title: Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015.
abstract: This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Augusto Cesar Soares Dos
authors.initials: AC
authors.lastname: Santos
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Luíza de Oliveira
authors.initials: LO
authors.lastname: Rodrigues
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Daniela Castelo
authors.initials: DC
authors.lastname: Azevedo
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Lélia Maria de Almeida
authors.initials: LM
authors.lastname: Carvalho
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Mariana Ribeiro
authors.initials: MR
authors.lastname: Fernandes
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Sandra de Oliveira Sapori
authors.initials: SO
authors.lastname: Avelar
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Maria Glória Cruvinel
authors.initials: MG
authors.lastname: Horta
authors.affiliation: Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil.|Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil.
authors.forename: Silvana Márcia Bruschi
authors.initials: SM
authors.lastname: Kelles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology* / Q000601:surgery*; D016741:Urinary Sphincter, Artificial / Q000191:economics
keywords: Prostatectomy; Urinary Incontinence; Urinary Sphincter, Artificial