Progrèsenurologie(2018)28,359—360
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EDITORIAL COMMENT BY . . .
Risky business: Adjusting the pressure of the artificial urinary sphincter reservoir
Ajuster la pression du réservoir d’un sphincter artificiel urinaire n’est pas sans risque
B. Peyronnet
a,∗, X. Gamé
b, D.S. Elliott
caDepartmentofUrology,UniversityofRennes,35000Rennes,France
bDepartmentofUrology,UniversityofToulouse,31000Toulouse,France
cDepartmentofUrology,SectionofPelvicandReconstructiveUrology,MayoClinic, Rochester,MN,USA
Received1stOctober2017;accepted8November2017 Availableonline6December2017
DearEditor,
We readwithgreatinterestthe article byBaron etal.
entitled ‘‘AMS 800 Urethral pressure controlled balloon refillingorballoonchangeforartificialsphinctersecondary procedure?’’recentlypublishedinProgrèsenUrologiePelvi- Périnéologie[1].
Recurrent urinaryincontinence due tonon-mechanical failureiscommonafterartificialurinarysphincterimplan- tation[2]and isfrequentlyattributedtourethralatrophy despitethisconcepthasbeenrecentlychallenged[3].Sev- eral techniques for treating urethral cuff atrophy have been described for AUS revision in such as cuff replace- ment, cuffdownsizing,cuff relocation, transcorporal cuff placement,tandemcuffplacementandpressure-regulating balloon(PRB)replacementwithahigherpressurerate.How- ever, there is currently no consensus regarding the best managementoptioninthesepatientsduetothepaucityof data available inthe literature. Inthat regard, thestudy
DOIoforiginalarticle:http://dx.doi.org/10.1016/j.purol.2017.
11.002.
∗Correspondingauthor.Serviced’urologie,hôpitalPontchaillou, 2,rueHenri-Le-Guilloux,35000Rennes,France.
E-mailaddress:peyronnetbenoit@hotmail.fr(B.Peyronnet).
byBaronetal.isofvalueastheyattemptedtoassesstwo revisionstrategies:PRBreplacementwithahigherpressure rateandPRBrefillingwithsaline,whichhaspreviouslynot beenreportedintheliterature[1].
InthisseriesPRBreplacementwithahigherpressurerate (61—70cmH2Oto71—80cmH2O)wasfoundtobeassociated withanacceptablesafetyprofile(4.7%ofpostoperativeero- sion,4.7% of balloon migration) [1]. However,we donot sharetheauthors’conclusionsthatthisisaneffectiveoption inviewofthepoorfunctionaloutcomesreported(subjective continenceachievedinonly38%ofpatients).
Theothertreatmentoptionassessedinthisstudyraised seriousconcerns.Witha40%erosionratepostoperatively, PRBrefillingappeareddangerousandpoorlyeffective(sub- jectivecontinence achievedin only 30%of patients). The series did include a wide proportion of « higher risk » urethras(38% ofpriorradiation therapy,29% ofpriorure- throtomy [4]) that could partly explain these outcomes.
However,wesharetheauthors’conclusionthatPRBrepres- siurizing should not be considered a suitable option for non-mechanical failure. The findings of this study fuels thedebateregardingtheadjustabilityforartificialurinary sphincter.
In the past few years,several adjustable artificial uri- narysphincter have been assessed [5].The adjustment is https://doi.org/10.1016/j.purol.2017.11.003
1166-7087/©2017ElsevierMassonSAS.Allrightsreserved.
360 B.Peyronnetetal.
madeby puncturingthe device toinject or remove fluid.
Thetwomainadjustablesphinctersdescribedoverthepast decades, namely the Flowsecure® (Promedon, Argentina) andtheZephyrZSI375®(Mayorgroup,Villeurbanne,France) werefoundtobeassociatedwithhigherosionandexplan- tation rates (up to 28% [6] and 61.5% respectively [7]).
The inabilitytoalter thecuff pressureand tocorrectfor delayed tissue atrophy without further surgery has often been regarded asa limitation of the AMS800 device [5].
ThefindingsreportedbyBaronetalreinforcestheideathat adjustingartificialurinarysphincterpressurecarriesahigh riskofcomplication,notablyerosionduetoexcessivepres- surefromthecuffontheurethralwall,causing ischaemia oftheunderlyingspongiosum.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/
j.purol.2017.11.002.
Disclosure of interest
DrBenoitPeyronnetandPrXavierGameareconsultantsfor BostonScientific.
Pr Daniel Elliot declares that he has no competing interest.
References
[1]BaronMG,AubleA,etal.AMS800Urethralpressurecontrolled balloonrefillingorballoonchangefor artificialsphinctersec- ondaryprocedure?ProgUrol2017[inpress].
[2]AnusiowuI,WrightEJ.Indicationsforrevisionofartificialuri- nary sphincterand modifiable riskfactors for device-related morbidity.NeurourolUrodyn2013;32:63—5.
[3]BugejaS,IvazSL,FrostA,etal.Urethralatrophyafterimplan- tationofanartificialurinarysphincter:factorfiction?BJUInt 2016;117:669—76.
[4]PicG,TerrierJE,OzenneB,Morel-JournelN,PaparelP,Ruffion A. Impact of anastomotic strictures on treatment of post- prostatectomystressincontinencebyartificialurinarysphincter.
ProgUrol2016;26(11—12):635—41.
[5]ChungE. Contemporary surgical devices for male stress uri- nary incontinence: a review of technological advances in current continence surgery. Transl Androl Urol 2017;6(2):
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[6]AlonsoRodriguezD,FesAscanioE,FernandezBarrancoL,etal.
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[7]KretschmerA,HuschT,ThomsenF,et al.Efficacyandsafety ofthe ZSI375 artificial urinary sphincterfor male stress uri- nary incontinence: lessons learned. World J Urol 2016;34:
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