Artificial urinary sphincter in high risk patients: assessment of patient satisfaction.Radiation therapy and previous failed artificial urinary sphincter have been described as risk factors associated with higher rates of complications after artificial urinary sphincter (AUS AUS abbr. Army of the United States ) implantation. We sought to determine if repeat placement of an AUS preserving the bulbous bulbous /bul·bous/ (bul´bus) 1. bulbar. 2. shaped like, bearing, or arising from a bulb. bulbous having the form or nature of a bulb; bearing or arising from a bulb. muscle complex is a safe, effective option to manage these difficult patients. Fifteen patients underwent AUS implantation. During implantation, care was taken to "stay outside" the bulbous urethral urethral pertaining to or emanating from urethra. urethral agenesis, urethral atresia failure of development of all or part of the urethra: characterized by complete urine retention. A rare cause of neonatal uremia. muscle complex in order to avoid urethral injury and prevent erosion. A chart review and telephone interview by an independent examiner was performed. A questionnaire was developed to assess patient satisfaction and improvement of incontinence after sphincter implantation. Fifteen men had an average age of 69 (47-77) years. All had post-prostatectomy incontinence; 10 patients had prior radiation therapy, and 5 patients had failed prior AUS implant; 2 patients had both radiation therapy and prior failed AUS. The average follow-up is 14.2 months. Three post-operative complications occurred: 1 urinary retention, 1 scrotal scrotal /scro·tal/ (skro´t'l) pertaining to the scrotum. scrotal pertaining to scrotum. scrotal abscess hematoma hematoma /he·ma·to·ma/ (he?mah-to´mah) a localized collection of extravasated blood, usually clotted, in an organ, space, or tissue. , and 1 developed an AUS infection; 1 patient required downsizing (1) Converting mainframe and mini-based systems to client/server LANs. (2) To reduce equipment and associated costs by switching to a less-expensive system. (jargon) downsizing of the cuff, and another patient has developed tissue atrophy and awaiting cuff revision. No case of urethral injury or erosion was encountered. Ten patients (66.7%) are "very satisfied" with their outcome, 3 (20.0%) are "moderately satisfied," 1 is "mildly satisfied" (6.7%), and 1 (6.7%) patient is "not satisfied." Preoperative pre·op·er·a·tive adj. Preceding a surgical operation. preoperative preceding an operation. preoperative care the preparation of a patient before operation. pad usage averaged 9.4 pads per day (ppd) and improved to 2 ppd in 2 patients (13.3%), 1 ppd in 4 patients (26.7%), and 0 ppd in 8 patients (53.3%). The AUS represents a safe, effective option for male patients afflicted with urethral sphincteric incompetence in cases after radiation therapy or failed AUS. Patient satisfaction is high with minimal morbidity. Tissue atrophy may occur more commonly in this group of patients. Chip Roth, MD, and J. Christian Winters MD, New Orleans, LA. |
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