Introduction and Objectives
In men urinary incontinence appears after operation on prostate and it is serious disability. Implantation an artificial urethral sphincter AMS 800 is chosen method of therapy in this patients. Indication for this procedure is total urinary incontinence, which is untreated other methods. The success of treatment with AMS 800 is determinated by appropriate qualification of this patients, which depend on: assessment of manual and mental efficiency as well as exclusion of: bladder neck stenosis and/or urethral stricture, current local infection, neurogenic bladder and appropriate component selection of artificial urethral sphincter during operation. The aim of the study is show difficulties in the qualification to implanting the artificial urethral sphincter AMS 800, because of the coexistence of additional diseases which are permanent or temporary contraindications.
Material and Methods
In the Department of Urology Collegium Medicum N.C. University in Bydgoszcz, in the period from 2004 to June 2009 48 patients with urinary incontinence (age 48–80) were hospitalized. They were qualified to implant AMS 800. The symptoms of urinary incontinence occurred after the first operation: total prostatectomy (24), TUR-P (17), adenomectomy (5) and internal urethrotomy after teleradiotherapy of prostate cancer (1). In all cases performed following procedures before the operation: voiding urethrocystography, urodynamic examination, urine culture. In some of them the examination was extended of: ureterocystoscopy and psychological testing. On the our research 2 patients were without urinary incontinence, 21 patients were direct qualified to implant AMS 800, however 25 patients required additional treatment and re-qualification. Urethral stricture was demonstated in 19 from 48 cases, variations in psychological testing were in 4 from 15 cases, however neurogenic bladder in 5 from 48 cases was the reason of primary disqualification.
Results
30 patients from 48 were qualified to implant AMS 800. Artificial urethral sphincter was implanted to 29 of them and one is still waiting to do it. 9 from 25 cases changed for the better after surgical/drug treatment and they were also qualified to implant AMS 800. 18 patients were disqualified. Treatment of recurrence urethral stricture was successful in 7 patients from 18. One of 5 patients got better and was qualified to implant AMS 800 after antimuscarine drug treatment and the injection in the bladder wall of botulinum toxin typ A. 2 of 4 patients with psychological disorders got better after drug treatment and they were qualified to implant AMS 800.
Conclusions
Recurrence posterior urethral stricture is the most common cause of permanent disqualification for implanting the artificial urethral sphincter. Relative contraindications, which can be treated pharmacologically are as follows: neurogenic bladder, urinary tract infection, transient depressive state.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
