Local recurrent cancer after radical prostatectomy and incontinence. Is the artificial urinary sphincter a useful therapeutic option?
OBJECTIVE
The artificial sphincter AMS AS 800 is the treatment of choice in postprostatectomy urinary incontinence. However, when the incontinence is combined with a local tumour recurrence, the insertion of an artificial sphincter may pose a problem. Tumour mainly localised at the site of the anastomosis could cause problems with the insertion of the cuff. It is also questionable whether this elaborate and expensive operation is appropriate in patients with a progressive carcinoma.


METHODS
The charts of 220 patients who received a bulbar artificial sphincter between 1986 and 1996 were reviewed. Five patients were selected who suffered from simultaneous urinary incontinence and local recurrence of prostate cancer. The follow-up of these patients was between 18 and 70 months.


RESULTS
In all 5 patients the implantation of the artificial sphincter at the bulbous urethra could be performed without any complications. All patients were continent during follow-up. Two changes of the cuff were necessary due to tissue shrinkage of the urethra below the cuff. One patient, 2 years after local excision of recurrent prostate cancer, was found, during implantation, to have a macroscopically inconspicuous though histologically tumour-infiltrated area. In the follow-up 5 years after the implantation his prosthesis is still working well.


CONCLUSIONS
Even with local recurrence of prostatic carcinoma after radical prostatectomy, the patients' prognosis 'quo ad vitam' is not bad. The follow-up of patients proves that they profit from implantation of an artificial sphincter in terms of better quality of life. Sphincter-related complications are not more frequent than in comparable groups of patients without local recurrence.
Grein
U
U
Department of Urology and Paediatric Urology, EN-Süd Klinikum Schwelm, Germany. Ulrich-Grein@t-online.de
Meyer
W W
WW
D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*; D016741:Urinary Sphincter, Artificial