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Title: A pilot study of autologous rectus fascial wrap at the time of artificial urinary sphincter placement in patients at risk of cuff erosion.
Austin Authors: Gani, Johan ;Hennessey, Derek B;Hoag, Nathan;Lee, D ;Chung, E
Affiliation: University of Melbourne, Melbourne, Victoria, Australia
Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Department of Urology, St George Hospital, Kogarah, NSW, Australia
Department of Urology, Western Health, Footscray, Victoria, Australia
Department of Urology, Mercy University Hospital, Cork, Ireland
Issue Date: May-2020
Date: 2020-01-17
Publication information: International Urology and Nephrology 2020; 52(5): 851-857
Abstract: Cuff erosion is one of the dreaded complications of artificial urinary sphincter (AUS) implantation. Patients with a history of pelvic irradiation are at increased risk of erosion. To reduce the risk of erosion we describe a novel technique and report the results in our initial series of patients. A prospective analysis of patients treated with AUS and rectus fascial wrap was performed. Inclusion criteria were severe urinary incontinence (UI) and previous pelvic radiation therapy (RTX). Primary outcomes were erosion rate, complications and continence rate. Secondary outcomes were patient satisfaction. Twenty-three patients were analysed. The median age was 70 years. Nine (39%) had previous surgery; 6/9 had an Advance sling, 2/9 had a Virtue sling, and 1/9 had an AUS which had eroded. Median pad use was five pads/day IQR, (4-6). Median pad weight was 630 ml, 6 cm of fascia was harvested in every case, but cuff size varied. Complications occurred in 6/23 (26%): two patients with Clavien 1 and four patients with Clavien 3B (urinary retention requiring suprapubic catheter). In all cases, the retention resolved. One patient presented at 3 months post-op with erosion (4.3% erosion rate). Median follow-up was 32 months, IQR (24-37). Excluding the patient with erosion, 17/22 (77.3%) of patients achieved complete continence, while 5/22 (22.7%) achieved social continence. The autologous fascial wrap technique is efficient and easy to harvest, with comparable clinical outcomes to other techniques. The medium-term results have been encouraging, but longer-term follow up is needed.
DOI: 10.1007/s11255-020-02380-7
ORCID: 0000-0002-7372-0100
Journal: International Urology and Nephrology
PubMed URL: 31953717
Type: Journal Article
Subjects: Artificial urinary sphincter
Rectus fascia
Sphincter erosion
Urinary incontinence
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