Investig Clin Urol.  2018 Jan;59(1):44-48. 10.4111/icu.2018.59.1.44.

What is the fate of artificial urinary sphincters among men undergoing repetitive bladder cancer treatment?

• Heiner SM
• Viers BR
• Rivera ME
• Linder BJ
• Elliott DS

• KMID: 2399264
• DOI: http://doi.org/10.4111/icu.2018.59.1.44

Abstract

PURPOSE
Functional characteristics and durability of the artificial urinary sphincter (AUS) among patients who develop bladder cancer has been poorly characterized. We sought to evaluate AUS outcomes among patients subsequently diagnosed with bladder cancer, in order to describe device survivability when subject to diagnostic and therapeutic procedures such as cystoscopy, transurethral resection, and cystectomy.
MATERIALS AND METHODS
We retrospectively reviewed 1,803 male patients treated with AUS surgery at a single institution between 1983-2014. We describe AUS device outcomes among patients undergoing surveillance and treatment for bladder cancer.
RESULTS
Following AUS placement, 14 (0.8%) patients were subsequently diagnosed with and treated for bladder cancer and 4 patients with bladder cancer undergoing treatment and screening, subsequently received AUS placement. The median follow-up from device placement was 7.2 years (interquartile range [IQR], 2.8-11.5), and the median time from AUS placement to bladder cancer diagnosis was 6 (IQR, 0-9). There were a total of 8 primary and 1 secondary devices failures. Despite a median of 2 diagnostic cystoscopies (IQR, 1-6) and 0 bladder tumor resections (IQR, 0-0) per patient following device implantation, only 1 (5.6%) patient experienced an iatrogenic erosion related to urethral manipulation. Among those undergoing cystectomy (n=4), 1 device was left in situ without complication.
CONCLUSIONS
Bladder cancer surveillance and treatment with an AUS device in place appears to confer minimal additional risk to AUS survival. Careful attention should be given to device deactivation and use of the smallest caliber instruments available to minimize the risk of iatrogenic urethral erosion.

Keyword

Cystoscopy; Urinary bladder neoplasms; Urinary incontinence; Urinary sphincter, artificial

MeSH Terms

Cystectomy
Cystoscopy
Diagnosis
Follow-Up Studies
Humans
Male
Mass Screening
Retrospective Studies
Urinary Bladder Neoplasms*
Urinary Bladder*
Urinary Incontinence
Urinary Sphincter, Artificial*

Reference

1. Scott FB, Bradley WE, Timm GW. Treatment of urinary incontinence by an implantable prosthetic urinary sphincter. J Urol. 1974; 112:75–80.

2. Van der, Drake MJ, Kasyan GR, Petrolekas A, Cornu JN;. 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.

3. Kim SP, Sarmast Z, Daignault S, Faerber GJ, McGuire EJ, Latini JM. 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.

4. Linder BJ, de Cogain M, Elliott DS. Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection. J Urol. 2014; 191:734–738.

5. Lai HH, Hsu EI, Teh BS, Butler EB, Boone TB. 13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine. J Urol. 2007; 177:1021–1025.

6. Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011; 306:737–745.

7. Rivera ME, Linder BJ, Ziegelmann MJ, Viers BR, Rangel LJ, Elliott DS. The impact of prior radiation therapy on artificial urinary sphincter device survival. J Urol. 2015; 195:1033–1037.

8. Seideman CA, Zhao LC, Hudak SJ, Mierzwiak J, Adibi M, Morey AF. Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion? Urology. 2013; 82:943–946.

9. Linder BJ, Piotrowski JT, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS. Perioperative complications following artificial urinary sphincter placement. J Urol. 2015; 194:716–720.

10. Ziegelmann MJ, Linder BJ, Rivera ME, Viers BR, Rangel LJ, Elliott DS. Outcomes of artificial urinary sphincter placement in octogenarians. Int J Urol. 2016; 23:419–423.

11. Agarwal DK, Linder BJ, Elliott DS. Artificial urinary sphincter urethral erosions: temporal patterns, management, and incidence of preventable erosions. Indian J Urol. 2017; 33:26–29.

12. Myers JB, Brant WO, Hotaling JN, Lenherr SM. Urethral strictures and artificial urinary sphincter placement. Urol Clin North Am. 2017; 44:93–103.

13. Gousse AE, Tunuguntla HS, Leboeuf L. Two-stage management of severe postprostatectomy bladder neck contracture associated with stress incontinence. Urology. 2005; 65:316–319.

14. Cefalu CA, Deng X, Zhao LC, Scott JF, Mehta S, Morey AF. Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience. Urology. 2013; 82:1436–1439.