Implantation of an Artificial Urinary Sphincter (AUS) In patients with Bladder Neck Contracture (BNC) or Prostatic Stenosis (PS) managed endoscopically. Is it safe?
BAUS ePoster online library. Bugeja S. 11/10/20; 304143; P6-11
Simon Bugeja
Simon Bugeja
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Implantation of an Artificial Urinary Sphincter (AUS) In patients with Bladder Neck Contracture (BNC) or Prostatic Stenosis (PS) managed endoscopically. Is it safe?

Bugeja S1, Ivaz S1, Frost A1, Jeffrey N1, Dragova M1, Andrich D1, Mundy A1
1University College London Hospitals NHS Foundation Trust, London, United Kingdom

Introduction:
Treatment of sphincter weakness incontinence after prostate cancer(CaP) treatment in the presence of concomitant BNC/PS is particularly challenging.

Patients and Methods:
115 patients had an AUS(AMS800™) inserted following CaP treatment between 2009-2017, after having a BNC/PS treated. All were followed-up for minimum of 12 months. Mean follow-up 39.2months (range12-82.9 months).

Results:
27 patients underwent open reconstruction of BNC/PS. The other 88 were managed endoscopically. Of these 88, 71 were primary implants , 11 revisions and 6 replacement for malfunction. 60(68.2%) had radiotherapy. All 88 underwent at least one bladder neck incision/resection/dilatation prior to AUS insertion. 8 required repeat dilatation at the time of AUS implantation. 25 performed self-dilatation (SIC) to stabilise the contracture before AUS insertion. 7 continued SIC with the device in-situ. 7 others required repeat dilatation. 75(85%) required no further intervention. Explantation rate was 20.4% (11 erosions; 7 infections). In the 14 performing SIC or requiring re-intervention there were 3 erosions(21.4%). 8 erosions and 7 infections occurred in the other 75 patients(20%). Only 2 erosions occurred in the 27 patients undergoing open reconstruction (7.4%) however only 5 (18.5%) had radiotherapy.

Conclusions:
Endoscopic management of BNC/PC followed by AUS is feasible. Few patients require further intervention after device insertion. Explantation rate is higher compared to those managed by open reconstruction. However these are higher risk patients, many of whom have had radiotherapy which probably accounts for the higher explantation rate in the first place. Self-dilatation or interval dilatation once the device is in place does not increase the risk of erosion.
Implantation of an Artificial Urinary Sphincter (AUS) In patients with Bladder Neck Contracture (BNC) or Prostatic Stenosis (PS) managed endoscopically. Is it safe?

Bugeja S1, Ivaz S1, Frost A1, Jeffrey N1, Dragova M1, Andrich D1, Mundy A1
1University College London Hospitals NHS Foundation Trust, London, United Kingdom

Introduction:
Treatment of sphincter weakness incontinence after prostate cancer(CaP) treatment in the presence of concomitant BNC/PS is particularly challenging.

Patients and Methods:
115 patients had an AUS(AMS800™) inserted following CaP treatment between 2009-2017, after having a BNC/PS treated. All were followed-up for minimum of 12 months. Mean follow-up 39.2months (range12-82.9 months).

Results:
27 patients underwent open reconstruction of BNC/PS. The other 88 were managed endoscopically. Of these 88, 71 were primary implants , 11 revisions and 6 replacement for malfunction. 60(68.2%) had radiotherapy. All 88 underwent at least one bladder neck incision/resection/dilatation prior to AUS insertion. 8 required repeat dilatation at the time of AUS implantation. 25 performed self-dilatation (SIC) to stabilise the contracture before AUS insertion. 7 continued SIC with the device in-situ. 7 others required repeat dilatation. 75(85%) required no further intervention. Explantation rate was 20.4% (11 erosions; 7 infections). In the 14 performing SIC or requiring re-intervention there were 3 erosions(21.4%). 8 erosions and 7 infections occurred in the other 75 patients(20%). Only 2 erosions occurred in the 27 patients undergoing open reconstruction (7.4%) however only 5 (18.5%) had radiotherapy.

Conclusions:
Endoscopic management of BNC/PC followed by AUS is feasible. Few patients require further intervention after device insertion. Explantation rate is higher compared to those managed by open reconstruction. However these are higher risk patients, many of whom have had radiotherapy which probably accounts for the higher explantation rate in the first place. Self-dilatation or interval dilatation once the device is in place does not increase the risk of erosion.
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