C10 PSYCHOLOGICAL ASPECTS OF QUALIFICATION TO IMPLANT AN ARTIFICIAL URETHRAL SPHINCTER AMS 800
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No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2000ARTIFICIAL URINARY SPHINCTER FOR POST-PROSTATECTOMY INCONTINENCE: IMPACT OF PRIOR COLLAGEN INJECTION ON COST AND CLINICAL OUTCOME CRISTIANO M. GOMES, GREGORY A. BRODERICK, RICARDO F. SÁNCHEZ-ORTIZ, DONALD PREATE, ERIC S. ROVNER, and ALAN J. WEIN CRISTIANO M. GOMESCRISTIANO M. GOMES , GREGORY A. BRODERICKGREGORY A. BRODERICK , RICARDO F. SÁNCHEZ-ORTIZRICARDO F. SÁNCHEZ-ORTIZ , DONALD PREATEDONALD PREATE , ERIC S. ROVNERERIC S. ROVNER , and ALAN J. WEINALAN J. WEIN View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67979-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively reviewed our experience with the artificial urinary sphincter in men with post-prostatectomy incontinence to determine the impact of prior collagen injection therapy on surgical outcome and overall cost of treatment. Materials and Methods: The records and preoperative urodynamic studies of 30 men with post-prostatectomy incontinence who underwent artificial urinary sphincter placement were reviewed. Of these patients 23 (76.6%) had undergone prior collagen injection (collagen group) and 7 had not (noncollagen group). Preoperative and postoperative severity of incontinence was assessed with the American Urological Association quality of life index (scale 0 to 6) and number of pads used daily. Using a Valsalva leak point pressure of less than 60 cm. water as a predictor of failure with collagen injection, we calculated the potential savings had these patients foregone collagen injection and chosen artificial urinary sphincter primarily. Results: Of the 30 patients 24 (80%) were incontinent following radical retropubic prostatectomy and 6 (20%) after transurethral resection. Intrinsic sphincter deficiency was the sole etiology of incontinence in most patients (83.3%) and 5 (16.7%) had concomitant detrusor instability. Six patients alternated the use of pads with the use of clamps or a condom catheter to aid in controlling leakage. Mean number of collagen treatment sessions for the injection group was 2.9 (range 1 to 7). There was a significant difference in mean time from prostatectomy to artificial urinary sphincter between the noncollagen (25.3 months) and collagen (35.8 months) groups (p = 0.04). There were no other statistically significant differences between the groups, including mean age (66.2 years, range 45 to 83), mean followup (26.2 months), mean preoperative pads daily (5.8 ± 3.4), median preoperative quality of life index (6, range 3 to 6), median preoperative American Urological Association symptom score (13, range 3 to 35) and mean preoperative Valsalva leak point pressure (42.7 ± 21.4 cm. water). For all patients in the study the mean postoperative pads daily was 0.8, mean quality of life index 1 and surgical complication rate 13.3%. There were no statistically significant differences between the collagen and noncollagen groups in any of these parameters. Among the collagen group 17 patients (73.9%) had a Valsalva leak point pressure less than 60 cm. water. Considering the mean additional period of incontinence (time between prostatectomy and artificial urinary sphincter) to be 12.9 months and the additional treatment costs (including pads daily and mean number of collagen syringes per patient), the direct costs of treatment for the collagen group were 85.6% higher than those for patients who chose artificial urinary sphincter primarily. Conclusions: Prior collagen therapy did not adversely influence the surgical complication rate or compromise effectiveness of the artificial urinary sphincter. However, patients with Valsalva leak point pressure less than 60 cm. water have lower rates of success with collagen injection therapy and could benefit from a more successful, timely and cost-effective treatment of incontinence by choosing the artificial urinary sphincter as primary therapy. References 1 : Effect of radical prostatectomy for prostate cancer on patient quality of life: results from a Medicare survey. Urology1995; 45: 1007. Google Scholar 2 : Impact of anatomical radical prostatectomy on urinary incontinence. Urology1996; 48: 769. Google Scholar 3 : Collagen injection therapy for post-prostatectomy incontinence. J Urol1998; 160: 364. Link, Google Scholar 4 : Collagen injection for intrinsic sphincteric deficiency in men. J Urol1996; 155: 10. Link, Google Scholar 5 : Transurethral collagen injection for urinary incontinence. Urology1994; 43: 413. 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Google Scholar 12 : Post-prostatectomy incontinence and the artificial urinary sphincter: a long-term study of patient satisfaction and criteria for success. J Urol1996; 156: 1975. Link, Google Scholar 13 : Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a review of 323 cases. J Urol1998; 159: 1206. Link, Google Scholar 14 : The artificial urinary sphincter (AS800): experience in 166 consecutive patients. J Urol1992; 147: 380. Link, Google Scholar 15 : Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3. 