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Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra

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Abstract

Purpose

To compare transcorporal vs bulbar artificial urinary sphincter (AUS) implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this population.

Methods

The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. The primary endpoint was device explantation-free survival. Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal.

Results

464 patients were included for analysis. 88 patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. Explantation-free survival was similar in both groups (estimated 5-year explantation free survival rates 55.3% vs. 58.4%; p=0.98). In the subgroup of patients with a history of previous AUS explantation, transcorporal approach tended to bring longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate analysis, the only risk factor of shorter explantation-free survival was the history of previous AUS explantation (HR=2.65; p=0.01).

Conclusions

Transcorporal AUS implantation was not associated with longer explantation-free survival. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival and this subgroup of patients may be the only one to draw benefits of transcorporal AUS implantation.

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Fig. 1
Fig. 2
Fig. 3

AUS explantation. Log-rank test: p = 0.096. NA not applicable

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Funding

No disclosures. This research did not receive any specifc grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Service d’Urologie, Hopital PONTCHAILLOU, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France

    Mehdi El-Akri & Benoit Peyronnet

  2. Department of Urology, University of Nice, Nice, France

    Imad Bentellis & Daniel Chevallier

  3. Department of Urology, University of Strasbourg, Strasbourg, France

    Thibault Tricard, Victor Gaillard, Baptiste Poussot & Christian Saussine

  4. Department of Urology, University of Toulouse, Toulouse, France

    Thibaut Brierre & Xavier Game

  5. Department of Urology, University of Bordeaux, Bordeaux, France

    Tiffany Cousin & Grégoire Capon

  6. Department of Urology, University of Rouen, Rouen, France

    Hugo Dupuis & Jean-Nicolas Cornu

  7. Department of Urology, Bichat Hospital, Paris, France

    Nicolas Hermieu & Jean-Francois Hermieu

  8. Department of Urology, University of Reims, Reims, France

    Damien Robin & Priscilla Bertrand-Leon

  9. Department of Urology, University of Nancy, Nancy, France

    Alice Pitout & Pierre Lecoanet

  10. Department of Urology, University of Lille, Lille, France

    Florian Beraud & Xavier Biardeau

  11. Department of Urology, University of Tours, Tours, France

    Franck Bruyere

  12. Department of Urology, Clinique Oceane, Vannes, France

    Hervé Monsaint

  13. Department of Urology, Clinique Plérin, Plérin, France

    Luc Corbel & Alain Ruffion

  14. Department of Urology, Lyon-Sud University, Lyon, France

    Luc Corbel & Alain Ruffion

Authors
  1. Mehdi El-Akri
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  2. Imad Bentellis
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  5. Tiffany Cousin
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  6. Hugo Dupuis
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  7. Nicolas Hermieu
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  8. Victor Gaillard
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  15. Franck Bruyere
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  18. Luc Corbel
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  19. Christian Saussine
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  20. Jean-Francois Hermieu
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Contributions

MEA: Protocol/project development, data collection or management, data analysis, manuscript writing/editing; IB: protocol/project development, data collection or management; TT: data collection or management; TB: data collection or management; TC: data collection or management; HD: data collection or management; NH: data collection or management; VG: data collection or management; BP: data collection or management; DR: data collection or management; AP: data collection or management; FB: data collection or management; PB-L: data collection or management; DC: data collection or management; FB: data collection or management; XB: data collection or management; HM: data collection or management; LC: data collection or management; CS: data collection or management; JFH: data collection or management; PL: data collection or management; GC: data collection or management; J-NC: data collection or management; XG: data collection or management; AR: data collection or management; BP: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Mehdi El-Akri.

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Conflict of interest

Benoit Peyronnet, Jean Nicolas Cornu, Xavier Gamé, Franck Bruyère, Gregoire Capon, Xavier Biardeau, Jean Francois Hermieu are consultant for Boston Scientific. Other authors have no conflicts of interest.

Informed consent

As this was a retrospective study, no informed consent was required for this study by the internal review board.

Research involving human participants and/or animals

As this was a retrospective study, this study did not contain any contact with human participants or animals performed by any of the authors.

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El-Akri, M., Bentellis, I., Tricard, T. et al. Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra. World J Urol 39, 4449–4457 (2021). https://doi.org/10.1007/s00345-021-03783-6

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  • DOI: https://doi.org/10.1007/s00345-021-03783-6

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