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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Myers JB, "Urethral strictures and artificial urinary sphincter placement" 44 : 93-103, 2017

2 Gousse AE, "Two-stage management of severe postprostatectomy bladder neck contracture associated with stress incontinence" 65 : 316-319, 2005

3 Scott FB, "Treatment of urinary incontinence by an implantable prosthetic urinary sphincter" 112 : 75-80, 1974

4 Rivera ME, "The impact of prior radiation therapy on artificial urinary sphincter device survival" 195 : 1033-1037, 2015

5 Van der Aa F, "The artificial urinary sphincter after a quarter of a century: a critical systematic review of its use in male non-neurogenic incontinence" 63 : 681-689, 2013

6 Cefalu CA, "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" 82 : 1436-1439, 2013

7 Linder BJ, "Perioperative complications following artificial urinary sphincter placement" 194 : 716-720, 2015

8 Ziegelmann MJ, "Outcomes of artificial urinary sphincter placement in octogenarians" 23 : 419-423, 2016

9 Kim SP, "Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan" 179 : 1912-1916, 2008

10 Linder BJ, "Long-term device outcomes of artificial urinary sphincter reimplantation following prior explantation for erosion or infection" 191 : 734-738, 2014

11 Seideman CA, "Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion?" 82 : 943-946, 2013

12 Freedman ND, "Association between smoking and risk of bladder cancer among men and women" 306 : 737-745, 2011

13 Agarwal DK, "Artificial urinary sphincter urethral erosions: temporal patterns, management, and incidence of preventable erosions" 33 : 26-29, 2017

14 Lai HH, "13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine" 177 : 1021-1025, 2007