Exposing The Myth Of Urethral Atrophy As Etiology Of Recurrent Incontinence After Artificial Urinary Sphincter: The Role Of Capsulotomy With Intraoperative Pressure Profiling Of The Pressure Regulating Balloon.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-07 EXPOSING THE MYTH OF URETHRAL ATROPHY AS ETIOLOGY OF RECURRENT INCONTINENCE AFTER ARTIFICIAL URINARY SPHINCTER: THE ROLE OF CAPSULOTOMY WITH INTRAOPERATIVE PRESSURE PROFILING OF THE PRESSURE REGULATING BALLOON. Amy Pearlman, Alison Rasper, and Ryan Terlecki Amy PearlmanAmy Pearlman More articles by this author , Alison RasperAlison Rasper More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent stress urinary incontinence (rSUI) after artificial urinary sphincter (AUS) placement can be vexing for patients and prosthetic urologists. In absence of malfunction, the etiology is often assumed to be urethral atrophy. Urethral constriction by subcuff encapsulation, however, may preclude proper coaptation. Our technique involves incision of the subcuff capsule with intraoperative observation for urethral recovery and pressure profiling of the pressure regulating balloon (PRB). We aimed to characterize the incidence and extent of both urethral recovery following capsulotomy and that of PRB material fatigue in men undergoing AUS revision for rSUI. METHODS Retrospective review of a prospectively collected, IRB-approved single surgeon database was performed. Cases of AUS removal/replacement for rSUI involving ventral subcuff capsulotomy and intraoperative PRB pressure profile assessment (via transducer) were identified. Urethral circumference was measured before and after capsulotomy. PRB profiles were recorded and compared to initial manufacturer ratings. RESULTS The described operative approach involving capsulotomy was applied in 7 patients from November 2015 to September 2017. Mean patient age was 75. Mean time between original AUS placement and AUS revision surgery was 103 months. 6 patients underwent prior prostatectomy and the remaining patient underwent prior transurethral resection of his prostate followed by brachytherapy. Urethral circumference increased in all patients after capsulotomy (mean increase 1.1cm; range 0.5-2.5cm). Cuff size increased, remained the same, and decreased in 2, 3, and 2 patients, respectively. Of the 2 patients whose cuff size decreased, 1 was a prior transcorporally placed cuff and both cuff sizes decreased by only 0.5cm. 6 of the 7 patients underwent PRB interrogation. 66.7, 16.7, and 16.7% of PRBs demonstrated pressures in a category below, at the same, or higher than the original manufacturer rating. Mean follow up between AUS revision surgery and last encounter was 6.7 months. CONCLUSIONS Despite visual appearance to suggest urethral atrophy, subcuff capsulotomy results in increased urethral circumference in all patients. Furthermore, intraoperative PRB profiling demonstrates material fatigue. Future multicenter efforts are warranted to determine if capsulotomy, with or without PRB replacement, may simplify surgical management of rSUI with reductions in cost and morbidity. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e554 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amy Pearlman More articles by this author Alison Rasper More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...