AUA 2017: Brantley Scott Lecture: My Journey in Treating Post-Prostatectomy Incontinence, Dr Tim Boone
Boston, MA (UroToday.com) Dr Boone reviewed artificial urinary sphincter placement after post-prostatectomy incontinence in this year’s Brantley Scott lecture. He recommends the basic evaluation for all patients to include a history and physical, urinalysis, post-void residual, Pad testing, bladder diary, and cystourotheroscopy. There is little evidence to using urodynamics prior to AUS placement, as there is not a good correlation between outcomes and the urodynamics data. However, there may be some use for the study in patients with confounding symptoms or a history of radiation. Of note, in men with a history of radiotherapy, there is an significant increased risk of developing erosion. Finally, her reports a decrease in complications with AUS placement after approximately 25.
He prefers a perineal approach with placement in the bulbar urethra. For revisions, he attempts to place the cuff first more proximally, then transcorporally. He rarely will place a double cuff. He injects each urethra with antibiotic to ensure that there is not a urethral injury.
He does not try to formally repair erosions, but instead will just leave a catheter in place. To evaluate for a device leak, he will use an ohmmeter.
His final recommendation was the need for continued education to other physicians regarding AUS. The majority of injuries, he finds, are secondary to catheter placement in a patient with an sphincter.
Presented By: Tim Boone, MD
Written By: Lisa Parrillo, MD, Genitourinary Reconstructive Surgery Fellow, University of Colorado