Elliott, Daniel S.

Abstract Background Concerns exist regarding inflatable penile prosthesis (IPP) placement after transcorporal artificial urinary sphincter (TC-AUS) surgery due to potential risk of damaging the AUS cuff during corporal dilation and device placement. Aim To evaluate perioperative complications, infections, revision rates, and device longevity in patients undergoing IPP placement following prior TC-AUS surgery. Methods We present a case series of men who underwent IPP surgery with an existing TC-AUS in place. A retrospective review was conducted of all patients who underwent TC-AUS placement at a single tertiary institution between 2015 and 2025. Patients who subsequently received IPP surgery were identified. Standard IPP techniques were used with additional precautions to protect the AUS, including use of electrocautery instead of sharp dissection and contralateral reservoir placement. Demographics, operative details, complications, infections, revision events, and device survival were collected through review of operative notes and patient records. Outcomes Primary outcomes included intra-operative difficulties, perioperative complications, infection and erosion rates, and revision or failure rates for both the TC-AUS and IPP devices. Results Among 757 TC-AUS placements, 17 patients subsequently underwent IPP surgery. Seven patients (41%) had a history of pelvic irradiation. The median operative time for IPP placement was 83 minutes (interquartile range [IQR] 68-87), and median follow-up was 31.5 months (IQR 11.2-40.6). All reservoirs were positioned contralateral to the AUS reservoir. A 12 Fr catheter was left postoperatively in 10 patients (59%) for <24 hours. Proximal corporal dilation was noted to be challenging in 3 patients (18%) but dilation was completed without cuff injury or corporal perforation. One patient (6%) had TC-AUS cuff erosion 9.5 months after IPP surgery; one patient (6%) experienced TC-AUS device infection 11.5 months after IPP surgery when his AUD pump eroded through the scrotum. Four patients (24%) developed AUS mechanical failure due to cuff leak at a median of 31.9 months after IPP placement (39.9 months post-AUS). Clinical implications IPP implantation following TC-AUS can be performed safely using careful surgical technique, though vigilance for later AUS mechanical failure is warranted. Strengths and limitations This study represents one of the largest single-institution series evaluating IPP after TC-AUS and includes detailed operative and follow-up data. However, its retrospective design, small cohort size, and limited follow-up duration restrict generalizability. Conclusion IPP placement after TC-AUS appears safe, with low infection and erosion rates, though AUS cuff leaks may occur more frequently than when either device is implanted alone.

ABSTRACTIntroduction and ObjectiveProcedural therapies for overactive bladder (OAB) most often include intradetrusor onabotulinumtoxinA (BTX) injections, sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS). Despite their proven efficacy, real‐world data on therapy continuation and crossover rates between these modalities remain limited. This study aimed to evaluate longitudinal patterns of treatment continuation and therapy crossover among women receiving procedural OAB treatments.MethodsWe conducted a multi‐institutional retrospective cohort study of women with idiopathic OAB who underwent index BTX, SNM, or PTNS between 2014 and 2022. Patients were identified using electronic medical records, and follow‐up data were collected through December 31, 2023. The primary outcomes included duration of maintenance treatments and crossover to another procedural therapy for OAB. Kaplan–Meier survival analysis estimated rates of continued treatment, and a log‐rank test assessed differences in crossover rates among treatment groups.ResultsA total of 506 women met inclusion criteria: 266 (52.6%) received BTX, 114 (22.5%) underwent SNM, and 126 (24.9%) received PTNS. Ongoing treatment rates were lowest for PTNS, with only 17.1% maintaining therapy between 3 and 5 years and 26.1% crossing over to another procedure within 3 years. Among BTX patients, 65.2% underwent repeat treatment within 3 years, and 9.5% of patients crossed over to another procedure within 3 years. Of those with 5 or more years of follow‐up, 39.1% of patients continued with BTX procedures in the 3–5‐year follow‐up timeframe. Among SNM patients, the cumulative revision rates were 7.6% at 1 year and 10.9% at 2 years. 13.1% of patients crossed over from SNM to another procedure within 3 years (the vast majority to BTX).ConclusionsPTNS had the lowest ongoing therapy rates and the highest crossover rates. BTX and SNM demonstrated similar crossover rates. These findings underscore the importance of individualized patient counseling and treatment selection based on expectations of therapy persistence. Future research should focus on optimizing patient selection, improving long‐term adherence strategies, and evaluating novel or combined therapeutic approaches for OAB management.

