Placement of UroLume Stent Followed by Artificial Urinary Sphincter after Local Therapy for Prostate Cancer: Long-Term Results
William I Jaffe1, Steven A. Kaplan*2
1Temple University 7/1/05, Philadelphia, PA;2New York-Presbyterian Hospital, NY, NY
Introduction: Bladder neck contracture (BNC) and sphincteric incontinence (SUI) after local therapy for prostate cancer presents a therapeutic challenge. We present long-term data on 43 men who underwent placement of Urolume stent followed by artificial urinary sphincter (AUS).
Methods: 43 men (mean age 61.3 y) who underwent radical prostatectomy (n=26), brachytherapy (n=10) or cryotherapy (n=7)presented with BNC confirmed cystoscopically and SUI confirmed with videourodynamics. Mean pad usage was 5.9 per day. Urolume stent was inserted a mean of 11.4 weeks prior to AUS. Placement of AUS was dependent on complete epitheliazation of the stent and sterile urine culture.
Results: Mean follow-up was 67.3 months. A single Urolume was placed in 81%, 2 in 14% and 3 in 5% for recurrent BNC. 16 patients developed UTI. Of the 43 men, 79% are dry, 14% require 1 pad or fewer and 5% are persistently incontinent at last follow-up. 37% of patients are taking anticholinergic therapy for overactive bladder. 3 patients developed superficial wound infections post-operatively. 7 patients complained of persistent perineal discomfort which resolved. 2 patients have had recurrent BNC after AUS placement requiring dilation. 1 patient had an intraoperative urethral injury. 1 patient had a urethral erosion 4 months after placement with recurrent BNC and underwent urinary diversion. There were no other operative complications or significant morbidity.
Conclusions: This long-term data suggests the durability and effectiveness of combining Urolume and AUS in challenging patients with BNC and SUI after local therapy for prostate cancer with acceptable complication rates.
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