5 years of followup. J Urol1997; 158: 435. Link, Google Scholar 16 : Transurethral collagen injection for treatment of postprostatectomy urinary incontinence in men. Urology1997; 49: 907. Crossref, Medline, Google Scholar 17 : Artificial urinary sphincter for post-prostatectomy incontinence. Br J Urol1996; 77: 248. Google Scholar 18 : Artificial urinary sphincter AMS 800 for urinary incontinence after radical prostatectomy: the French experience. Urol Int1998; 60: 25. Google Scholar 19 : Experience with the artificial urinary sphincter model AS800 in 148 patients. J Urol1989; 141: 307. Link, Google Scholar 20 : Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management. Urology1998; 51: 715. Crossref, Medline, Google Scholar 21 : The model AS 800 artificial urinary sphincter: Mayo Clinic experience. J Urol1987; 137: 668. Link, Google Scholar From the Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited bySandhu J (2014) Treatment Options for Post-Prostatectomy IncontinenceUrology Practice, VOL. 1, NO. 4, (194-197), Online publication date: 1-Nov-2014.Ribeiro L, Prota C, Gomes C, de Bessa J, Boldarine M, Dall'Oglio M, Bruschini H and Srougi M (2010) Long-Term Effect of Early Postoperative Pelvic Floor Biofeedback on Continence in Men Undergoing Radical Prostatectomy: A Prospective, Randomized, Controlled TrialJournal of Urology, VOL. 184, NO. 3, (1034-1039), Online publication date: 1-Sep-2010.Migliari R, Pistolesi D, Leone P, Viola D and Trovarelli S (2018) Male Bulbourethral Sling After Radical Prostatectomy: Intermediate Outcomes at 2 to 4-Year FollowupJournal of Urology, VOL. 176, NO. 5, (2114-2118), Online publication date: 1-Nov-2006.STERN J, CLEMENS J, TIPLITSKY S, MATSCHKE H, JAIN P and SCHAEFFER A (2018) LONG-TERM RESULTS OF THE BULBOURETHRAL SLING PROCEDUREJournal of Urology, VOL. 173, NO. 5, (1654-1656), Online publication date: 1-May-2005.ULLRICH N and COMITER C (2018) THE MALE SLING FOR STRESS URINARY INCONTINENCE: 24-MONTH FOLLOWUP WITH QUESTIONNAIRE BASED ASSESSMENTJournal of Urology, VOL. 172, NO. 1, (207-209), Online publication date: 1-Jul-2004.Comiter C (2018) THE MALE SLING FOR STRESS URINARY INCONTINENCE: A PROSPECTIVE STUDYJournal of Urology, VOL. 167, NO. 2 Part 1, (597-601), Online publication date: 1-Feb-2002. Volume 163Issue 1January 2000Page: 87-90 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordscost-benefit analysisurinary incontinenceoutcome assessment (health care)prostatectomycollagenMetricsAuthor Information CRISTIANO M. GOMES More articles by this author GREGORY A. BRODERICK More articles by this author RICARDO F. SÁNCHEZ-ORTIZ More articles by this author DONALD PREATE More articles by this author ERIC S. ROVNER More articles by this author ALAN J. WEIN More articles by this author Expand All Advertisement PDF downloadLoading ...
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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We assessed the impact of preoperative overactive bladder on the continence results of artificial urinary sphincter implantation, and describe the rates and risk factors associated with the development of de novo and persistent overactive bladder after artificial urinary sphincter surgery.A total of 129 consecutive patients treated with radical prostatectomy who had preoperative videourodynamics and virgin artificial urinary sphincter implantation were included in the study. During preoperative and postoperative visits patients were specifically queried about overactive bladder symptoms, anticholinergic medication use and continence status.The presence of concomitant overactive bladder symptoms before artificial urinary sphincter surgery did not negatively impact the overall continence results of the artificial urinary sphincter. De novo overactive bladder developed after artificial urinary sphincter surgery in up to a fourth (23%) of patients with pure stress incontinence (no overactive bladder). Most patients (71%) with preoperative mixed stress urinary incontinence plus overactive bladder symptoms continued to have persistent overactive bladder after artificial urinary sphincter surgery despite marked improvement of incontinence. Patients with a low preoperative cystometric capacity of 200 ml or less were more likely to have overactive bladder after artificial urinary sphincter surgery. Other clinical and urodynamic factors (eg the presence of detrusor overactivity) were not predictive. No risk factors predicted the development of de novo overactive bladder after artificial urinary sphincter surgery.The presence of preoperative overactive bladder does not adversely impact the overall continence results of the artificial urinary sphincter. Patients with mixed stress urinary incontinence plus overactive bladder symptoms preoperatively should not be denied the male incontinence surgery (artificial urinary sphincter) unless the overactive bladder symptoms are intractable. De novo and persistent overactive bladder occurs commonly after artificial urinary sphincter surgery. Thorough preoperative counseling is imperative to align patient expectations.
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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