 375 artificial urinary sphincter for male urinary incontinence from one urological centre in Poland. Cent European J Urol. 2018;71:320-325.
Venn SN, Greenwell TJ, Mundy AR. The long-term outcome of artificial urinary sphincters. J Urol. 2000;164:702-707. DOI: https://doi.org/10.1097/00005392-200009010-00020
Kim SP, Sarmast Z, Daignault S, et al. Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol. 2008;179:1912-1916. DOI: https://doi.org/10.1016/j.juro.2008.01.048
Queissert F, Huesch T, Kretschmer A, et al. Artificial urinary sphincter cuff size predicts outcome in male patients treated for stress incontinence: results of a large central European multicenter cohort study. Int Neurourol J. 2019;23:219-225. DOI: https://doi.org/10.5213/inj.1938032.016
Llorens C, Pottek T. Urinary artificial sphincter ZSI 375 for treatment of stress urinary incontinence in men: 5 and 7 years follow-up report. Urologia. 2017;84:263-266. DOI: https://doi.org/10.5301/uj.5000243
Ostrowski I, Śledź E, Wilamowski J, et al. Patients' quality of life after implantation of ZSI 375 artificial urinary sphincter due to stress urinary incontinence. Cent European J Urol. 2020;73:178-186.

How to Cite

Aragão Vital, J., Marques Monteiro, M., Lobão Teixeira, B., Grilo Mendes, G., Rocha, A., Madanelo, M., Mesquita, S., Vinagre, N., Oliveira, B., Magalhães, M., Isabel Lopes, A., Ferreira, C., Príncipe, P., & Fraga, A. (2024). Single-component artificial urinary sphincter: Outcomes from one centre in Portugal. Archivio Italiano Di Urologia E Andrologia, 96(3). https://doi.org/10.4081/aiua.2024.12661
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