ABSTRACTIntroductionArtificial Urinary Sphincter (AUS) placement is the preferred treatment for moderate to severe incontinence following prostate cancer treatment. While device related outcomes related to device survival are well reported, literature on quality‐of‐life outcomes, including the use of validated measures is limited.MethodsWe queried a prospectively maintained database of male patients undergoing primary AUS implantation from 2015 to 2023 at our institution. All patients completed a preoperative Michigan Incontinence Symptom Index (M‐ISI) and Patient Global Impression of Improvement (PGI‐I). Postoperative quality of life data was obtained by mailed correspondence. Surveys obtained following AUS reoperation/revision were excluded. Pairwise comparisons were performed between preoperative functional status and the Postoperative responses. Logistic regression analysis was performed to identify preoperative variables associated with a favorable PGI‐I score defined as “very much better or much better,” or a decrease in pad usage from > 1 pad per day to ≤ 1 pad per day.ResultsDuring the study timeframe, 383 patients underwent primary AUS placement, of which 163 patients (42%) completed a postoperative survey and were included in the study. Median age was 69.0 (IQR: 64–74) and 54.6% of patients had a history of pelvic radiation. The median time from surgery to the postoperative survey was 2.2 years (IQR: 0.9, 4.3). Compared to baseline, following AUS placement there was a significant improvement in the total M‐ISI score (10 [6, 16) vs 26 [22, 30]; p < 0.0001) (Minimally Important Difference = 4). This included improvements in the SUI subscore [4 (IQR 2, 6) vs 10 (IQR: 9, 12); p < 0.0001] and bother score [1 (IQR: 0, 3) vs 6 (IQR: 5, 7); p < 0.001)]. Pad usage significantly decreased following device placement (p < 0.0001). The vast majority of patients (90.7%) would “definitely or probably recommend to a friend/family member.” On univariable analysis, active smoking (ref. never) was associated with adverse pad use outcomes (OR: 0.1, 95% CI: 0–0.8; p = 0.03) and older age was associated with adverse PGI‐I outcome (OR: 0.93, 95% CI: 0.87–0.99; p = 0.02).ConclusionsFollowing AUS implantation, most patients have significant improvement in validated quality of life outcomes and low pad usage. These findings persist despite multiple preoperative comorbidities and should be considered when counseling patients before AUS placement.

Objective The aim of this study was to evaluate national patterns of care for women with overactive bladder (OAB) in an administrative data set and identify potential areas for improvement. Methods We performed an analysis using the OptumLabs Data Warehouse, which contains deidentified administrative claims data from a large national US health insurance plan. The study included women, older than 18 years, with a new OAB diagnosis from January 1, 2007, to June 30, 2017. We excluded those with an underlying neurologic etiology, with interstitial cystitis/painful bladder syndrome, were pregnant, or did not have continuous enrollment for 12 months before and after OAB diagnosis. Trends in management were assessed via the Cochran-Armitage test. Time to discontinuation among medications was compared using t test. Results Of 1.4 million women in the database during the study time frame, 60,246 (4%) were included in the study. Median age was 61 years [interquartile range (IQR), 50–73], and median follow-up was 2.6 years (IQR, 1.6–4.2). Overall, 37% were treated with anticholinergics, 5% with beta-3 agonists, 7% with topical estrogen, and 2% with pelvic floor physical therapy; 26% saw a specialist; and 2% underwent third-line therapy. Median time to cessation of prescription filling was longer for beta-3 agonists versus anticholinergics [median, 4.1 months (IQR, 1–15) vs 3.6 months (IQR, 1–10); P < 0.0001]. Use of third-line therapies significantly increased over the study time frame, from 1.1% to 2.2% ( P < 0.0001). Conclusions Most of the patients do not continue filling prescriptions for OAB medications, and a minority of patients were referred for specialty evaluation. Although third-line therapy use is increasing, it is used in a small proportion of women with OAB. Given these patterns, there may be underutilization of specialist referral and other OAB therapies.

AbstractObjectiveTo evaluate efficacy and outcomes of the autologous transobturator midurethral sling for treatment of stress urinary incontinence (SUI).MethodsIn a prospective cohort study, an autologous transobturator mid‐urethral sling was used to treat SUI among women attending a university hospital in Montevideo, Uruguay, from June 2017 to July 2018. In the first phase, autologous tissue of the abdominis rectus fascia was collected. In the second phase, the midurethral sling was placed via the transobturator approach. Outcomes were measured every 3 months by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ‐FLUTS) Score. Preoperative and postoperative results were compared by Wilcoxon test.ResultsEighteen women with a median age of 51 years were enrolled. The median follow‐up was 9 months (range 6–15 months). Overall, 17 women showed symptomatic improvement after the procedure. In a comparison of preoperative versus postoperative ICIQ‐FLUTS questionnaires, improvement in the incontinence subscore was observed at 3 (P<0.001), 6 (P<0.001), and 12 (P=0.008) months. No severe complications were observed.ConclusionUse of an autologous transobturator urethral sling was found to be technically feasible and safe for SUI, with good short‐term outcomes. Longer follow up and larger series are needed to validate the procedure.

Aims To perform a systematic review of studies reporting the outcomes of AMS‐800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). Methods A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. Results Of 886 records screened, 17 were included. All were retrospective or prospective non‐comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot‐assisted AUS implantation and one compared open and robot‐assisted implantations. The vast majority of patients had undergone at least one anti‐incontinence surgical procedure prior to AUS implantation (69.1‐100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow‐up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. Conclusions AMS‐800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.