Details

Autor(en) / Beteiligte

• Van der Aa, Frank
• Drake, Marcus J
• Kasyan, George R
• Petrolekas, Andreas
• Cornu, Jean-Nicolas

Titel

The Artificial Urinary Sphincter After a Quarter of a Century: A Critical Systematic Review of Its Use in Male Non-neurogenic Incontinence

Ist Teil von

• European urology, 2013-04, Vol.63 (4), p.681-689

Ort / Verlag

Kidlington: Elsevier B.V

Erscheinungsjahr

2013

Link zum Volltext

Quelle

ScienceDirect

Beschreibungen/Notizen

• Abstract Context The artificial urinary sphincter (AUS) has historically been considered the gold standard for the surgical management of non-neurogenic stress urinary incontinence (SUI) in men. As new surgical alternatives attempt to offer alternatives to treat male SUI, a contemporary assessment of the evidence supporting the use of AUS appears mandatory for clinical decision making. Objective To conduct a critical systematic review of long-term outcomes after AUS implantation in male patients with non-neurogenic SUI. Evidence acquisition A literature search was conducted in PubMed/Medline and Embase databases using the keywords urinary incontinence and urinary sphincter, artificial and male , restricted to articles published in Dutch, English, French, and German between 1989 and 2011. Studies were included if they reported outcomes after AUS implantation in patients with non-neurogenic SUI with a minimum follow-up of 2 yr. Studies with heterogeneous populations were included if information about non-neurogenic patients was displayed separately. Evidence synthesis Twelve reports were identified, gathering data about 623 patients. Only three studies were prospective. Continence, evaluated only by patient-reported pad use and various questionnaires, was achieved in 61–100% of cases (no pad or one pad per day). Dry rates (no pad) were only available in seven studies and varied from 4% to 86%. A pooled analysis showed that infection or erosion occurred in 8.5% of cases (3.3–27.8%), mechanical failure in 6.2% of cases (2.0–13.8%), and urethral atrophy in 7.9% (1.9–28.6%). Reoperation rate was 26.0% (14.8–44.8%). Patient satisfaction was evaluated in four studies with four different tools and seems to improve after AUS implantation. Conclusions Quality of evidence supporting the use of AUS in non-neurogenic male patients with SUI is low, based on heterogeneous data, low-quality studies, and mostly out-of-date efficacy outcome criteria. AUS outcomes need to be revisited to be compared with new surgical alternatives, all of which should be prospectively evaluated according to current evidence-based medicine standards.